Saturday, October 21, 2006

P4P for Physicians

The Centers for Medicare and Medicaid Services (CMS) announced a new initiative to pay physicians for the quality of the care they provide to seniors and disabled beneficiaries with chronic conditions, reflecting the Medicare Administration's ongoing commitment to reward innovative approaches to get better patient outcomes for the health dollar.

We intend to provide better financial support for quality care," said CMS Administrator Mark B. McClellan, "Through this demonstration and the rest of our set of value-based payment demonstrations, we are finding better approaches to doing that than ever before. This is another important step toward paying for what we really want: better care at a lower cost, not simply the amount of care provided."

As the next step in its efforts to make higher payments for better quality, CMS announced the implementation of a new demonstration aimed at physicians practicing in solo or small to medium sized group practices. CMS has already implemented several other "pay-for-performance" demonstrations, including the Premier Hospital Quality Incentives Demonstration which involves acute care hospitals and the Physician Group Practice demonstration which involves 10 large multi-specialty group practices across the country.

The Medicare Care Management Performance (MCMP) Demonstration was authorized under section 649 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). It will be implemented in four states: Arkansas, California, Massachusetts, and Utah in 2007.

A question for home care leaders: With CMS working on P4P for hospitals and physicians, how long do you think it will take to also create a P4P for home care? We've heard a lot of talk about P4P for our industry segment. Will it really come soon, and what will it look like? Give us your comments below.

November is National Family Caregiver Month

New York, NY – This November, Companion Connection Senior Care, a national home care membership organization, honors Americans who are the primary caregiver for an aging or disabled loved one during the annually celebrated National Family Caregiver Month.

With over 50 million Americans caring for an aging parent and more than 50% of those caregivers reporting “burn-out,” National Family Caregiver (NFC) Month offers validation and support for the growing population of family caregivers. One of the key ways that family caregivers can avoid burnout and practice self-care is through finding support and outside help. Professional non-medical home care is a perfect solution for family caregivers because it offers assistance with caregiving duties and support and expert advice for the family caregiver.

Respite or supplemental care reduces caregiver stress, helps restore balance and enhances the relationship between the caregiver and their loved one.Companion Connection Senior Care offers support and respite resources for family caregivers through referrals for home care to supplement and relieve family caregivers. Americans can locate quality, compassionate and trustworthy home care.

Elda DeLorenzo of Hollis, New Hampshire, is one of millions of Baby Boomers who is currently facing the responsibility of managing care for an aging parent. DeLorenzo brought her elderly mother home to live with her after she began declining in nursing care. “I first tried putting my mother in a nursing home but she was getting worse. I knew that the only option was to care for her myself but I quickly found myself in over my head,” said DeLorenzo. “Finally I sought help from Classic In-Home Care, a local home care agency and member of Companion Connection Senior Care, and now I receive support 20 hours a week from wonderful and compassionate caregivers. Before I got help I was going crazy. Getting help that I could trust was such a relief and made my life so much easier.”

Across America, more and more aging Americans are choosing to stay at home and be cared for by family members instead of entering institutionalized care. In fact, according to a recent AARP study, 89% of people over 50 wish to remain at home as long as possible. This shift towards aging at home is putting pressure and responsibility on adult children, grandchildren and loved ones of elderly. Suddenly they are faced with the responsibility of providing care and aren’t always prepared for the emotional and physical toll.

National Family Caregiver Month was developed to recognize and validate the roles of family caregivers.“Supporting and caring for loved ones of family caregivers is a privilege for our members and as leaders in the home care industry we understand the challenges that these caregivers face,” said David Goodman, president of Companion Connection Senior Care. “We honor and support family caregivers by providing them with referrals to high quality respite or supplemental help if and when they need it.”

About Companion Connection Senior Care

Companion Connection Senior Care is a national membership organization for non-medical home care agencies. Members are provided with regular ongoing training and support and are held to high standards. With over 80 members across the United States, Companion Connection Senior Care is a pioneer in the home care industry, meeting the exploding need for non-medical home care services.

