Healthcare at Home: The Rowan Report

Overland Park, KS, August 9, 2016– Netsmart has announced that Dawn Iddings has joined the company as senior vice president and general manager of Netsmart Homecare™.

Iddings will manage the continued development of Netsmart’s market-leading home care, hospice, palliative care and private duty solution, including integration into the Netsmart CareFabric® suite of clinical and business solutions.

Iddings brings more than 15 years of healthcare and technology experience to Netsmart, including senior-level positions at Siemens Healthcare, Cerner and Garmin International. [Details about The Netsmart Homecare solution to be used to assist home care, hospice/palliative care and private duty healthcare organizations are touched on in this article and more details about Iddings background are also provided. In addition, details about Netssmart’s recently acquiring Allscripts is provided. Its doing so, NetSmart became established as “the largest human services and post-acute technology provider in healthcare,” the article reports.

“Dawn has a proven record of facilitating long-term collaborative relationships with both clients and healthcare industry leaders,” said Netsmart CEO Mike Valentine. “Her diverse experience in the healthcare ecosystem complements our ability to meet the needs of our clients as we grow our quality, innovative home care solutions.”

The Netsmart Homecare solution is designed to fit home care organizations of all sizes nationwide. It provides business, clinical and scheduling functionality for home health, hospice palliative care and private duty, and automates clinical and business processes from care engagement to billing and accounts receivable.

The announcement about Iddings joining Netsmart as Netsmart Homecare executive was made on the opening day of the 2016 Allscripts Client Experience (ACE) user conference, attended by thousands of Allscripts clients and industry leaders. The Allscripts Homecare business unit was acquired by Netsmart as part of a new venture with Allscripts (NASDAQ: MDRX) and GI Partners in April 2016 (see HCTR, 3/30/16, “Allscripts Reinvests in Home Care” and “A Great Marriage“). The relationship established Netsmart as the largest human services and post-acute technology provider in healthcare.

by Michelle Boasten

To avoid 30-day readmission penalties and prepare for new payment systems that emphasize value-based care, Cedars-Sinai hospital in Los Angeles offered development and financial support to 11 startup innovators. HomeHero was one of the participants in the hospital’s Techstars Healthcare Accelerator, designed to address comprehensive regulatory changes set in place by the Affordable Care Act and CMS. [The article highlights the work of HomeHero, a post-acute care services company, and its role in assisting Cedars-Sinai transport and further attend to the needs of discharged patients home in its Safe Transitions Program.]

We followed up with Mike Townsend, co-founder of HomeHero, to see how his role in the accelerator program was unfolding in its goal to reduce inpatient readmissions, raise patient satisfaction and improve health outcomes. HomeHero’s entry, the Safe Transition Program, was designed to smoothly transition patients from the hospital to their homes.

From April to June this year, the private pay, non-medical home care services provider transported a couple dozen Cedars-Sinai patients who did not have any available family or friends on the day of their discharge fromprofile an inpatient stay or outpatient surgery. At no expense to the patient, Cedars-Sinai dispatched hospital staff to accompany the patient from the hospital to the HomeHero vehicle, in which they were driven home. Once home, the “Hero” caregiver spent up to four hours helping the patient inside the home, running errands and conducting a safety inspection based on the patient’s particular condition and needs.

There are many things unique about HomeHero, but what most makes them stand out from other private pay agencies is that they are developing platform technology which will allow them to scale across the country. While most private pay home care agencies start up with budgets of less than $10,000, HomeHero was able to raise $23 million in venture capital to build an impressive technology platform using talent from UBER and Apple. Their goal is to scale their business in markets across the United States while providing services like the Safe Transition Program to other hospitals.

We will keep an eye on this company and bring periodic updates.

About HomeHero
HomeHero is a non-medical home care provider based in Santa Monica, California, offering post-acute services such as personal care and companionship, transitional care, postoperative recovery, medication management, transportation and assistance with activities of daily living through hundreds of licensed and trained caregivers. Launched in May 2013 by Kyle Hill and Mike Townsend, originally as a service for their own families, HomeHero has grown to be one of the largest home care providers in California. Recently, the company made the decision to transition all of its field staff from 1099 to W-2 employees. The company has raised $23 million in venture funding from Graham Holdings, Social+Capital Partnership, Science Inc, The Launch Fund, Tencent Holdings, Techstars and Cedars-Sinai Medical Center. homehero.org

About Cedars-Sinai
Cedars-Sinai, the largest nonprofit academic medical center in the western United States, is known internationally for providing the highest-quality, most advanced patient care. Over its 113-year history, Cedars-Sinai has evolved to meet the needs of one of the most diverse regions in the nation, setting standards in quality and innovative patient care, research, teaching and community service. Cedars-Sinai has a long history of transforming healthcare — at the bedside, in the clinic and in the community. Innovations from Cedars-Sinai include the invention of the Swan-Ganz catheter to measure blood pressure inside the heart, the start-up of a company that developed one of the world’s top evidence-based clinical decision-support systems for physicians, and the first experimental use of stem cells to cure heart disease.

