Wednesday, October 10, 2007

PPS - An Inside Perspective on the Data

Tuesday afternoon, I attended a session by Amanda Twiss, CEO of Outcome Concept Systems on the impact of the new PPS from a data perspective. We've been working withOCS on their Private Duty Benchmarking project, and I wanted to hear what Amanda had to say about PPS and the data.

She began by giving us an overview of the PPS changes, including a graph showing the average case weight mix for each of the last seven years. Starting at about 1.3 in 2000, Case Weights dipped during 2001, 2002, and 2003 and then trended upward beyond the starting point. This graph shows the data points that led to the concern for "Case Mix Creep" that we heard Bill Dombi talking about. CMS has written a rule that will reduce home health payments by 2.75% to account for this "creep" in case mix.

Amanda then went on to talk about the industry impact of the new PPS based on that available data and some practices that OCS has identified.

Looking at the projected case weight by agency type and translating that into dollars, she was able to project the following financial changes per episode:
  • Urban Agencies - +$28
  • Rural Agencies - -$131
  • Not For Profit - +$99
  • For Profit - -$93
  • Free Standing - -$22
  • Facility Based - +$63

The overall range of the impact will be plus or minus 5%, but there will extremes where agencies see a swing of plus or minus 30%.

Some Snappy Facts:

  • 50% of agencies will do better
  • Large, Not For Profits have the greatest magnitude of positive change
  • Organizations with the most positive change have increased management and staff stability
  • Organizations with the most positive change have disease management programs and point of care in place
  • Organizations with the mose positive change are more likely to have case management in place

The Impact on Sales & Marketing

I was very interested to hear Amanda's comments on how these changes will affect sales and marketing in successful home health care organizations. Since the beginning of PPS, we've been saying that your agency could increase its case mix weight and revenue by focusing your sales and marketing efforts. To do that, you need to understand and apply the principles that drive the PPS reimbursement system.

Amanda made several points throughout here presentation the show the increased need to focus your sales efforts:

  • One of the attributes of home health organizations with the highest profitability is that they have a formal marketing department
  • In adjusting to the new PPS, successful companies will revise their sales and marketing plans to identify what patients and referral sources to target
  • Industry leaders interviewed by OCS are planning a number of additional strategies, including changing their marketing focus.

If you would like some assistance in refocusing your sales and marketing plans and training your sales team to go after the right target patients and referral sources, give us a call at Leading Home Care at 502-339-0653, or send an email to Stephen at

Go Put Your Strengths to Work

The highlight of Tuesday's opening general session at the 2006 National Association for Home Care and Hospice annual meeting was Marcus Buckingham, author of the new book, Go Put Your Strengths to Work. Using research from the Gallup Organization and information from their famous Gallup Poll, Marcus has written two previous books. First, Break All the Rules; What theWorld's Greatest Managers Do Differently; and Now, Discover Your Strengths.

I've been a huge fan of Marcus Buckingham since my wife Elizabeth spoke at a conference with him several years ago, and came back with a signed copy of his first book. She raved about the content of his message, the eloquence of his speaking style, and the fact the he's "really good looking." I'm not sure if it was his message, his delightful British accent and humorous speaking style, or the fact that he's "really good looking," but the women ( and a guy or two) at NAHC were lined up for an hour to talk with him and get his book signed.

Here are some highlights from his speech that I think you'll find very interesting.

Marcus begins with a statement:

"Build on your strengths and manage around your weaknesses."

Most people don't believe that. The Gallup Organizations asked thousands of people in six countries this question:

"Which do you think will help you be most successful; Building on your strenghts, or fixing your weaknesses?"

In the year 2000, people said:
  • United States - Build on Strengths - 41%, Fix Weaknesses - 59%.
  • Canada - 38% - Build, 62% Fix
  • Great Britain - 38% Build, 62% Fix
  • France - 35% Build, 65% Fix
  • Japan - 24% Build, 76% Fix
  • China - 24% Build, 76% Fix

The idea in our world is that to promote excellence, we find weaknesses and try to fix them.

Buckingham says, "You don't learn about excellence by studying failures." His mission is to start a "Strengths Revolution."

Some other key points:

We live in a deeply remedial world

Women age 34 - 45 are far more remedial - 73% want to fix weaknesses

(When I heard that statistic, I thought of some home care nurses and managers I know. This point explains a lot about how they think, act, make decisions and manage. More about this later.)

You've heard the old addage spoken by corporate CEO's,

" People are our greatest asset."


"People's strengths are our greatest asset."

What % of people in your organization say they spend most of their time playing on their strenths?

A study in the U.S. showed that in 2005, the number was 17%, in 2006 it was 14%, and in 2007 it was 12%. Fewer and fewer people in the workplace say they are spending most of their time using their strengths. How about in your home care company?

The whole point of Marcus Buckingham's speech to the leaders in the home health industry gathered at NAHC is that we need to find the right people, and then we need to help them spend most of their day doing what they do best, and what they like to do.

We need to focus our attention on building their strengths.

I'd suggest you go to his web site and purchase a copy of the book, Go Put Your Strengths to Work. Begin by applying these principles to yourself. I'm working on that right now for myself.

Then examine how you can help every member of your home care team go put their strengths to work.

Tuesday, October 09, 2007

Profitable Niches in Private Duty Home Care

We had a lively group for my presentation on Profitable Niches in Private Duty Home Care yesterday at the NAHC convention in Denver.

The purpose of this presentation was to look at three niches that you focus on in order to grow your PDHC company profitably. The three niches are:

  1. Niche by Referral Source
  2. Niche by Programs & Services
  3. Niche by Geography

They key to "niching" is to gather data to know where you Private Duty business is coming from, and how much revenue is coming from each type of client or referral source.