About National Family Caregiver Month

NFC Month—observed every November—is a nationally recognized month that seeks to draw attention to the many challenges facing more than 50 million family caregivers, advocate for stronger public policy to address family caregiving issues and increase the community programs that support family caregivers. NFC Month is sponsored by the National Family Caregivers Association.

Friday, October 20, 2006

NPDA Starts Florida Chapter

The National Private Duty Association (NPDA), a group for private duty home care providers, has formed a Florida state chapter.

NPDA President Sheila McMackin said a large percentage of the nation's private duty home care providers currently operate in Florida.

The nonprofit organization already represents more than 600 home care agencies in 44 states and Puerto Rico. McMackin said the Florida chapter will give this state's private duty home care providers an opportunity to work cooperatively on important legislative issues, share resources with other agencies and participate in training and education programs.
Members are also to have access to industry news and information that could affect the way all agencies conduct business.

"Because of the many challenges facing the providers of private duty home care, it is becoming increasingly important for agencies to join together so that we can continue to improve the industry and protect the health and safety of consumers," McMackin explained. "The NPDA promotes strong ethical standards and is dedicated to educating the public about private duty home care."

The NPDA has scheduled informational meetings around the state for private duty home care agencies. In South Florida, there are sessions scheduled at 5 p.m.:

Oct 24, at Atlantis, 6026 Old Congress Road, in Lantana

Oct. 26, at The Sterling of Aventura, 2777 N.E. 183rd Ave., in Aventura

Nov. 7, at Summerville at Regency Residence, 5600 Lakeside Drive North, in Margate

To sign up for one of the informational sessions, call (866) 282-4823 or e-mail

Thursday, October 19, 2006

USA Today Article promotes Home Care & Hospice for End of Life Care

The cover story in the Money section of USA Today for Thursday, October 19, 2006 focuses on the cost of end-of-life care, and poses the question, "Should treatment be provided, regardless of cost or quality of life?"

The story is based on data from the Dartmouth Atlas Project that evaluates variation in medical care across the country. The report shows that the cost of care during the last six months of life varies from $24,591 in the District of Columbia to $12,878 in Idaho. The biggest factor affecting cost is the availability of doctors and hospital beds. Another factor that comes into play is the willingness of doctors, hospital staff, and hospices to talk with patients about end-of-life, what kind of care they want, and where they want to die.

According to Joanne Lynn, a geriatrician who worked for the RAND corporation, "Substantial progress could be made in slowing rising costs if the U.S. health system could find better ways to reduce hospitalization for people at the end of life, such as providing more in-home services."

What can we do as leaders in home care & hospice to get this message out to the rest of the healthcare delivery system? Post your comments below.

Wednesday, October 18, 2006

What's the Best Way To Expand Your Business?

You have a successful home care business. What's the best way to expand it?

You could start up new programs and services. You can start up a new branch in a new location. Or, you can acquire an exisiting business.

One of the best breakout sessions at NAHC (other than mine, :-) ) was presented by Dexter and Steve Braff from the Braff Group. They mixed their typical "growing up brothers back-and-forth humor" combined with solid financial data to give us some real meaty information to consider.

First, Steve identified four specific costs to consider in expanding your business:
  1. The initial capital outlay
  2. The loss you may need to absorb
  3. Lost opportunity costs over time
  4. Use of senior management time and resources

Then he gave us an expanded view of ROI - Return on Investment. To fully grasp the ROI on your expansion strategy, you need to consider:

  1. Profits from the new business
  2. The terminal value of the new business when you exit or sell it
  3. The value of intellectual or human capital that is accumulated in the business
  4. Stock price movement
  5. Arbitrage -- buy low and sell high
  6. Elimination of barriers to entry (CON, Licensure)
  7. Allocation of Scarece Resources

Then he outlined the alternatives:

  • Acquisitions
  • Start up
  • New Program Development

Then brother Dexter came up and ran through several very interesting spread sheets showing the cost of the three alternatives, and the potential return in each of the categories described by Steve.

If you'd like more information on their concepts, go to The Braff Group web site, and then contact Dexter or Steve. I'm sure they'll be happy to send you a copy of their presentation information.

Congratulations to Warren Hebert on Robert Wood Johnson Fellowship

If you see Warren Hebert, CEO of the Home Care Association of Louisiana, tell him "Congratulations."Warren was selected to be part of a very small group of nursing executives to become a RWJ Executive Nurse Fellow.