About Techstars
Techstars is a global ecosystem that empowers entrepreneurs to bring new technologies to market wherever they choose to build their business. With 18 mentorship-driven accelerator programs worldwide, Techstars exists to support the world’s most promising entrepreneurs throughout their lifelong journey. Techstars provides access to over 3,000 founders, mentor investors, and corporate partners, allowing entrepreneurs to accelerate the pace of innovation and do more faster. Techstars makes entrepreneurship more accessible by providing access to capital, guidance, marketing, business development, customer acquisition, and recruitment. techstars.com

Michelle Boasten is a humanitarian and social entrepreneur. She is the Founder of You Can Care, Inc. an IRS 501(c)3 non-profit. Michelle has invented and developed a web and mobile incentivized volunteer caregiving platform to tackle the twin issues of caregiving and student loan debt. www.OnlyOneNurse.com

Prior to You Can Care, Ms. Boasten founded EVV (electronic visit verification) in 1996. By 1998 the product was patented and today more than 50% of all home health agencies are required and mandated by law to use an EVV system to evidence accountable caregiving activity. 

©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

By Tim Rowan, Editor & Publisher, Home Care Technology Report

Looking at Medicare claims data for calendar years 2014 and 2015, the Office of the Inspector General has concluded that more than $10 billion of the $18.4 billion paid in CY2015 for healthcare services to Medicare beneficiaries in their homes was “improper.”

The use of this word instead of “fraudulent” or “illegal” allows the report to lump together both fraudulent and non-fraudulent activities into one large category, one that includes payments made for services never provided, such as in criminal activities; services actually provided that were later determined to be not medically necessary, such as when clinicians either recertify relatively well patients¹ or their documentation is incomplete or sloppy; and services actually provided and medically necessary but that were denied for technicalities, such as missing dates or inadequate wording or signatures on the wrong line on the referring physician’s Face-to-Face document.[Very precise details are provided about extremely fraudulent activities followed by the OIG and CMS and these agencies’ extensive work over the years identifying fraudulent activities in home healthcare and “hot spots” where such activity is likely to happen.]

To illustrate what it has determined to be a common problem, OIG cites the extreme example of Dallas physician Jacques Roy, who coordinated a $375 million fraud scheme and was convicted along with five HHA owners.² The report makes clear that only claims data was examined to produce the OIG’s characteristics common to fraudulent providers, stating, “This data brief is based on analysis of Medicare claims data only; we did not review medical records or other documentation. Moreover, our measures were designed to assess characteristics commonly found in OIG-investigated cases of home health fraud, not to accurately predict or reveal fraudulent activity. Accordingly, our analysis should not be interpreted as demonstrating that specific providers were engaged in fraud.”

Two years ago, the OIG issued a report that criticized CMS for failing to train physicians on their expectations for wording on the then new Face-to-Face documentation requirement, and then denying home health claims based on inadequate physician documentation.³

Using a list of five characteristics common to agencies with improper payments (see sidebar), OIG identified “hot spots,” or geographical areas where fraud is more common. In order to be named a hot spot, a region had to have

• outliers on two or more measures, or
• ten or more HHAs that were outliers on two or more measures, or
• 50 or more physicians that were outliers on two or more measures.

Outliers were identified using a standard statistical tool, which is better described as a direct quote than in summary:

For each measure, we used a standard technique known as the Tukey method to identify HHAs, physicians, and geographic areas that were statistical outliers. Specifically, we identified an HHA, physician, or geographic area as an outlier if its percentage for a given measure was above the 75th percentile plus one and a half times the interquartile range on the distribution of percentages across all HHAs, physicians, and geographic areas, respectively.

Prior to performing the outlier analyses, we excluded HHAs, physicians, and geographic areas with low volumes of home health services. For the first three measures, we excluded HHAs, physicians, and geographic areas with fewer than 10 total episodes of home health care. For the fourth and fifth measures, we excluded HHAs, physicians, and geographic areas with fewer than 10 home health beneficiaries. For all measures, we further excluded geographic areas with fewer than five HHAs.

