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By Tim Rowan, Editor & Publisher, Home Care Technology Report President-elect Donald Trump has nominated Georgia Congressman Tom Price, MD, to be his Secretary of Health and Human Services, and Seema Verma, MPH, to be administrator for the Centers for Medicare and Medicaid Services. Price is well known as the author of most of the 54 House bills designed to change or repeal the Affordable Care Act and for his work with Speaker Paul Ryan to design a plan to privatize Medicare, but few outside Indiana know Ms. Verma’s name. A quick look at the Medicaid rules she set up in Indiana may give a preview into how she would run CMS. [Rowan reviews Verma’s extensive work in Medicaid reform in the state of Indiana, and notes her educational achievements. Extensive attention is given to: “Seema Verma’s Indiana Medicaid” in which Rowan notes how Verna adapted the ACA’s Medicaid expansion provisions to include subsidized premiums and co-pays for Medicaid beneficiaries. Known as the “Healthy Indiana Plan” (HIP). Extensive features of HIP are provided, detailing how Medicaid recipients in Indiana benefit from the key feature of HIP 2.0 — a Personal Wellness and Responsibility (POWER) account.]  According to her web site, Seema Verma is the President, CEO and founder of SVC Consultants, Inc., a national health policy consulting company. “For over 20 years, Ms. Verma has worked extensively on a variety of policy and strategic projects involving Medicaid, insurance, and public health, working with Governor’s offices, State Medicaid agencies, State Health Departments, State Departments of Insurance, as well as the federal government, private companies and foundations.”1 Verma also served as vice president of planning for the Health and Hospital Corporation of Marion County. She also holds a master’s of public health from Johns Hopkins University. As the State of Indiana’s health reform lead following the passage of the Affordable Care Act, Ms. Verma, under former Governor Mitch Daniels and Vice President-elect Governor Mike Pence, adapted the ACA’s Medicaid expansion provisions to include subsidized premiums and co-pays for Medicaid beneficiaries. Known as the “Healthy Indiana Plan,” the second generation of which is described below, HIP 2.0 is described as “the nation’s first consumer directed Medicaid program.” In that capacity, her firm was paid $3.5 million by the state of Indiana. Simultaneously, she was under a $1 million consulting contract with Hewlett-Packard, which landed more than $500 million in Indiana contracts during her tenure.2 Seema Verma’s Indiana Medicaid:
2 IndyS ©2016 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com tar: Part of the USA Today Network, 11/29/16 |
17
Nov
stored in: Tim Rowan's Home Care Technology Report and tagged: "Healthy Indiana Plan" (HIP) Medicaid plan--and offer to recipients of a "Personal Wellness and Responsibility (POWER) account., Medicaid services in Indiana--and extensive policy work of Seema Verma to benefit Medicaid beneficiaries in Indiana, Seema Verma MPH--and nomination by President-elect Donald Trump to be administrator for the Centers for Medicare and Medicaid Services, Tom Price MD (and long history of government service)--and nomination by President-elect Donald Trump to become Secretary of Health and Human Services
17
Nov
stored in: Tim Rowan's Home Care Technology Report and tagged: CY 2017 HH PPS Final Rule--and webinar hosted by HEALTHCAREfirst on extensive changes to be implemented by CMS, healthcare at home-based webinar on HHPPS 2017 Final rule (12/1/2016), HEALTHCAREfirst (Springfield MO)-- and work in assisting healthcare at home agencies with managing business and clinical operations
Springfield, Mo. –November 23, 2016 –HEALTHCAREfirst, the leading provider of Web-based home health and hospice software, billing and coding services, and advanced analytics, announced that it is hosting a complementary webinar detailing upcoming home health regulatory changes and challenges, including the CY 2017 HH PPS Final Rule. [Topics include: Rates/Payment changes, Recalibration of case mix, Outlier payment changes, and other pertinent topics of interest to healthcare at home service providers. The free-of-charge, 60-minute we, presented by HEALTHCAREfirst (Springfield, MO) about which extensive details are provided.]
Topics include:
- Rates/Payment changes
- Recalibration of case mix
- Outlier payment changes
- Quality updates
- Home Health Value-Based Purchasing
- Pre-Claim Review
- Automated denials of claims with no OASIS
- Important home health regulatory reminders (12/1/2016)
The 60-minute webinar will be held on Thursday, December 1, 2016 at 1:00 pm CST (2:00 pm EST).
The webinar is free of charge, however advance registration is required. For more information, or to register for “Home Health Regulatory Update: CY2017 Final Rule,” visit the HEALTHCAREfirst website at healthcarefirst.com/webinars.