For example, I shared a case study in which one Private Duty company got 16.25% of their referrals from hospitals, and averaged $526.25 per week in revenue per client. They received 6.88 % of their referrals from Geriatric Care Managers, and averaged $1,472 per week in revenue.

The sources of your referrals and the average amount of revenue from each client will be influenced by how you focus your marketing efforts.

Sharing this data generated many questions and much discussion during the presentation and in the hallway afterwards.

If you would like a copy of the handout from this presentation, send an email to Stephen at

To talk more about ho.w you can grow your PDHC company by focusing on "Profitable Niches," give us a call at 502-339-0653

Mary St. Pierre on PPS Revisions

Mary St. Pierre, Vice President for Regulatory Affairs, gave us a great update on some of the details of the new PPS formula and it's impact on agencies. It's pretty clear that much education will be required to help your home care team understand the implications of this new system, and how their decisions will have financial implications.

As Mary Described it, PPS will use a "four equation mode" to determine your payment for a given episode.

  • Early Episodes - first or second
  • Late Episodes - third and beyone
  • Low Therapy - 0 - 13 therapy visits
  • High Therapy - 14 or more therapy visits

There will also be a big bump in payments for episodes with more than 20 therapy visits.

The new formula for determining the payment for an episode will be based on capturing 45 clinical variables that will result in 153 Case-mix groups or HHRGs. This will be applied to five categories of episodes:

  • Early Episode ( 1-2) Low Therapy (0 - 13)
  • Early Episode (1-2) High Therapy (14 - 19)
  • Late Episode (3 +) Low Therapy (0-13)
  • Late Episode (3+) High Therapy (14 - 19)
  • All Episodes over 20 Therapy visits

The details of this revised system point to the importance of having trained, competent coders on your home care team.

Another important comment that Mary made reinforced what we always say, "What gets measured get managed." Using research results from Abt Associates, the proposed CMS rule for PPS was written using 2003 data, and the final rule was written using 2005 data.

It appears that there are problems in the some providers did not provide complete and accurate data in their reporting. Thus, the new rule was written using questionable data.

As a home health care leader, it is important for you to stress to your team the importance of capturing data accurately and completely and reporting in correctly. In my experience looking at date, it's clear that many agencies do not do a good job capturing data at intake, at the point of care, or in other transactions. Part of home health care quality is accurate data.

It's also important to participate in industry research and surveys so that we have the data to guide good decisions that will benefit our industry, our agencies, and our patients.

What do you think about the revise PPS? Give us your comments below.

Bill Dombi on the Revised PPS System

Bill Dombi, Vice President for Law at NAHC, and Mary St. Pierre, Vice President for Regulatory Affairs, give us a great update on the new PPS revisions that are taking effect in January.

Bill said a couple of things that I think are significant:

"We've only begun to introduce you to confusion today." These revisions have many confusing features, and it will take a while for us to understand the changes and their implications for our home health agencies.

And, he made it cleear:

"Don't be worried. Be Attentive.
Pay attention. Get ready.
If you survived IPS, this will be a cake walk."
Bills words confirmed for me what I had been observing all along. These changes are significant, but many people have been making much more of them that is needed. I remember being the Interim President and CEO of a $25 million home care company that lost $2.75 million in 1998. We were able to turn that ship and survive. Two years after the roll out of PPS, that agency was making more money that the hospital it is part of.

Bill did give us a "Weather Report" for the coming impact of the revised PPS based on CMS projections.

  • Voluntary non-profits (VNAs), facility based agencies, and government agencies will gain. Free standing for-profits will lose. The main reason is therapy thresholds.
  • Urban agencies ill gain slightly and rural agencies will lose.
  • Agencies in the north will gain and agencies in the South will lose. ( A friend from New Orleans leaned over to me and whispered, "We did lose the civil war, after all.")
  • Agencies in New England and Mid-Atlantic will gain and agencies in the West South Central will lose.
  • Smaller agencies are at greater risk than larger agencies.

But remember, how accurate is the weatherman in your town?

Did you hear Bills message? What do you think about the impact of the PPS revisions? Give us your comments below.

Senator Susan Collins to introduce the Home Health Care Protection ACT in the U.S. Senate

Senator Susan Collins of Maine spoke during the opening general session at the NAHC convention in Denver. A strong advocate for home health care, Senator Collins is introducing this bill to prevent drastic cuts to home care that are looming in the congress and at CMS. She was particularly critical of the U.S. House of Representatives for the approach to the SCHIP bill that President Bush recently vetoed. This bill would have taken $2.5 Billion from home care over five years to pay for SCHIP.

Senator Collins also discussed proposed CMS administrative cuts of $6 Billion over five years to account for "Case Mix Creep," the perported "gaming" of the system to increase billing by increasing the acuity level of OASIS assessments at the start of care. Rather than artificially inflating acuity, there is evidence to show that home care patients are in fact more acutely ill than when PPS started in 2000.

Senator Collins asked us to do four things to address this issue:

1. Urge your Senator to sign onto the letter to the Senate Finace Committee urging them to take issue with the CMS cuts. So far, 60 Senators have signed on. We need 67.

2. Write or call your Senators and Congressmen to support the Home Health Care Protection Act when it is introduced. Senator Collins will introduce it in the Senate, and Congressman Jim McGovern will introduce it in the House of Representatives.

3. Invite your Senator and Members of Congress to make a home visit. Senator Collins became a passionate advocate for home care after making home visits in her state.

4. Get involved personally in the political process. Go visit members. Vote. Contribute. Volunteer.

How the Age Wave will Transform Home Care

I've heard Ken Dychtwald speak several times, and I read his book, Age Wave, when it came out. For three decades, Ken has been studying, speaking, and writing about the impact of an aging population, and particularly the aging Baby Boomers.