Twenty-seven problem regions
Using this criteria and the measures described below, OIG named the following cities or counties and their respective surrounding regions as fraud hot spots:

¹ For an elaboration on the problem we have dubbed “toxic census syndrome” see HCTR, 4/29/15: “Seminar Keynoter Outlines Path Toward Healthcare Reform Success

² HCTR 2/29/12. Texas Physician Succumbs to H.E.A.T., Takes Hundreds of Home Care Agencies Down With Him

³ OIG, April 2014. “Limited Compliance with Medicare’s Home Health Face-to-Face Documentation Requirements” oig.hhs.gov/oei/reports/OEI-01-12-00390.pdf

©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

By the Visiting Nurse Associations of America

In response to the June [2016] report by the HHS Office of Inspector General, the Visiting Nurse Associations of America issued the following statement.

VNAA appreciates the Office of Inspector General’s identification of characteristics of potentially fraudulent home health claims.

The Health and Human Services’ Office of Inspector General released a report that highlights the legal settlements and prosecutions that the federal government has reached in the past year. The report references home health agencies, individual physicians and heads of home-visiting physician companies that defrauded Medicare by, among other conduct, making (or accepting) payments for patient referrals, falsely certifying patients as homebound and billing for medically unnecessary services or for services that were not rendered. [Details are provided about 5 characteristics of fraud typically committed, according to the OIG report, but the authors see them as only “good first steps” to identifying fraud activity. They say that the CMS must not concentrate on following its Pre-Claim Review Demonstration for Home Health Services which they think  will itself root out fraud but instead identify and use other means for proving fraud.]

According to the Office of the Inspector General, home healthcare fraud cases typically involve five characteristics, including high percentages of:

1. episodes of care during which a beneficiary had no recent visits with the supervising doctors
2. episodes of care not preceded by a hospital or nursing home stay
3. episodes of care with a primary diagnosis of diabetes or hypertension
4. beneficiaries with claims from multiple agencies
5. beneficiaries with multiple home health readmission in a short time

While these five characteristics are a good first step in identifying fraud, some of the characteristics are not clear indicators of fraud. As long as there is a due process for the agencies to prove actual care, this is a very positive step.

Unfortunately, the Centers for Medicare and Medicaid Services continues to move forward with their Pre-Claim Review Demonstration for Home Health Services, which will not achieve their purported claim of rooting out fraud. The five characteristics that have been proven to be effective fraud discovery devices are not a part of the Pre-Claim process.

We ask that CMS use more effective and proven methods to eliminate fraud in the home health industry and not just create administrative burden on those providing necessary care.

©2016 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared on the VNAA web site. Reprinted by permission. homecaretechreport.com Further reproduction and distribution is encouraged. editor@homecaretechreport.com

By Tim Rowan, Editor & Publisher, Home Care Technology Report

On June 23, Judge Michael L. Rankin of the Superior Court of the District of Columbia, Civil Division, declared null and void the October, 2015 dismissal of Joanne Cunningham and Laurie Neander from the National Association for Home Care Board of Directors. The lawsuit was brought in January against NAHC, its president Val Halamandaris, its board chair Denise Schrader, and its attorney Hugh K. Webster by the Home Care Association of New York on behalf of Cunningham, its president. Ms. Neander is the Executive Director of At Home Care in Oneonta, New York. She is an HCA member and former board member. [Details are provided in tis article about the background of this case, activities undertaken by the NAHC and Home Care Association of New York (HCANY) during 2015-2016,  and Judge Rankin’s ruling against NAHC.  Longer-term consequences of this ruling  are expected to affect home healthcare organizations’  needed compliance with their organizations’ own bylaws.]

Background
On October 23, 2015, Attorney Hugh Webster delivered letters on behalf of NAHC informing Cunningham and Neander that they had engaged in activities that disqualified them from remaining on the NAHC board. This in spite of a NAHC by-law, Judge Rankin noted, that requires such dismissals to occur during a board meeting with the member in question present. Cunningham had been elected to the board by her peers in the Forum of State Associations, a NAHC affiliate organization made up of state executive directors. Her two-year term was set to expire four days after she received the Webster letter. (See HCTR, October 29, 2015 and December 2, 2015)

In addition to violating this NAHC by-law, Webster’s letters also crossed a line by grounding his argument in the fact that both board members headed organizations that had become members of the Visiting Nurse Associations of America, which NAHC regards as a rival association. This accusation ignored another NAHC by-law, which bars board members only from serving on a rival agency’s board, not from holding a membership in other national home care organizations.