About HEALTHCAREfirst
HEALTHCAREfirst provides cloud-based technologies and services to support business and clinical operations for over four thousand home health and hospice providers across the United States. Based in Springfield, Missouri, the company provides agency and clinical management software, outsourced revenue cycle management services (billing, coding and chart audits), CAHPS surveys, and advanced analytics, in any combination.
healthcarefirst.com©2016 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com
HEALTHCAREfirst provides cloud-based technologies and services to support business and clinical operations for over four thousand home health and hospice providers across the United States. Based in Springfield, Missouri, the company provides agency and clinical management software, outsourced revenue cycle management services (billing, coding and chart audits), CAHPS surveys, and advanced analytics, in any combination.
healthcarefirst.com©2016 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com
10
Nov
stored in: Tim Rowan's Home Care Technology Report and tagged: Optima Healthcare Solutions ((Palm City FL)--and genesis of this post-acute therapy provider software, Randy Wallin (co-founder of Optima Healthcare Solutions)-- background and role in development of company's post-acute therapy provider software, Ryan Katri--and rise from teenage computer whiz to Chief Technology Office (CTO) for Optima Healthcare Solutions, Steve Mackie (co-founder of Optima Healthcare Solutions)-- background and role in development of company's post-acute therapy provider software
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By Tim Rowan. Editor & Publisher, of Home Care Technology Report
Last month’s release of “Optima Homecare” (HCTR 10/19/16) was not merely the familiar story of another garage programmer helping out a buddy in the business, later deciding to put his homemade home health EMR software on the open market. Optima Healthcare Solutions (Palm City FL) had already made its way to the top of the therapy provider software market, boasting customers the likes of HCR ManorCare, Brookdale Senior Living, dozens of regional and national rehab facility organizations and hundreds of contract therapy companies. Intrigued by an initial glimpse of the new product and by the caliber of the people whom Optima had attracted to design it, market it and sell it — all industry veterans we had already come to know and respect over the years in their previous companies — this reporter decided to motor down to Palm City, Florida to meet the founders and hear their story. It was not the expected story but it is one worth telling! [Rowan provides details about the two founders of the company, along with the immense contribution of two teenaged brothers, and their perfecting of software products for skilled nursing facilities (SNFs) and work to develop products well-suited to care of the elderly. The improved/revised versions of the partners’ FoxPro product are described, and subsequent and wide-ranging sales noted. Subsequent developments in the business and gaining significant investors both are noted.] Chance meeting, lifelong partnership Surfboard to Boardroom Not surprisingly, he admitted, his wife prevailed. “I had done a little database programming so, to keep her happy, I grabbed a copy of FoxPro and managed to develop a DOS system that worked well for my wife’s friend in the SNF. After we demonstrated the finished product, he liked it so much he asked to buy it. “‘Buy it?’ He was my wife’s friend and I thought I would give it to him as a favor to her; I had never thought about making money on it. How much do I charge? Do I have to support it? What if the MDS changes? In the end, he didn’t have ‘a’ SNF; he had 24 facilities located throughout the East, headquartered out of Buffalo, New York. I decided to sell it to him.” Junior achievement “We found a phone number for the developer of the tool,” he grins as he remembers, “and were greeted by a pleasant female voice.” “Yes, this is Ryan Katri’s number but he is in school right now.” “Oh, he’s still in class? What college does he attend?” “Well, he’s not in any college.” Steve and Randy looked at each other. “The tool that is going to save us was written by a high school kid?” “No,” his mother said,” he is in junior high. Ryan is 14.” The end of the story, which today is legendary in Optima hallways and part of every new employee orientation, is that young Ryan Katri finished junior high, finished high school, got a degree from Cal Poly, and is now married with children, and is the Chief Technology Officer for Optima Healthcare Solutions. Ryan’s brother Michael was also brought aboard as the first salesman and is now Chief Product Officer. It was Michael who saw their therapy customers opening or acquiring home health agencies and suggested developing another software product for them. And then we fell in love In 2000, they were asked by another customer to build a therapy product for them. When MDS 3.0 appeared 10 years later, they opted against another re-write and sold their MDS business to PointClickCare. That was when they changed the company name from “GiftRAP” (for “Resident Assessment Protocol”) to its present name and focused their attention on the therapy market in SNFs and ALFs. Since that day, Optima has soared, providing software to more than half of the residential therapy market. To get to that level of success, however, Mackie said he first had to fall in love with the elderly. “It was during a site visit to West Palm Beach when I admitted that I never really intended to work with old people,” he reminisced. “The owner there told me we needed to fix that. ‘Go sit with them,’ he insisted. ‘Talk to them, listen to their stories.’ So I did, and I was transformed. They were not just elderly people; they were people with incredible life stories. I talked to WWII heroes. I met the man who invented Tylenol! I-fell-in-love. Being a part of the team that brings them services, makes their caregivers more efficient and profitable, was very rewarding. That’s when we knew we were absolutely doing something worthwhile here. That experience has fueled our company’s passion ever since.” As the post-acute market continued to shift over the years, the founders knew they could do more to serve post-acute providers, including in-home healthcare providers. Though the final chapter may not have been written yet, those that are written resulted in the company’s home health EMR product launch at last month’s NAHC Annual Meeting. Vetting investors As minority owners, Mackie concluded, the passion of the founders remains unwavered, “but we four partners and friends will always find time to take our boards to the beach — or hit the slopes together in winter — all the while making sure Optima continues to develop great software and treat customers as friends.” ©2016 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com |