Ken was the opening keynote speaker on Monday morning at the NAHC annual meeting in Denver. His message was more relevant and his presentation more powerful than ever before. Using stories, pictures, facts and data, he painted a clear picture of the power of the aging population and the impact it will have on all of our lives. He also created a clear focus for the influence of home health care on the healthcare system of the future.

Ken described for us "Four Powerful Engines of Change," and how these four engines will affect our future. Here are his four points, and some words of wisdom I heard in his presentation.

1. The Longevity Revolution.

"Two thirds of all people in the history of the world who have lived past age 65 are still alive today." Wow!

"With live expectancy going up 2 1/2 years each decade, the probably of people living to 85 or 105 will be commonplace."

2. From Baby Boom to Age Wave

"Demography is De$tiny." Using graphics showing the increase in the number of people in each age cohort over time, we could see clearly the proverbial "pig in the python" of the baby boomers moving through the decades.

Seeing this group of boomers coming through time, we could predict many of the things that we are experiencing in our country today. For example, When the 76 million kids born between 1946 and 1964 were groing up, why were school districts surprised when they arrived in overcrowded schools. They had 13 years to prepare for it.

Why are we so surprised that our healthcare system is overtaxed. We've had decades to prepare for it. I like what he said about the critics of our healthcare system.

"We wait for the elephant to pass, and then we shoot it in the butt with arrows. We should be digging a pit ahead of it and trapping it."

3. Transforming Adulthood.

Ken played a video clip of Billy Crystal in the movie "City Slickers" describing life. Then he described "The Linear Life Plan." Learn - Love - Work - Relax - Die.
Because of that linear plan, with work ending at age 65 and relaxation starting then, we find that longevity is the extension of old age.

In the "Cyclic Life Plan" of the future, people will learn, work, relax, learn some more, work in a different role, play differently, go back to school, work in a new calling.

He gave us Webster's definition of "retire": To diappear, to do away, to withdraw.

His new definition of "Retire": To be connected, to re-invent, freedom.

4. Searching for the Fountain of Health

This section was most powerful as he talked about the shift from acute illness to chronic disease and the impact on our health care system.

"The future of healthcare is NOT the hospital."

The future is home and community based care. We're seeing this already with the explosive growth of self-pay non-medical home care. Boomers are very clear that they fear going into a nursing home three times more than they fear dieing.

Ken's Solutions for the future of Healthcare:

1. No more political Band Aids
2. Mandate "Geriatric Competency"
3. Preventive Science
4. Re-orient to focus on the contiuum of care
5. Palliative care for end of life.

Were you there for Ken's presentation? What do you think? Give us your comments below.

Sunday, October 07, 2007

Technology and Private Duty Dominate NAHC Expo

The first evening of the NAHC convention, I begin by taking a quick walk through the exhibit hall to see what's new in our industry. Looking at the exhibit booths and talking with the exhibitors gives me a sense of the changes taking place in our industry. This is one of the ways that I track the trends.

This evening in my first quick walk through, I found two things catching my attention. First, the information system company booths are bigger and brigher than ever before. The IT companies must be doing well, and their trade show budgets are growing. And there are more software venders that ever.

Also, I noticed the increasing number of telehealth and PERS vendors.

Second, there's Private Duty. We've been on the leading Edge of Private Duty Home Care for the past five years, and I've never seen so many vendors and consultants promoting their services. I suspect some of it has to do with the start up of NAHC's Private Duty Home Care Association, and the inclusion of a Private Duty track in this conference.

(I'll be speaking tomorrow on "Profitable Niches in Private Duty Home Care." If you'd like a copy of my presentation, drop me a note. )

For more on our work with Private Duty Home Care, visit our other web site at

Congressman Jim McGovern Opens NAHC Annual Meeting

The opening keynote speaker at the 2006 annual NAHC convention in Denver was the Honorable James P. McGovern, member of the U.S. House of Representatives from Massachusetts. Representative McGovern has been a strong advocate for home care, and is introducing a new bill into the congress to protect home health care from harmful cuts in reimbursement that could devastate the industry.

Congressman McGovern made specific referrence to the huge cuts created by the Balanced Budget Act of 1997, and told us that Congress did not intend to cut the home health program to the extent that is was cut. McGovern's bill in the House will be closely related to a bill being introduced in the Senate by Senator Susan Collins of Maine. Senator Collins will be speaking tomorrow, and we'll bring you a report on her speech.

Congressman McGovern urged all NAHC members present to go directly to the internet cafe here in the convention center, and send a messasge to their congressman and senators encouraging them to support these upcoming bills to protect home health care.

NAHC Kicks Off 26th Annual Meeting In Denver

The National Association for Home Care & Hospice kicked off its 26th annual conference and expo at the Colorado Convention Center in Denver. President Val Halamandaris and Chairman Elaine Stephens welcomed members and guests to the opening general session.

Bob Fazzi of Fazzi Associates gave us a quick overview on the National Telehealth Study conducted by Fazzi, NAHC, and Philips corporation. I'll give you more details on the study in a later posting.

As always, the NAHC leadership team did a great job of giving us an update on what's going on in the industry. Here are some highlights, with more to follow:

Theresa Forster, Vice President for Policy, Yvonne Santa Anna, Director of Government Affirst for the U.S. House, and Jeff Kincheloe, Director of Government Affairs for the U.S. Senate, gave us updates on the legislative issues they are addressing. The big concerns are proposed cuts in Medicare Reimbursement. According to Jeff, if the proposed cuts are passed, by 2011 over 50% of home health agencies in the country will be losing money on their Medicare patients.