On June 11 of this year, long after the HCA-NY lawsuit was filed and initial court hearings had been conducted, NAHC took a second formal action to reaffirm its dismissal of the two board members. Judge Rankin’s decision voided both the October letters and NAHC’s June, 2016 action. The HCA suit did not seek monetary damages other than that NAHC pay its legal fees, which the judge did agree to and which are still being calculated.

Next steps
On July 13, a status hearing was held before Judge Rankin so that NAHC attorneys could produce evidence that their client had obeyed his June 23 instructions, which included a demand that the NAHC board pass a formal resolution declaring that Cunningham and Neander had never been dismissed, that they had continuously been and were still members in good standing of the NAHC board. We are awaiting publication of the results of that hearing.

Shortly after the judge’s June 23 reinstatement, Joanne Cunningham and Laurie Neander resigned as NAHC board members. According to the explanation in the HCA newsletter:

Both Ms. Cunningham and Ms. Neander resigned from the NAHC Board of Directors on July 6, 2016. They both resigned because it became apparent during the course of the lawsuit that, although certain members of the NAHC Board and management remain dedicated to furthering the interests of NAHC, other members of the NAHC Board and management appeared focused on advancing their personal interests ahead of NAHC’s interests. Ms. Cunningham and Ms. Neander could no longer work and fulfill their Board duties in that type of environment.

Long term consequences
Will this court case end here or will it have a broader impact beyond home care? It does set a precedent that may well be cited in future cases. Associations have been put on notice that they must comply with their own bylaws as they would comply with a contract. Attorneys have been alerted that they may not aid and abet an association that schemes to violate its own by-laws. With the decision being rendered in a DC Superior Court and so many national associations based in Washington, this may be a case that reaches beyond the parties involved, beyond home care, even beyond healthcare.

For reference, we reprint HCA’s letter updating its members elsewhere in this week’s issue.

©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

From the July 15 edition of ASAP, a weekly publication of the Home Care Association of New York State:

In January 2016, HCA commenced litigation against the National Association for Home Care and Hospice (NAHC), NAHC’s Board Chair, its President and CEO, and outside legal counsel, for violating the NAHC bylaws when they illegally attempted in October 2015 to remove HCA’s representatives – HCA President Joanne Cunningham and HCA Member (and HCA Board Member) Laurie Neander – from the NAHC Board of Directors.

HCA just prevailed overwhelmingly in the lawsuit. In a June 23, 2016 order (available at http://hca-nys.org/wp-content/uploads/2016/07/ HCANAHCorderofjudgment.pdf ), the Superior Court of the District of Columbia ruled in HCA’s favor, declaring that: the October 2015 action (as well as a subsequent June 2016 Board action) of the Defendants violated NAHC’s bylaws and were invalid; both Ms. Cunningham and Ms. Neander were never removed from the Board; and Ms. Cunningham and Ms. Neander continued to serve as Board members of NAHC with uninterrupted service following Defendants’ invalid actions.  [More details about Neander’s and Cunningham’s  subsequent activities with NAHC  activities and duties are provided in this short article.]

The Superior Court also ordered NAHC to pay HCA’s legal fees. The Superior Court will be reviewing HCA’s invoices for legal fees and determine the exact amount NAHC must pay HCA.

Both Ms. Cunningham and Ms. Neander resigned from the NAHC Board of Directors on July 6, 2016. They both resigned because it became apparent during the course of the lawsuit that, although certain members of the NAHC Board and management remain dedicated to furthering the interests of NAHC, other members of the NAHC Board and management appeared focused on advancing their personal interests ahead of NAHC’s interests. Ms. Cunningham and Ms. Neander could no longer work and fulfill their Board duties in that type of environment.

HCA has been reasonable in its approach throughout. It made numerous attempts to informally resolve its concerns with NAHC before it commenced the lawsuit, but NAHC had refused to engage or respond to HCA’s outreach. This forced HCA to commence the lawsuit and seek its relief through the Superior Court. The Superior Court’s order did not address HCA’s count in the lawsuit concerning wrongful interference with business relations. That count is still pending. HCA will continue to pursue relief on that count.

This article originally appeared in ASAP, the newsletter of the Home Care Association of New York State. Reprinted by permission.