10
Nov
stored in: Tim Rowan's Home Care Technology Report and tagged: HIV--and new research on N6 antibodies to neutralize HIV infections, Mark Connors MD--and research on N6 antibodies to neutralize HIV infections, N6 antibodies--and research use to neutralize HIV infections, National Institutes of Health (NIH)--and new research on N6 antibodies to neutralize HIV infections
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By Tim Rowan, Editor & Publisher of Home Care Technology Report Scientists from the National Institutes of Health (NIH) have identified an antibody from an HIV-infected person that potently neutralized 98 percent of HIV isolates tested, including 16 of 20 strains resistant to other antibodies of the same class. The remarkable breadth and potency of this antibody, named N6, make it an attractive candidate for further development to potentially treat or prevent HIV infection, say the researchers.The scientists, led by Mark Connors, M.D., of NIH’s National Institute of Allergy and Infectious Diseases (NIAID), also tracked the evolution of N6 over time to understand how it developed the ability to potently neutralize nearly all HIV strains. This information will help inform the design of vaccines to elicit such broadly neutralizing antibodies.[More details about the research on the N6 and its possible uses to curb HIV progression, and the advantages of its use over the VRC01, antibody currently being used in clinical trials.] antib Identifying broadly neutralizing antibodies against HIV has been difficult because the virus rapidly changes its surface proteins to evade recognition by the immune system. In 2010, scientists at NIAID’s Vaccine Research Center (VRC) discovered an antibody called VRC01 that can stop up to 90 percent of HIV strains from infecting human cells. Like VRC01, N6 blocks infection by binding to a part of the HIV envelope called the CD4 binding site, preventing the virus from attaching itself to immune cells. Findings from the current study showed that N6 evolved a unique mode of binding that depends less on a variable area of the HIV envelope known as the V5 region and focuses more on conserved regions, which change relatively little among HIV strains. This allows N6 to tolerate changes in the HIV envelope, including the attachment of sugars in the V5 region, a major mechanism by which HIV develops resistance to other VRC01-class antibodies. The new findings suggest that N6 could pose advantages over VRC01, which currently is being assessed as intravenous infusions in clinical trials to see if it can safely prevent HIV infection in humans. Due to its potency, N6 may offer stronger and more durable prevention and treatment benefits, and researchers may be able to administer it subcutaneously (into the fat under the skin) rather than intravenously. In addition, its ability to neutralize nearly all HIV strains would be advantageous for both prevention and treatment strategies. ARTICLE: WHO: The research team included scientists from NIAID’s Laboratory of Immunoregulation and Vaccine Research Center. This article originally appeared on the web site of the National Institutes of Health, under the heading “National Institute of Allergy and Infectious Diseases.” https://www.niaid.nih.gov/news-events/nih-scientists-identify-potent-antibody-neutralizes-nearly-all-hiv-strains. Reprinted by permission. |
10
Nov
stored in: Tim Rowan's Home Care Technology Report and tagged: post-acute online care education-- from The Institute for Professional Care Education LLC (Vancouver WA), Sharon Brothers (CEO) The Institute for Professional Care Education LLC (Vancouver WA), The Institute for Professional Care Education LLC (Vancouver WA)--genesis and development of online post-acute care educational courses, The Institute for Professional Care Education LLC (Vancouver WA)--providing online learning techniques such as storytelling and gamification
By Tim Rowan, Editor & Publisher of Home Care Technology Report
Sharon Brothers thought she would operate residential facilities for seniors for her entire career. She had prepared for it, earned a Masters Degree for it, and was good at it. Starting in the late 1980’s, she opened assisted living facilities in a number of Washington, Oregon and California communities. As the poet said, however, “Life is what happens to you while you’re busy making other plans.” Today, as the CEO of an online learning company with 58 employees, she looks back on her choices and is happy they led her here, where she is certain she is making a difference. [Rowan provides details on Brothers’ genesis of her online educational company, The Institute for Professional Care Education, LLC. Based in Vancouver, Washington, and which today offers over 500 online and DVD courses in five categories: Home Care, Home Health, Assisted Living, Government Required Training, and Individual Professional Certifications. As it grew into a successful, full-time business, Brothers and partners sold their ALFs to Brookdale in order to be free to concentrate on education. Brothers and staff markedly started listening to educational needs of customers and potential customers; and then provided ways to provide comprehensive educational courses that were fun through learning techniques such as gamification and storytelling.]