The Robert Wood Johnson Executive Nurse Fellows Program is an advanced leadership program for nurses in senior executive roles who are aspiring to lead and shape the US health care system of the future. Their mission is to inspire experienced nurses in executive roles to continue the journey toward achieving the highest levels of leadership in the health care system of the 21st century.

The program seeks applications from outstanding nurses in executive roles from health services (including patient care service, integrated delivery systems, health plans, and other health organizations engaged in organizing and delivering health care), public/community health, and nursing education who, along with their employing institutions, are willing to make a three-year commitment to the program. The fellowships are intended to offer participating nurses the experiences, insights, competencies and skills necessary to achieve, or advance in executive leadership positions in a health care system undergoing unprecedented change.

The RWJ Executive Nurse Fellows Program is a national program supported by The Robert Wood Johnson Foundation with direction and technical assistance provided by the Center for the Health Professions, University of California, San Francisco.

Tuesday, October 17, 2006

Here's the Law Governor Romney Described on Monday at NAHC

A landmark bill was signed into law which will allow many more low-income seniors and disabled adults to be able to receive the state-funded home care services they need in their own homes or in the community rather than in nursing homes.

Entitled "An Act Regarding Choice of Long Term Care Setting," the bill requires that low-income elders and disabled (specifically those covered by Medicaid or Mass Health) a) receive pre-admission counseling prior to long- term care placement about home care/community care options that are less restrictive such as home care, adult foster care, or day care.

Should these persons choose home care or community care options over nursing home placement, the funding that would have gone to reimburse the nursing home for the individual's care can now instead be used to pay for home care/community care services.

In other words, the "dollars follow the person" as his/her setting of care changes. Pre-admission counseling about such options will also be provided to non-Medicaid/Mass Health covered elders/disabled persons, but on a voluntary basis.

New state legislation also creates a work force registry to match consumers with caregivers, retains the right of persons with disabilities to have control (hiring/firing) over their personal attendants, creates a council to recruit and train caregivers, provides a network of backup/substitute caregivers, and allows attendants to join unions. This is key legislation as the turnover rates for caregivers is between 40 and 60 percent annually.

source: The Sharon Advocate

Home Health Care Provider Pleads Guilty for Medicare Fraud

I believe this may be the case that Bill Dombi mentioned in his presentation during the opening general session on Sunday at the NAHC annual conference:

LOS ANGELES, CA (AP) -- The San Diego-based owner of California's two largest home health care businesses has pleaded guilty to health care fraud that cost Medicare 40 million dollars.
Lourdes ''Lulu'' Perez entered the plea yesterday in federal court as part of a settlement in which she, her husband and her two businesses repaid nearly 34 million dollars to the government.

Perez is scheduled to be sentenced on October 16th. Prosecutors have recommended that the 53-year-old be sentenced to 46 months in prison, but she could get up to 59 years.
Perez was the owner of Los Angeles-based Provident Home Health Care and San Dimas-based Tri-Regional Home Health Care. Prosecutors say the businesses billed Medicare for work that was never performed.

Former provident nursing director Margaret Tan has cooperated with the prosecutors' investigation. She's scheduled to enter a plea October 23rd.

Delta Health Technologies Announces Strategic Partnership with CellTrak Technologies

Monday October 16, 10:15 am ET

ALTOONA, Penn., Oct. 16 /PRNewswire/ -- As part of its ongoing commitment to bringing reliable software products and unyielding service to home care, Delta Health Technologies has announced a strategic partnership and distribution agreement with CellTrak that will allow Delta customers to transmit clinical data via their cell phones, eliminating paper in the home care setting. Under the terms of the agreement, Delta will make the CellTrak product available to its customers effective immediately, integrating the product with its software.

What other innovations are you seeing in home care technology? Comment below:

Monday, October 16, 2006

Selecting, Hiring and Managing Home Care Sales Professionals

This afternoon, I presented a program on Selecting, Hiring and Managing Home Care Sales Professionals. The room was full, and we had great interaction. Thanks so much to all of you who were there.