One concern had been the SCHIP program which President Bush just vetoed. It sounds like the House and Senate are working 0n a new bill that would use an increase in Cigarette taxes to fund SCHIP instead of taking money away from other healthcare providers. We'll watch to see where this goes.

Janet Neigh,Vice President for Hospice Programs, told us that there are no reimbursement cuts on the horizon for Hospice, but the sector is in the crosshairs of congress because of the rapid growth of hospice, and because of the increase in the number of Hospice patients with longer lengths of service. MEDPAC wants to gather more data from Hospices about the costs of providing care. NAHC has proposed a pilot study to determine what data to gather, and the processe by which Hospices can reasonably gather the data.

Janet also discussed a QAPI project involving a patient and family member satisfaction tool being developed in conjunction with the Yale University School of Public Health. NAHC will be collecting this satisfaction data and creating industry benchmarks.

Mary St. Pierre, Vice President of Regulatory Affairs told us that as of January 1, 2008, all home health agencies will need to be using their NPI - National Provider Identifier. Also, CMS has written regulations requiring agencies to pay a provider fee when it is necessary for the Medicare Surveyor from your state to make a re-survey visit. Ror Off-site resurvey's, the fee will be $168 for ll providers. For on-site re-survey visits, the fee will be $1613 for home health agencies, and $1736 for Hospice.

Amanda Thomas, Director of Research, introduced us to some new reasearch projects that NAHC is conducting to support our legislative work. There will also be additional research information made available to members online. I'd like to encourage all of you who are reading this to participate in research projects when requested. The more data we have available, the more we can do to influence good decisions and sound policy for home health care and hospice.

Bill Dombi, Esq, Vice President for Law, gave us updates on three major issues he's working on:

1. Oversight and Enforcement.

There are four major efforts here.

  • Home Health Agency re-enrollment in Houston and Los Angeles. Because of the huge proliferation of new agencies, CMS is going back and requiring all agencies in these two areas to go through the Medicare enrollment process again.
  • HomeHealth Outlier payments in Miami. Data from CMS shows that a huge percentage of all outlier payments made to home health agencies are made to agencies in Miami/Dade county in Florida.
  • Home Infusion demonstration project in Florida
  • Claims oversight by Program Safeguard Contractors.

2. Overtime Compensation.

NAHC filed a brief with the U.S. Supreme Court in the Long Island Home Care v. Coke case. The Court rule 9-0 in favor of Long Island Home Care, saying that home care aides are exempt from overtime under the federal companion exemption. Now, we're seeing new litigation at the state level, and the SEIU is working to change state laws on overtime.

3. Case Mix Creep

CMS is taking action to control what they are calling "Case Mix Creep", and NAHC is preparing a law suit to address the issue, contending that is not what congress intended when they wrote the current law. More on this to follow.

Stay tuned to this site as we send you continuing updates from the NAHC conference.

Friday, August 17, 2007

VNA Nazareth Home Care wins Home Care Elite honor

VNA Nazareth Home Care, a service of Jewish Hospital & St. Mary's HealthCare in Louisville, KY, has been named a 2006 HomeCare Elite provider by OCS Inc. in Seattle
HomeCare Elite is an inaugural compilation of the most successful home care providers measured by quality, improvement and financial performance.

"We applaud the success of all the providers named to the 2006 HomeCare Elite," said Bill Bassett, senior director of market strategy at OCS. "Being noted as one of the top performers in the nation in this very competitive environment shows that VNA Nazareth Home Care is dedicated to quality and performance."

At Leading Home Care, we are particulary proud of this accomplishment at VNA. As many of you know, I was on the Board of Directors of the VNA of Louisville when was merged with Jewish Hospital. Later, in 1999 and 2000, I served as interim President & CEO of the VNA during the very difficult and challenging times of IPS.

This award demonstrates that a troubled agency can in fact turn itself around and become a national leader in quality and performance AOTF --- Agency Of The Future.

I give the credit to Gerri Leppert, the new CEO of VNA. When I was the interim CEO, Gerri was Director of Home Health. She has been with the agency many years and has demonstrated the process of growing from a new front line home health nurse into a successful and significant home health leader and company CEO.

Congratulations, Gerri, to you and your team on an amazing accomplishment, and best wishes, for continued success.


Wednesday, August 08, 2007

NPDA Defines Three Levels of Caregivers for Private Duty Home Care

The National Private Duty Association, the largest free-standing national association representing non-medical home care companies has just published a white paper defining three levels of caregivers in Private Duty Home Care.

Level I - Companions and Homemakers
Level II - Personal Care Attendants
Level III - Home Health Aides and Certified Nursing Assistants

The white paper defines the Activities, Training Guidelines, and Supervision for each level of caregiver.

For copy of this white paper, visit the National Private Duty Association web site at

Tuesday, August 07, 2007

Heroes in the Home

This morning I woke up early, poured some coffee, and went to my sun porch overlooking the rose garden to read through the "Heroes in the Home" nominations. For the past five or six years, I have been a member of an advisory panel that helps select the "Heroes of the Home" for the New York State Association of Health Care Providers. The award recipients are recognized formallly at the association's annual meeting.