How fate intervened
Years ago, before “online education” and “distance learning” were common terms, Ms. Brothers invested quite a sum to take several of her Assisted Living Community staff to an education conference in Las Vegas. “It was a horrible experience,” she shuddered. “The instructors let everyone sit there and listen while they talked among themselves on the stage. It was as though their sole responsibility was to provide CEs, not a quality educational opportunity, and our only responsibility to earn those CEs was to show up.”
She put it to her staff, “Can’t we do this better? The technology is out there; why did we have to travel all the way to Las Vegas to receive mediocre information badly presented?”
That was how the seed was planted that eventually grew into The Institute for Professional Care Education, LLC. Based in Vancouver, Washington, IPCed today offers over 500 online and DVD courses in five categories: Home Care, Home Health, Assisted Living, Government Required Training, and Individual Professional Certifications. As it grew into a successful, full-time business, Brothers and partners sold their ALFs to Brookdale in order to be free to concentrate on education.The Institute for Professional Care Education, LLC.
“We started by listening to consumers and potential customers,” Brothers told us, “and building programs to serve unmet needs.” The early days, before regulators were familiar with online learning, were not without obstacles “California told us, ‘You can’t do this online. You have to be face-to-face with an instructor in order to earn CEs.’ So we challenged them, asked why not, and found ourselves in a three-year tug of war. Finally, California said, ‘OK, you can take half your courses online.'”
Since then, she concluded, IPCed has changed the way training is delivered to caregivers, which has changed the way they deliver care. “What sets up apart,” Ms. Brothers opined, “is that we do not define ourselves as a compliance training provider. We are not here to simply allow people an easy way to check the box.”
She said the Institute’s message to its thousands of learners is meant to inspire as much as encourage:
- “What you know impacts the people you serve.”
- “The more you know, the better care you will give.”
- “You are more than just a minimum wage worker; you are the most important person in this industry.”
- “View yourself as a professional; commit to lifelong learning.”
Making learning fun
IPCed’s use of learning techniques such as gamification and story-telling encourage course completion, Ms. Brothers explained. “What we are after are the ‘aha’ moments,” she laughed. “We love it when we hear them say, ‘Oh, I see, I make a difference in people’s lives when I know these things and do these things I’ve learned.’ Or ‘I know I was told to take as long as I wanted to complete this course but I finished it all in one night because I had to find out what happened to the lady in the story.'”
Her favorite, she added, is when they say, “I could never have gotten this certification without online learning because I can’t take time off work to go to a class.”
“We’re trying to create a success environment,” she concluded. “Training is a marketing, retention and recruitment tool. As agencies thrive, they build strong marketing relationships, touch more lives, and become better at providing care. When they do that, they become more stable employers, pay better, and employ people who provide a more consistent quality of care. I hope our company has moved the needle a little in the way education is changing the care we provide in this country.”
©2016 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com
10
Nov
stored in: Tim Rowan's Home Care Technology Report and tagged: "NDoc®" at home software from Thornberry Ltd.--features and assessment of use of documentation and compliance in post-acute care, BAYADA Home Health Care (Moorestown NJ) and strategic partnership with Prepared Health (Chicago) to enable at-home care patients to be more well with use of eTouch™ and DNA™ software, BAYADA Home Health Care (Moorestown NJ) and strategic partnership with Prepared Health (Chicago) to enable at-home care patients to me more well at home with use of eTouch™ and DNA™ software, Robert C. DeArmitt-- professional background in post-acute care sales and software and new role as VP of sales at Thornberry Ltd (Lancaster PA), Thornberry Ltd. (Lancaster PA) –- and leading role in healthcare at home sofftware icluding "NDoc®" at home software
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Vendor Watch: [1) Thornberry Ltd and new VP of sales Robert C DeArmitt; 2) Bayada Home Health Care & Strategic Partnership with Prepared Health and DNA™ and enTouch™software programs; 3) PasswordWrench and launch of patent-pending password management solution.