Here are some of the points we discussed:

The Role of the Sales "Coach."

  1. Pick the right players
  2. Teach the basic skills
  3. Drill the fundamentals
  4. Push your sales team members to be bette than THEY think they can be
  5. Implement your sales game plan
  6. Maintain motivation & enthusiasm
  7. Provide immediate and ongoing feedback.

Then we talked about the Top Ten Recruiting Techniques in Home Care:

  1. Employee Referrals
  2. Word of Mouth
  3. Newspaper Ads
  4. Web Site
  5. E-newsletter
  6. Direct marketing
  7. Public Relations
  8. Paper Newsletter
  9. Flyers & Posters
  10. Special Events

We Examined the Three Criteria for Picking Great Home Care Sales Professionals

  1. Behavioral Styles
  2. Workplace Motivators
  3. Sales Competencies

We then discussed in detail tools for assessing behavior and motivators.

If you'd like a copy of the slides and handouts from this email, send me an email and I'll send the handout to you.

What do you think about selecting and hiring sales professionals in home care? Give us your comments below.

The Exhibit Hall is a Great Learning Place

One of my favorite ways to experience the annual NAHC Conference and Exhibit is to walk the aisles of the trade show. Each year, I am constantly amazed by the size of the exhibits, the number of vendors selling information technology, and the new inventions that were not hear last year.

This year, one of my focal points was to talk with IT vendors about the capabilities of their systems to provide CRM - Customer Relationship Management. This is a huge hole in the IT infrastructure of home care. Many of my clients are frustated because their home health care clinical and billing software won't interface with their CRM system. I talked with several IT vendors, and no one really addresses this problem. What's your experience? How do you capture data to help your sales and marketing team members focus on your most profitable referral sources? I'd love to hear from you.

Walking the trade show is also a great place to meet old friends from the industry. It has been wonderful seeing people who I've known for the 24 years I've been working in home care. For example, I ran into Mary Kay Perra, who was the Executive Director of the Pennsylvania Association for Home Health Agencies in 1982 when I spoke for a home care group for the first time. She's now living in New Mexico and doing some work with Joie Glenn and the home care association there. I won't go on and list all of the othe wonderful folks I talked with because I'll surely miss someone. But suffice it to say, the exhibit area is a great place to learn what's new in our industry and what's new with old friends.

I was surprised how few people were taking advantage of the show. Talking with many vendors, they were dissapointed with the traffic in their boothes.

What's your take on the Exhibit? What did you observe that others might like to know about? Comment below:

Claude Pepper Awared Winner: Governor Mitt Romney of Massachusetts

Welcome back to the 2006 NAHC annual convention in Baltimore. Today's session opened with the introduction of the winner of the Claude Pepper Award. President Val Halamandaris introduced the award winner, Governor Mitt Romney of Massachusetts.

Governor Romney opened with a fun joke from the speaking business. He said that Val called him and asked if he believed in "free speech." The governor said that of course he did. Val said, " Great, I'd like you to give one." The crowded enjoyed it.

Then Governor Romney gave us four points for being and effective leader:

  • Throw out conventional wisdom and come up with new answers
  • Gather data
  • Analyze the data and develop new perspectives
  • Bring people around you who bring new perspectives

As an example, the Governor described how he approached the problem of the uninsured in Massachusetts.

The Problem: Many people are uninsured, and those who have insurance pay more to cover for those who don't.

The Solution: Get everybody health insurance.

Problem: You can't have the government provide universal health insurance. "If you think health care is expensive now, wait until it's free."

Governor Romney brought together a group of business and government leaders. They analyzed the data and explored new perspectives. They identified three types of people who don't have health insurance. They thought they would find low income, minority, single mothers. Instead they found young, male, working adults. The three types of uninsured:

1. Young working males who qualified for Medicaid but had never applied. The solution was to set up a system to have them apply on the spot when they appeared for treatment.

2. The Middle Income. They make $54,000 to $70,000 per year, but choose not to buy health insurance because it was so expensive at about $400 per month. The solution was to remove insurance regulations that drove up cost and reduce the premiums to around $200.