It rejuvenates me, and reminds me why we do this business when I read the stories of the nurses, therapists, and home health aides who serve our patients. Comments like:

  • "Last June, during the terrible flooding, ____ and her family lost their home and most of their possessions. On that day, she still went to work anyway. She knew that her patients needed care and may be suffering from the flood as well."
  • "She noticed that "J", the patient, could communicate with her eyes. The eyes would enlarge when the pain was unbearable, crinkle around the edges at a joke, and blink to say yes or no. Amazingly, no one every realized "J's" abilty to community before. Nobody ever spent enough time with her to noice."
  • "She takes Monday mornings off so she can volunteer at the local homeless shelter. During the summer, she bakes pies and fried chicken for the local firemen's blueberry pie fund raiser."
  • "Her house recently burned down to the ground with everything she owns in it. She did not miss a beat! She went to work, worked a full schedule, turned in time sheets ON TIME, and made sure she was available to assist in orienting a new aide on the case."
  • "I don't know what I'd do without _________ who gives me something to look forward to each week, and gives me goals to reach for each visit."
  • "____ is one of the most dedicated therapists who makes sure patients get whatever they need to make their lives easier and complete.
  • " _____ has seen improved outcomes in tele-monitered patients. Rates of hospital admissions and emergent care are 20 percent lest than non-monitored patients."

Who are your "Heroes in the Home." What are you doing to recognize them, and to show appreciation for all that they do.

Our research at Leading Home Care shows that employees who feel they are valued and appreciated and who are doing meaningful work have less turnover and are more likely to perform at higher levels that home care workers who do not feel appreciated and recognized.

It's amazing how a piece of paper and some applause make people feel like they are doing worthwhile work. Show your home care team members that they are appreciated!

Saturday, July 21, 2007

Walgreen expands Home Care business with acquisitin of Option Care

Walgreen, the huge drug store company, has expanded its role in the home care marketplace with the acquisition of Option Care.

Option Care is a national provider of specialty pharmacy and home infusion services. Through its pharmacy services, it provides medications and treatments for patients suffering from complex diseases, including cancer and multiple sclerosis. It also provides therapy for patients requiring intravenous medication or nutrition.

This latest move greatly expands Walgreen's existing specialty pharmacy business, adding 100 locations to its current 45 home-care facilities. Option Care has the largest geographic coverage in the industry with 400 managed care organizations. Furthermore, through Option Care, Walgreen gains access to medications that currently have limited distribution, giving customers a reason to choose its drugstore over the competition.

CMS Targets Houston and Los Angeles for Medicare Fraud Focus

Top officials with the Centers for Medicare and Medicaid Services said this week that the federal government is targeting Houston and Los Angeles because of suspected problems in both cities.

"We want to make sure the good operators are allowed to continue to operate and provide good, quality services," said acting Medicare administrator Herb Kuhn. "But we want to get those that are committing fraud out of the program."

Kuhn said Houston has been targeted, in part, because of the staggering growth of home health care agencies. Between October 2002 and May 2007, the number in Harris County increased from 151 to 403.

What do you think about his issue?

You may recall that I began projecting in about 2002 that the home health industry had about seven years of uninterrupted growth and financial prosperity before we see CMS pulling in the reigns again. That's been the pattern. Well, we're coming up on seven years since PPS went into effect in October of 2000.

There are two trends that you want to watch. Once is the proposed revision to PPS. The other is the rapidly growing number of home health agencies. Remember that growth in the number of home health agencies in the 1990's was one of the triggers that led to severe cuts in home helath spending under the balanced budget act of 1997. Over 25% of Medicare Certified Home Health Agencies were closed between October of 1997 and October of 2000.

Some folks suggested that Medicare purposely imposed severe cuts in order to drive agencies out of business. I won't go that far, but I do see the rapdily growing number of agencies as a trend that we need to watch. Not only does it increase competition in your marketplace, but it opens up the potential for fraud and abuse, and another industry-wide crack down.

Let us know if you see other examples of this trend.

PA Governor Signs Law Allowing Nurse Practitioners to Order Home Health Services

On Friday, July 20, 2007, Governor Ed Rendell of Pennsylvania signed into law a bill allowing Nurse Practitioners to sign certain orders that previously were limited to physicians.

Nurse Practitioners in Pennsylvania are now permitted to perform some duties only doctors had been allowed to do, such as ordering medical equipment, home health and hospice care; making therapy and dietitian referrals; and issuing homebound schooling certifications. The expanded responsibilities apply only to registered nurses with specialized training and advanced degrees.

Tine Hansen-Turton, head of the Philadelphia-based National Nursing Centers Consortium, said "Nurse practitioners are the cure for an ailing U.S. health system faced with a growing number of patients and a looming shortage of general doctors, especially ones willing to treat poor patients."

What do you think? How will the growth of Nurse Practitioners affect the future of home care? Post your comments below.

Ohio Governor Signs Order Granting Collecting Bargaining Rights to Independent Home Care Workers

We told your earlier about how the Service Employees International Union has aimed their sights on organizing home health care workers. Here's another example:

COLUMBUS — Gov. Ted Strickland signed an executive order Tuesday that gives collective bargaining rights to about 7,000 independent home health care workers and said he'll soon sign a similar order for child care workers.

Senate President Bill Harris, R-Ashland, called it a huge step backward. He said, "Collective bargaining will drive up costs and decrease the state's buying power without any tangible proof that quality will be improved for those served."

Before the close of business, a union — SEIU 1199 — had requested the list of health care workers from the state and announced plans to organize them.

"We are the health care workers' union. We absolutely understand the issues of the long-term care workers," said Service Employees International Union 1199 Executive Vice President Becky Williams. "We have talked to this group for some time."

The order covers about 2,000 nurses and 5,000 direct care aides who are independent contractors not employed by the state or home health care agencies. They provide services to elderly or disabled patients and are paid through Medicaid, the state and federally funded health care program.

What do you think about his issue? Post your comments below.

If you have other examples of union activity in home care, let us know.

Mayo Clinic Offers Home Care Advice

The highly respected and world renown Mayo Clinic is a supporter of home health care services. They recently posted a page on their web site offering advice to consumers on how to choose the best provider of home care services.

Here's a link to the site: May Clinic Home Care

One thing you may want to consider is posting a link to this site on your web site. Linking back to Mayo Clinic gives your patients and referral sources an objective source of information.