LANCASTER, PA – Thornberry Ltd., provider of home health software solutions for over 20 years and an industry forerunner in both EMR certification and interoperability, announced that Raymond C. DeArmitt has joined the company as Vice President of Sales. DeArmitt brings with him 25 years of healthcare sales experience, including leading national sales in the post-acute space for the last 15 years. Showing proven results in the homecare information technology market, DeArmitt has well-documented skills developing successful sales strategies and processes and keeping customer satisfaction high through strong partnerships. “Home health and hospice agencies require comprehensive and integrated software that can handle all aspects of the business,” DeArmitt said. “Thornberry has tremendous offerings for both markets and has the highest customer satisfaction reputation in the industry. Their dedication to their customers and the market is one of the many reasons that this opportunity is so exciting.” DeArmitt comes to Thornberry from his role as VP of Key Accounts at ContinuLink, where he started the national accounts program. Earlier executive positions include VP of Sales at CareAnyware, since acquired by Brightree, where he vigorously expanded the company’s deals portfolio; and VP positions at CellTrak Technologies and Allscripts Homecare, now known as NetSmart, where he significantly increased revenue and expanded the customer base at both companies. In his new role, DeArmitt will report to Thornberry President and CEO Tom Peth, and will bring home health and hospice agencies into the future by driving sales of the company’s Best in KLAS EMR software, NDoc®. “These are exciting times for both the homecare industry and Thornberry,” said Peth. “We are pleased that our sales organization will be led into our next phase of growth by a seasoned sales executive who is very familiar with home health and hospice. Ray is a great guy, a capable leader, a consummate professional and highly regarded in our industry.” About Thornberry
Chicago, Illinois and Moorestown, New Jersey – November 16 – BAYADA Home Health Care, the nation’s largest private provider of home-based services, and PreparedHealth, a growing healthcare engagement company, announced today a multi-year strategic partnership. The alliance comes on the heels of several successful projects in Pennsylvania, New Jersey, and Florida that proved to proactively keep patients out of the hospital and lowered overall readmissions for health system partners and health insurance companies. The two companies are currently expanding the offering of enTouch™, a social network for healthcare, and DNA™, a Digital Nursing Assistant, across BAYADA’s network of home health, personal (assistive) care, hospice, physician house calls and home-based pharmacy specialties. DNA™ helps care providers identify clients who require timely interventions. enTouch™ is a secure social network to bring together providers and family caregivers. Once on the network, participants can easily identify which of their patients require intervention, coordinate referrals, manage transitions, place orders, and even involve family caregivers as needed. About PreparedHealth
Sacramento, CA – Nov. 15 – PasswordWrench announced the launch of a patent-pending password management solution which protects individuals’ and corporations’ confidential information, reducing online identity theft. The secure password manager system helps users create and recall complex passwords, making it nearly impossible for criminals to hack information. Currently, over 15 million people in the U.S. have their identities stolen each year and with recent hacks into Yahoo!, Dropbox, LinkedIn and other major databases. This number continues to grow, leaving over 100 million people’s information vulnerable. Increased hacks, whether via sophisticated Internet attacks or by peering over a shoulder at a coffee shop, have left corporations and individuals vulnerable. The PasswordWrench system mitigates those risks and keeps digital data safe, without storing passwords in the cloud, where events have shown they are still vulnerable to attack. Instead, this technology eliminates weak passwords, protects against threats from keyloggers, hidden cameras, insider errors and guesswork or brute-force threats. There is a free plan for individuals and customizable packages for businesses. ©2016 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com |
10
Nov
stored in: Tim Rowan's Home Care Technology Report and tagged: Jennifer Artabane (MBA)-- background and new role as Senior Director of Product at PlayMaker CRM, PlayMaker CRM (Franklin TN)--software for post-acute care, Wayne Gattinella ( MBA)-- background and new role as board member at PlayMaker CRM
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FRANKLIN, TN – November 17, 2016 – PlayMaker CRM announced today the addition of Jennifer Artabane, MBA as Senior Director of Product and former WebMD CEO Wayne Gattinella, MBA as Board Member. Ms. Artabane will serve as Senior Director of Product. “These additions to our company reflect our continued commitment to bringing together the brightest minds in healthcare and technology to solve the business growth challenges of the post-acute care space,” said John Griscavage, CEO of PlayMaker CRM. “We are delighted to have Jennifer join the team; her product leadership and insight will ensure that PlayMaker CRM remains at the forefront of innovation for post-acute care providers.” [Details about Jennifer Artabane‘s and Wayne Gattinella‘s backgrounds and extensive career achievements are provided.] Most recently, Jennifer served as Product VP for Brooks Bell, Inc., a testing, optimization and personalization consulting and services firm. In this role, Jennifer was responsible for leading the organization’s nascent software product strategy, planning, and development. Prior to Brooks Bell, Jennifer served as the VP of Business Operations and Marketing for ReverbNation, where she worked with the product development and marketing teams to build and market solutions and services to assist independent artists advance their careers. Jennifer also spent six years working on and leading the ChannelAdvisor Product Management team, specifically responsible for the marketplace integrations and core functionality of the ChannelAdvisor platform. Jennifer earned her MBA from Duke University’s Fuqua School of Business, and her bachelor’s degree in Business Administration from the College of William and Mary. Gattinella brings impressive pedigree to board “Wayne has been at the helm of numerous healthcare technology success stories,” Griscavage said. “His unique perspective and experience will allow us to effectively manage the growth trajectory that we have been on for the past few years.” Wayne holds an MBA from St. Joseph’s University and a BS from Drexel University LeBow College of Business in Philadelphia. He also serves on the Board of Directors for HealthGrades and the Advisory Boards for Drexel University College of Medicine and LeBow College of Business.