3. The Working Poor. They make $15,000 to $55,000. The state helped them buy insurance through subsidies. The money came from funds that would have gone to hospitals to pay for care for the uninsured.

The next step was the "Personal Responsibility Principle." This requires every single citizen to purchase health insurance as the state had removed the barriers to coverage. Now, if you show up at the hospital emergency room, there's not excuse for not having health insurance to cover your care.

The state also reduced property taxes and provided tax credits for the elderly people who did not have sufficient health coverage. They also refocused the state mediaid program on providing the "least restrictive care," which enabled many Medicaid recipients to have home care instead of going into a nursing home.

I was intrigued by Governor Romney's examples because they cause me to rethink two main points:

1. The uninsured are not low income, minority, single moms, but rather middle income young males.

2. The concept of "The Personal Responsibility Principle" suggests that the government remove the barriers to buying health insurance, including subsidies for the poor. But then require that everyone purchase healthcare coverage to pay for their care.

What do you think about this approach? Give us your comments below by clicking on the somments button.

Sunday, October 15, 2006

NAHC Celebrates 25th Anniversary

Congratulations to the National Association for Home Care & Hospice for 25 years of significant contribution to the healthcare delivery system in our great country. I've been coming the NAHC conventions since 1983, and it's a delight to be part of the progress that has happened in our industry.

For the next three days, I'll be reporting to you live from the floor of the 2006 Annual Convention and Exhibit in Baltimore Maryland.

I'd love to read your comments about the topics we're covering. After each posting, there's a "comment" button which you can click to add your thoughts and ideas on the subject. We encourage our readers to engage this interactive process by commenting on the BLOG posts.

Thanks so much for your continued support and encouragement. I'd love to hear from you.

Best regards,


Stephen Tweed, CSP
Leading Home Care ... a Tweed Jeffries company


Stephen at

A Leadership Idea to Change our Country

The keynote speaker at the opening General Session of the 2006 NAHC Convention and Exhibit in Baltimore was Jim Clifton, CEO of the Gallup Organization. Clifton believes, as did Dr. George Gallup, that democracy is about the will of the people, which is why it is essential to ask what the public thinks.

Clifton founded an opinion research company after graduating from college, and built it into one of the most successful firms in the nation. Ultimately, he acquired the Gallup Organization in 1988 and turned it into a company with a global presence with 40 office in 20 countries. They're currently doing surveys in Iraq to find out what the people there want from their new government.

One of the interesting ideas that Clifton discussed is based on survey of healthcare employees. Surveys of over 2 million workers found that only 25% are "spirited, enthusiastic, and proud of their work." Most others are "actively disengaged."

What about your employees? How many are "spiritied, enthusiastic, and proud of your home care company?"

Clifton said that most healthcare workers are having a really good day when "they make other employees as miserable as they are. He said, "When you find miserable patients, you'll find miserable employees."

His solution: "Double the number of enthusatic, spiritied, and proud employees."

What can we as leaders in home care and hospice do to bring in more enthusiastic, spirited and proud employees? Give us your comments below.

And for more ideas on recruiting and retaining great employees, stay tuned to Leading Home Care Report and Private Duty Today. Visit our Web Sites at and

Do You Believe in Angels?

Jim Clifton, CEO of the Gallup organization, congratulated Val Halamandaris and NAHC on our 25th anniversary. In his keynote presentation, he told a story about people believing in angles. He said, " I have an announcement to make. There are angels. I've been in the presence of them."

Then he gave us some data from the Gallup Survey.

George Gallup, f0under of the company, 75 years ago crafted the question, "Do you Believe in Angels?"

25 years ago, 50% of Americans answered affirmatively to the question. Today, 80% of survey respondents say they believe in Angels. Said Clifton, "Val, because of you and the good people at NAHC, and others like you, more people believe in angels."

What about you? Do you believe in angels? Give us your comments below:

Coming Changes to Medicare PPS

Mary St. Pierre, Vice President for Regulatory Affairs brought us up to date on the proposed changes to Medicare PPS. CMS wants to create a "more equitable distribution of funds."