You can also use this in your home care sales efforts. Have your sales representatives encourage referral sources to visit the Mayo Clinic site.

All of this presumes that your agency is the one that patients or referral sources would choose after following the Mayo Clinic's advice.

Monday, July 16, 2007

Another look at the Uninsured in America

A friend sent me a link to a web site with a video giving some facts about the 44 million uninsured people in America. I found it interesting and thought you might like to see it as well.

Take a look at .

Click on the play button below the video window to play the video.

What do you think? Comment below.

I think this is an interesting perspective and one that causes us to look more closely at the cost of healthcare insurance in America and why is costs so much. It affects us because so many of the uninsured working poor are home care aides and non-medical caregivers. We'd find it much easier to recruit and hire home care aides and caregivers if we were able to find an affordable solution for health insurance.

I've been watching the developments in Massachusetts, where the state legislature passed a law requiring all residents to have health insurance, and requiring all employers to provide health insurance or pay into a state fund. It's still pretty early in the implementation of this law, so we don't yet know the outcome.

Do we have any readers from Massachusetts who can give us a perspective on this new law? Comment below.

Thursday, July 05, 2007

SEIU Launches National Health Care Union to Transform Healthcare in America

The Service Employees International Union's recently launched a 1-million-member health care union and will have an annual budget of about $120 million and 4,000 organizers at its disposal to sign up the 10 million unorganized non-supervisory health care workers, according to union organizers.

The "bulk of the work" of the new union will be in organizing. Organizers expect to add 80,000 to 100,000 new members to the union's rolls in the next year. “If we grow, we have more influence," and are able to improve the lives of members and patients, organizers stated.
There are “several initiatives” that include drives among national hospital and nursing home chains, Catholic institutions, investor-owned hospitals and nursing homes, and teaching hospitals. In addition, the union is organizing some 35,000 home care workers in various states including Ohio, Indiana, Massachusetts, New Jersey and Pennsylvania.

For more information, visit their new web site.


What's your experience with the SEIU? Do you have any of your home care employees who are members of this union? What has the impact been?

What's your view on how open home care workers are to being organized by this new healthcare union? Please give us your comments below.

Friday, June 29, 2007

How's Your Quality . . . compared to the industry?

Our friend Bob Fazzi and his team just released their chart showing the national Home Health Compare scores for June, 2007, and their estimate of the 80th Percentile scores.

How are you doing compared to these national numbers?

We have heard some interesting debate about the value of using Home Health Compare scores as a source of competitive advantage when selling your home care services to physicians. One viewpoint is that having the data to support your message about quailty of care can be persuasive. The other viewpoint that we have heard from physicians is that they don't trust the data, they think agencies can game the system, and that it's not a good measure of home health quality.

What do you think? Do you have any evidence that physicians or hospital discharge planners pay attention to your Home Health Compare scores?

Give us your comments below.

Wednesday, June 27, 2007

Canadian Home Care Association to Advance Information Technology Agenda in Home Care

OTTAWA, June 26 /CNW Telbec/ - The Canadian Home Care Association (CHCA) has entered into a partnership with Canada Health Infoway to lead a national project on technology in home care. The project - Integration through Information Communication Technology in Home Care in Canada - will begin immediately and will result in a better understanding for the potential of and readiness for information communication technology (ICT) in the home care
sector across Canada.

The Project will support the CHCA's goal of building a national knowledge base on technology in the home and community sector and exploring challenges and opportunities for current and future applications.

"As Canada's population continues to age and grow, Canadians will increasingly rely on home care services to meet their health care needs," said Richard Alvarez, President and CEO of Canada Health Infoway, a federally funded not-for-profit organization which invests with public sector partners to accelerate electronic health records across Canada. "Our ultimate objective through this investment is to help increase access to home care by fostering more efficient ways to deliver care through technology."

Key components of the project include surveying home care experts across Canada, hosting a pan-Canadian roundtable and sharing knowledge at a special workshop at the CHCA's Home Care Summit in December.

Tuesday, June 26, 2007

What do you think about "Sicko?"

Michael Moore's new film, "Sicko" comes out this week. Filled with specific examples of how individuals have been deprived of health care services because of their lack of insurance coverage, or attempts by insurers to deny claims, the film makes its points with great emotion.

What is your take on "Sicko?" Is our healthcare system really as bad as Michael Moore protrays it to be? Is the insurance industry really the problem?

What would health care in America look like if Moore's prescription were followed? What is your personal experience with national health care systems in other countries such as Canada, Great Britain, France, or Greece? Would you perfer a nationalized health care system like some of these other countries? How would you like the healthcare system of Cuba ... and their lifestyle to go with it?

What would be the implication for home care if we were to adopt a nationalized health care system?

Add your comments below. We'd love to hear your perspective.

Family Caregiving Costs Employers $33 Billion Annually

WASHINGTON, June 25 (UPI) -- At-home caregiving costs U.S. businesses up to $33 billion yearly in lost productivity as caregivers take time off from work, AARP said Monday.
For caregivers with the most intense responsibility, 92 percent said they have had to make major changes to their working patterns; 83 percent report arriving late to their jobs, leaving early or taking time off during the day; 41 percent say they had to take a leave of absence; and 37 percent report having to pare down their jobs to part-time to accommodate their care-related duties.

Moreover, the caregiver's own health is often at risk, the survey also suggested.
Against that backdrop, the study also found that informal caregivers' contribution had an economic value last year of $350 billion.

Source: AARP

As leaders in home health care, this information suggests that we need to let more of the major employers in our communities know about the benefits of home health care. One of our home health care clients actually has a home care service that they sell to employers, that will provide non-medical caregivers, or nurses if needed, to care for an elderly person so their son or daughter can go to work as planned.