©2016 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com |
03
Nov
stored in: Tim Rowan's Home Care Technology Report and tagged: Aaron Littl (BKD manager)--and negative views toward promising results from CMS's assessment of pre-claim reviews by healthcare at home providers, Aaron Little (BKD manager)--and negative views toward promising results from CMS's assessment of pre-claim reviews by healthcare at home providers, Bill Dombi (NAHC's legal counsel) and filing suit against CMS for failed pre-claim reviews by healthcare at home providers, CMS pre-claim reviews--IL healthcare at home providers' experience with this pilot program, CMS's positive assessment of pre-claim reviews tabulated as of Nov. 7 2016, Palmetto GBA reviewers of pre-claim data from IL and other healthcare at home providers--status of these submissions as of Nov. 2016, Palmetto GBH screening of Pre-Claim reviewsubmissions from healthcare at home providers, Palmetto GBH screening of PreClaim submissions from healthcare at home providers
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By Tim Rowan, Editor & Publisher, Home Care Technology Report
It is no easier to find something positive to say about the CMS Pre-Claim Review experiment in November than it was in August. This conclusion follows conversations with Illinois providers, a BKD managing director, NAHC’s Bill Dombi, and a Palmetto GBA staffer. Dombi announced at last month’s NAHC meeting that he is preparing a lawsuit to force CMS to stop Pre-Claim in Illinois and not start it up in Florida, Texas, Michigan and Massachusetts until such time as its contractors can get it working properly. He also pointed out that the volume of review requests that seem to have already overwhelmed the capability of PGBA reviewers to keep up is a fraction of the total number of RAPs sent from Illinois since August 3. This was confirmed in a November 4 CMS report. “Between August 3 and October 31, 2016, CMS received 23,061 pre-claim review requests from Illinois Home Health Agencies. In the same period of time, CMS received approximately 80,961 RAPs.” Reminder: the 25% penalty for submitting a final claim not preceded by a pre-claim review began on November 3. [Rowan provides more data for raising questions about packaging and submitting pre-claims data now before the very many kinks in this system are ironed out. It’s noted that the massive volume of data from large states (like Florida and Texas) may well overwhelm PGBA reviewers and submitting these data has been questioned by many healthcare at home agencies. Comments (not at all promising ones) on the current and future status of claims are provided in the closing paragraphs of this article.] These numbers are the same that BKD is seeing. Managing Director Aaron Little has been helping Illinois clients cope with the requirement. He told us that some agencies are sending a handful, as few as 10% of their episodes, in order to test the waters until they learn exactly what PGBA reviewers are looking for. Their intention is to make adjustments before they send the rest but they are still finding that some reviewers interpret the rules differently from each other. Dombi’s August comment that some of them make determinations based on rules that do not exist is still valid as well. “What are they going to do with the current number of reviewers when the volume from Illinois grows tenfold?” Little asked, “Not to mention after they expand to Florida and Texas, both of which are also the responsibility of PGBA?” Indeed, many people are questioning the wisdom of funneling the first three states, big states, to one MAC instead of starting PCR in a more sensible order that would spread the work across the three MACs that serve the five pilot states. 60 Days of Reviews CMS reported the first 13 weeks of Illinois Pre-Claim Review results on November 4. The report shows an affirmation rate of 45% in week 2, a dip to about 41% in weeks 3 and 4, then a slow, steady climb to 83% in week 13, with a brief plateau at 60% in weeks 6 and 7. These affirmations include “provisionally affirmed” and “partially affirmed” decisions in the tally. There is no category called “fully affirmed.” All requests that are deemed payable are called “provisionally affirmed decisions” pending the quality of the final claim. Claims can be denied even if the pre-claim request was affirmed. According to the report, “A partially affirmed decision indicates at least one service was provisionally affirmed.” We’ve got it handled “Wait, wait, what?” came a voice from Peoria, Illinois. Tarrah Gruber attended a Palmetto training session for Spoon River Home Health. She told us one of the two trainers, the only one that was a registered nurse, was herself a trainee, with three months on the job. The senior trainer, not an RN, had been with PGBA for 8 years, but only recently returned from an extended leave for family obligations. The two trainers were so unfamiliar with CMS Home Health rules that they had to call HQ, during the training session, in order to answer questions posed by the audience of veteran agency owners. Ms. Gruber confirmed that PGBA is reporting an 80% affirmation rate but noted that CMS will not discuss what percentage of partial affirmations is included in that number. According to Dombi’s explanation, this means that CMS would consider PCR a success, and justify extending it from pilot program to national rule, even if more than half of Illinois’ “provisionally affirmed decisions” turned a $3,000 claim into a $300 payment. Open questions Open floodgates Bill Dombi announced last month that he will try to force CMS to delay the Pre-Claim Review pilot until its contractors are better able to execute it. This sounds like one suit that CMS will be relieved to lose.