Some of the changes:
  • Adjustments to SCIC, PEP, and LUPAs
  • Adjustments to reimbursement for Medical Supplies
  • Revisions to the Case Mix

Case Mix Revisions include:

  • Diagnosis and co-morbidity
  • A "4 equation model"
  • Multiple therapy thresholds
  • Smoothing between thresholds

The target is to have these revisions implemented by January of 2008, which means the proposed rule will be drafted by January 2007, have a 60 day comment period, and write the final rule by July or August 2007. Stay tuned to NAHC or your state home care association for more updates on these revisions.

What are your thoughts on the proposed PPS changes? Add your comments below.

NAHC Legal Update

One of my favorite people in home care in Bill Dombi, Vice President for Law at NAHC. Bill is always on top of what's happening in our industry, and presents the latest updates from the legal front. And, he's fun and funny.

During the opening general session, Bill updated us on :

Coke vs. Long Island Home Care

This is a case where a home care aide is suing her employer over entitlement to overtime pay. The case has the potential of invalidating the "Companionship Services" exemption under Federal Law. The case is being appealed in the 2nd Circuit Court, and may well go to the U.S. Supreme Court.

Fraud And Abuse

Bill described a case in California where a company pleaded guilty of falsifying claims by having people sitting in a room creating paperwork to document home care visits and episodes that never took place. They entered a guilty plea and already $33 million has been recovered. Several physicians are being investigated and could be indicted.

We all need to be concerned about unsavory characters entering our home care community and giving all of us a bad name with CMS, the OIG, and the citizens of our communities.

Price Waterhouse Coopers Study

Bill described a study that is being conducted for NAHC by PwC to evaluate the methods being used by MedPAC, the Medicare Payment Advisory Committee, to assess the financial health of home care companies by using national margins. The early findings suggest that the methodology being used by MedPAC do not accurately portray the true financial health of our industry.

Bill also introduced the new Deputy Director for the Center for Home Care Law, Denise Bonn.

What do you think about these legal issues? What are your concerns about reimbursement and regulatory issues? Add your comments below using the "Comment" button.

Targeting the Baby Boomers: Innovative Ways to Reach Tomorrow's Private Duty Decision Makers

My NAHC experience kicked off on Sunday afternoon by moderating a panel presentation on how to communicate with Baby Boomers about Private Pay Home Care. The Panel consisted of:

  • Mike Ferris, CEO of Home Care Marketing Solutions, Chapel Hill, NC
  • Bob Roth, Managing Partner of Cypres Home Care Solutions, Phoenix, AZ
  • Pat Drea, Vice President for Operations, Visiting Angels, Haverford, PA
  • Dennis Stack, Founder of America's Life Stories, Phoenix, AZ

I began the program by giving a little background on the Baby Boomers.

Who are Baby Boomers?

  • Born between 1946 and 1964
  • 78.2 million individuals
  • 7918 will turn age 60 each day during 2006
  • They are the children of the fastest growing demographic - the over 85 group
  • They are positioned to inherit trillions of dollars over the next 10 years
  • They are the major influencers for buying Private Duty Home Care

Baby Boomers were influenced by:

  • The Viet Nam War
  • War protests
  • the Beatles
  • Motown
  • Hippies

How to reach Boomers?

1. Create innovative communication and marketing techniques

  • Radio
  • TV
  • Web Site
  • Email
  • Print media
  • Personal Notes

The key is not the techniques ... it's the implementation where innovation is key.

2. Create exceptional customer experiences.

According to Pat Drea, we need to move private duty from being a commodity to being a provider of exceptional experiences for our clients and their children.

Boomers want:

  • Quality of Life for their parent and themselves
  • Not just service, but a solution for their parent
  • Peace of Mind
  • Customized services to meet individualized needs
  • To shift from our product from a service to creating an experience

As an example of how Private Duty companies can help create experiences, Pat introduced two products to create lasting memories for clients and their families:

  • iMemories used DVD video to capture old home movie film, slides, photos, and video in a customized creative memory
  • America's Life Stories is a product that uses audio casettes and an interviewer to create an audio biography of the client for their family.

Dennis Stack presented an emotional story of his own personal experience and how he created this comapny to help Boomers capture the life story of their loved ones.

What are your thoughts about communicating with Boomers? Add your comments by clicking on the comments button below.