Employers find that making this investment in home care services for their employees more than pays for itself in savings from lost productivity, tardiness, or absenteeism of valued employees.

What success are you having with employers in your community to provide home care support to their employees? Let us know by adding your comments below.

Home Care on top of the list of Top Twelve Jobs for growth in U.S.

A recent report by the U.S. Department of Labor reinforces our projection that home care related jobs will continue to be in great demand, and that recruiting and retention will be the major strategic issues facing home care executives who want to grow their businesses.

If you want to grow your business, you need to get better at recruiting and retention.

Here are the Top Twelve Jobs for Growth between 2004 and 2014 on the Labor Departments list:

  1. Retail Sales - need 736,000 or 17.3% growth
  2. Registered nurses - need 703,000 or 29.4% growth
  3. College teachers - need 524,000 or 32.2% growth
  4. Customer Service Representives - need 471,000 or 22.8% growth
  5. Janitors - need 440,000 or 18.5% growth
  6. Waiters and Waitresses - need 376,000 or 16.7% growth
  7. Food Service Workers - need 367,000 or 17.1% growth
  8. Home Health Aides - need 350,000 or 56% growth
  9. Nursing aides, orderlies, attendants - need 325,000 or 22.3% growth
  10. General and operations managers - need 308,000 or 17% growth
  11. Personal and Home Care Aides - need 287,000 or 41% growth
  12. Grade school teachers - need 265,000 or 41% growth

As you can see, the two fastest growing occupation by % are Home Health Aides at 56% and Personal and Home care aides at 41%.

For information on how Leading Home Care can help you develop your recruiting and retention plan, vist our web site.

Friday, June 08, 2007

60% of Certified Home Health Agencies are participating in the 2007 Home Health Quality Improvement National Campaign

BALTIMORE, June 5 /PRNewswire-USNewswire/ -- In less than four months, 5,000 home health agencies have signed up to participate in the 2007 Home Health Quality Improvement (HHQI) National Campaign. This represents more than 60 percent of all Medicare-certified home health agencies in the country.

The Centers for Medicare & Medicaid Services (CMS) and Quality Insights of Pennsylvania, the Home Health Quality Improvement Organization Support Center (HHQIOSC), launched the HHQI National Campaign at CMS headquarters in Baltimore, Maryland on January 11, 2007. Since the launch, CMS, national stakeholders and individual Quality Improvement Organizations (QIOs) have worked closely to implement an extensive educational campaign aimed at reducing avoidable acute care hospitalizations in the home health setting. The purpose of this unified effort is to assist patients with remaining in their homes when it is appropriate, increase patient satisfaction, improve quality, and reduce health care costs.

The Home Health Quality Improvement National Campaign was founded by key home health stakeholders: National Association for Home Care and Hospice; American Association for Homecare; Visiting Nurse Association of America; American Telemedicine Association; Hospice and Palliative Nurses Association; Care Transitions Program, University of Colorado Health Sciences Center; American Occupational Therapy Association; American Physical Therapy Association; American Speech-Language-Hearing Association; Gentiva Health Services; Visiting Nurse Service of New York, Center for Home Care Policy and Research, Centers for Medicare & Medicaid Services (CMS) and its contractors, the Quality Improvement Organizations (QIOs); and The Remington Report.

Thursday, June 07, 2007

Is a little healthcare coverage better than none?

The June 6, 2007 issue of USA TODAY has a cover story entitled, "Is a little medical coverage that much better than none?" It presents the case of several people who had health care insurance provided by their employers that had limited coverage and maximum amounts for various conditions . . . called "Limited Benefits Plans." These people were surprised when they had a medical condition and went for treatment. They then discovered the limits in their coverage.

This raises three big questions for home care leaders.

1) Is a little coverage better than none?

Many of the home health agencies and private duty companies we work with are struggling with this issue of how to provide healthcare coverage for their employees. Our research shows that this is one of the most sought-after benefits of healthcare workers.

Yet, when limited benefit plans are offered, or when plans are offered in which the employee must pay part of the premium, few employees take advantage of the benefit.

2) Whose responsiblity is it to understand the healthcare insurance plan.

The cases presented in the article described people who learned about the limits of their healthcare plans only after they sought treatment. It seems to me that employees have some responsiblity to learn about the benefits included in their health plan, and not to assume that everything will be covered.

Part of the problem with the cost of healthcare insurance in America today is that many workers believe that their healthcare costs should be covered in full by their employers, and that they should be entitled to the best care money can provide without having to pay for any of it. Consequently, healthcare is one of the few areas where we insure frequently recurring, relatively low cost services such as doctors visits, prescription drugs, and medical supplies.

Your home owners insurance doesn't cover your electric bill, plumbing repairs, and outside painting. Your car insurance doesn't cover oil changes, new tires, and a brake job.

3) How do we deal with patients who find out that their insurance doesn't provide the coverage they thought it did?

What do you do when you provide care for a patient and later find out that they have limited benefit coverage and your services are not covered? Do you bill the patient? How to you collect for your services?

As home health care in America continues as the fastest growing segment of healthcare, our need for employees will continue to grow, and our need for effective healthcare insurance programs will continue to grow.

As leaders, we need to be more aware of what's happening in the insurance industry.

What do you think? What's your experience? Give us your comments below.

Friday, May 11, 2007

Home Care Contributes to ResCare Profit Growth

LOUISVILLE, Ky. — Res-Care Inc. is reaffirming a full-year profit outlook between $1.24 and $1.28 per share on projected revenue of $1.43 billion. In 2006, the company earned $1.11 per share on revenue of $1.3 billion.