©2016 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com |
03
Nov
stored in: Tim Rowan's Home Care Technology Report and tagged: " telehealth tools for seniors' self management of care needs at home, AARP and projected work to help change rules of "homebound" Medicare recipients, Baby Boomer generation and model of physical activity for older generations, JoAnn Jenkins (author) and presentation for Partners Healthcare symosium in Boston (2016) on seniors using new technolgies for self care, JoAnn Jenkins (CEO of AARP)--and views on needed changes in caring for today's seniors, Medicare and "homebound requirements of at-home seniors--and new ways to experience "aging in place
by Audrey Kinsella, HCTR Telehealth Reporter
I am technically not homebound, at least not by Medicare’s definition. Though I live with a debilitating chronic condition, I am able to go to the local YMCA every day to shower and swim. However, I can only get there with assistance from a home care aide, whom I must pay out of my own pocket.Last month, I finally got a chance to ask someone who should know why the tightly defined homebound requirement has remained unchanged in Medicare regulations since 1965, back when the majority of beneficiaries were treated for curable illnesses and injuries. Today, the vast majority are treated for incurable, chronic conditions, which need to be managed from diagnosis through the remainder of the sufferer’s life, but the homebound rule has not evolved to reflect that change.
“We can fix this,” is what JoAnn Jenkins told me. The AARP CEO had just completed her keynote presentation at the 13th annual “Connected Health Symposium,” sponsored by Partners Healthcare.
“Digital Technology that Cares: Bringing the Human Element to Life” was the theme of this year’s event, which took place in Boston, October 20-21. Ms. Jenkins and other speakers focused on the need to span the years-long chasm between “high touch” and “high tech” care. There should not be barriers between different kinds of service delivery, they maintained. Many contended that we ought to deliver both types of care even though today’s high touch care might be a “different kind of touch.”
This conclusion — to embrace technology and deliver different kinds of care services — reflected Ms. Jenkins’ book, the bestselling “Disrupt Aging: A Bold New Path to Living Your Best Life at Every Age.” In both, she asserted that combining high tech with conventional care services can help our patients live and age better. She explained this point as “much less hands-on care by providers and much more hands-on responsibility of patients to self-manage their own health.”[Kinsella provides details about Jenkins’ expansive views on seniors aging in today’s world, with ample telehealth tools to self manage their own health, and learn how to “live in place”–not just “age in place.”]
All of us, as well as our elderly patients, must learn to “experience aging as a time of continued growth and development,” she insisted. Her presentation, titled “The Changing World of Providers to Healthcare at Home for Seniors,” talked about kicking all of us out of our comfort zone, away from that hands-on, caring persona we have embodied for decades. That persona in that zone, she said, requires us to diligently and patiently care for the elderly, in person, using only conventional means.
“Today these patients need more,” Jenkins insists. Among these new needs are services to help them learn how to assist themselves, using new technologies to develop daily self-management routines. For this, in-home caregivers identify each patient’s unique needs and then diligently and patiently introduce technologies to assist them to stay well on their own.
Introducing connected blood pressure cuffs, glucometers, weight scales and tech-enabled care plans is essential, Jenkins notes, for helping patients begin their own journeys to “take control of their own health.”
This is a recipe for “disrupting the delivery of traditional care,” but it is necessary for this brand-new senior generation in-home caregivers are facing today.
“Exhilarating to think about, no question,” Jenkins told her audience. “While we are gathered here in Boston for two days, 20,000 Americans will turn 65 years of age. We can help our patients use technologies to get out of their homes and embrace life’s opportunities and technologies at every age.”
Oxymoron?
I had to think about this. I have read for years about the ideal of fit and active seniors embarking on day-long bicycle trips and the like. I am aware of the need for new ways to see to the health care of a new breed of seniors. Still, there is a reality check needed. Hence, my pointed question to Ms. Jenkins during her book signing session. “Seniors with chronic conditions need care so that they can live more normal, active lives. But, as Medicare beneficiaries, in order to get that care they need to be homebound.”
I told her my story. Debilitating chronic condition, confined to a wheelchair, but not technically homebound and so ineligible for Medicare’s home health services. “So, how can relatively active seniors like me who do need healthcare at home services (at least part of every day) get Medicare to agree to pay a small amount for aides to assist us with ADLs?”
It was to this question she gave me her “we-can-fix-this!” assurance. She said that her organization, AARP, is very much aware of this stifling Medicare regulation, adding that it is going to be addressed by AARP staff when they present arguments to government regulators…soon.
Changes to enable aging in place
I am not the first to ask for re-consideration of existing requirements in Medicare and I will not be the last. Ms. Jenkins is clearly way ahead of me. Look at one representative chapter in her book, titled “Let’s Change the Rules,” which she opens with a lesson she recently learned.
In 2015, Americans celebrated the 50th anniversary of Medicare’s enactment, begun when life expectancy was considerably shorter than now and Baby Boomers were in school. Fifty years later, these 76 million Boomers are living longer and planning to remain healthy as long as they can. This, she agrees, requires changes to be made in Medicare legislation. She writes:
“As baby boomers age, our infrastructure and systems for supporting people as they age are becoming more and more outdated. So just as the birth of boomers caused a disruption of our culture and social institutions, the aging of the boomers requires similar disruption.” (Disrupt Aging, p. 182)
The reason? To help people like me and many of your “homebound” clients get out of the house, be more active, which will keep them healthier. We need to change the rules, ultimately, to help them make their lives worth living. Not “age in place” but “live in place” is Jenkins’ new mantra for today’s senior population.
Audrey Kinsella, MA, MS, is HCTR’s telemedicine reporter. She has written on home telehealthcare and new technologies for home care service delivery for 20 years, in 6 books, multiple web sites, and more than 150 published articles. Audrey can be reached at audreyk3@charter.net or 828-230-0895.
©2016 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com
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stored in: Tim Rowan's Home Care Technology Report and tagged: CMS and payments to recovery audit contractors (RACs)--details on rules and fees, documentation--need for by healthcare at home providers getting reviewed by RACs, recovery audit contractors (RACs)--and new rules for RAC audits for CMS, recovery audit contractors (RACs)--and selected auditors by CMS in Oct. 2016
By Elizabeth E. Hogue, Esq.
The Centers for Medicare and Medicaid Services (CMS) has selected five new recovery audit contractors (RACs) and established new rules. RAC audits will undoubtedly resume soon. Performant and Cotiviti were awarded contracts, along with HMS Federal Solutions. A previous RAC auditor, CGI Group, did not bid in the latest round of contracts for RACs. Performant will focus on auditing home medical equipment (HME), home health agency (HHA) and hospice claims. [Details about CMS payments to auditors and rules payments to RACs for overpayments. Differences between RAC auditors and healthcare at home providers regarding understanding of reasonable and necessary treatment of healthcare at home patients are noted. Hogue stresses the importance of providing documentation in all things RAC related.]
CMS will continue to pay RAC auditors a contingency fee when overpayments are identified. Providers frequently point out that RACs are incentivized to find erroneous overpayments and these errors have resulted in a multi-year backlog of claims pending appeal, especially before administrative law judges (ALJs). Nonetheless, CMS announced that RAC auditors have recouped $8 billion for the federal government since the audits began in 2009.
Under previous rules, RACs received payments for overpayments they identified in less than forty-five days. Under new rules, RACs will now receive payments for overpayments they identify only after providers have an opportunity to appeal through the second level of an appeal process that provides five stages of appeals. As a result of this change, contingency rates for payments to RACs will likely increase substantially, from the current 9.5% to 12%.
Also under previous rules, RACs could review claims that were up to three years old. Under new rules, claims reviewed by RACs cannot be more than six months old.
Audits by RACs have been on “pause” while new rules were developed and disputes about the contracting process resolved. When RAC audits resume, providers can expect more of the same, i.e., a focus on vague eligibility criteria, such as home bound status and terminal illness, which are open to broad interpretation.
RAC auditors are also likely to continue their focus on whether care that was provided was reasonable and necessary. Unfortunately, RAC reviewers often seem to evaluate this issue very differently than providers who are “on the ground,” so to speak. It seems reasonable to require RACs to cite national standards of care to support their conclusions that care provided was not reasonable and necessary. Without such support, what constitutes reasonable and necessary care seems to be “in the eye of the beholder,” which makes such determinations extremely difficult for providers to address on appeal.
CMS’ initial meeting with new RACs is in November. Audits will begin soon thereafter.
As always, the “name of the game” for providers with regard to all types of audits, including RAC audits, is documentation, documentation and more documentation! Although it is an age-old “story” and most clinicians certainly know how to provide appropriate documentation, consistently excellent documentation appears to remain elusive.
©2016 Elizabeth E. Hogue, Esq. All rights reserved. Reprinted by permission of the author. Further reproduction of any portion of this material allowed only with advance written permission of the author.
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