Chief Executive Ralph Gronefeld said the company's recent acquisition of Kelly Home Care Services bodes well for the company's future earnings. "We expect that home care will continue to be a rapidly growing sector as demand increases with the aging of the American population."


Blogger's note: Res-Care has become the largest consolidator of private duty home care companies in the country. Their Kelly acquisition is just the most recent in a series of purchases of non-medical home care companies. While the Private Duty Home Care sector remains highly fragmented, there are a few companies like Res-Care who are purchasing companies and growing their "company owned" locations.

Home Care responds to Tornado Disaster in Kansas

Via Christi Home Care has a collection drive under way for patients and families affected by Friday's tornado in Greensburg.

The unit of Via Christi Wichita Health Network said it and its staff have donated and purchased personal care items for Greensburg residents and are opening the drive to all of the network's employees, including at the St. Francis, St. Joseph, Good Shepherd and Our Lady of Lourdes campuses.

Via Christi Home Care said it had approximately 40 home care patients in Greensburg. On Saturday morning, its staff in Hays and Dodge City worked to locate its Greensburg patients and provide them home medical equipment and oxygen.

Thursday, April 26, 2007

Most Doctors get money or gifts from healthcare companies

Ninety four percent of physicians in a recent survey reported accepting money or gifts from companies providing drugs, medical equipment, supplies, or other healthcare services. The study, reported in the New England Journal of Medicine was based on a national study of the relationships between physicians and suppliers to the healthcare industry.

The study surveyed 3167 physicians in six speciaties: anthesiology, cardiology, family practice, general surgery, internal medicine, and pediatrics. Here's a breakdown of what they accepted and how many:

  • Food or drinks in the workplace - 83%
  • Drug samples - 78%
  • Payments for consulting - 18%
  • Payments for speaking - 16%
  • Reimbursements for meeting expenses - 15%
  • Tickets to cultural or sporting events - 7%

source: New England Journal of Medicine

This data comes as no surprise to home care marketers. All of us have heard the phrase, "The doctor only sees sales reps who bring lunch."

Do you know that it is a violation of federal antikickback laws for the staff in a doctors office to request that you bring lunch in order to see the doctor if the purpose of the visit is to solicit Medicare or Medicaid patient referrals.

The OIG has ruled that small, non-cash gifts that total less than $326.00 per year may be acceptable to build relationships with physicians for educational purposes. However, it is our understanding that when a doctors office solicits gifts of any amount, that violates the law.

What's your view of this subject? How frequently are your sales reps solicited for meals or gifts in exchange for access to the doctor? What do you do to get around this sticky issue?

Give us your comments by clicking on the comment button below:

Thursday, April 12, 2007

Another New Online Referral Service for Home Health Agencies

LOS ANGELES, CA, April 9, 2007 – Today, HomeCare Referral introduces to the public the HCR Preferred Providers Network, a gateway to the leading home care service providers across the United States. Providers can now be contacted directly by potential clients through a subscription-based listing in the Network. There are no lead fees and no referral fees - only heightened online exposure at

Large For-profit Home Health Companies Explore Lobbying Options

Several large, for-profit home-health-services companies are considering joining forces to found a new lobbying entity after their trade association decided to stop representing them. Some of these firms may create a coalition separate from the industry’s leading trade association, an executive at one of the companies said.

Todd Brason, president and CEO of Buffalo, N.Y.-based WillCare, said that his company and others have talked about forming a coalition to represent their interests. But he emphasized that they are not contemplating founding a new trade association.

“We’ve had some conversations” in recent weeks, Brason said, adding the companies have not taken any formal steps to create an alliance. WillCare and other firms are weighing their options in response to the February decision by the American Association for Homecare (AAHomecare) to focus on the home-oxygen suppliers and other durable-medical-equipment companies that make up the bulk of its membership.

This change in strategy left out the group’s home-health members. Oxygen-supply companies had been agitating for a stronger lobbying presence, which instigated the shift at AAHomecare. In 2006, 11 members of the association formed a coalition called the Council for Quality Respiratory Care to advocate for their sector, which has been targeted for spending cuts under Medicare. The oxygen industry’s approach could serve as a model for large, for-profit home-health companies, Brason said.

Meanwhile, the National Association for Home Care and Hospice (NAHC), the main trade group for the home-health industry, may not benefit from the void created by the changes at AAHomecare. Brason said he was “kind of in the middle stage of considering NAHC.” But he emphasized that WillCare and other companies have concerns about the association’s priorities and its approach to lobbying.

NAHC “rides the fence a little bit,” Brason said, because its diverse membership includes both for-profit and not-for-profit companies and ranges from small businesses to large, publicly traded firms.

The NAHC is also not as aggressive in promoting the industry’s agenda as some companies would like, Brason said. “We feel it’s necessary to be more proactive than reactive,” Brason said, adding, “It’s time to move the industry up the food chain, so to speak.”

The chief executive of another large, for-profit home-health company agreed that the NAHC’s focus on the needs of smaller home-health agencies has led bigger firms to consider embarking on their own venture but expressed satisfaction with the existing association. “I think NAHC does a good job,” said David Geller, president and CEO of King of Prussia, Pa.-based Home Health Corporation of America. Home Health Corp. is an NAHC member.

The NAHC has concentrated on fighting proposed freezes or cuts in Medicare payments to home-health providers. But Brason indicated that other issues have become more important to his company. Specifically, firms such as WillCare are trying to adjust to the increasing role of private managed-care health-insurance companies in both the Medicare and Medicaid programs.“That’s our biggest headache right now,” he said.


What's your take on this issue? Do you feel well represented in Washington by NAHC? What are the issues you feel need to be addresses?

What's your take on AAHomecare? Are you a member? If so, how come? If not, why not?

Saturday, April 07, 2007

U.S. Supreme Court to hear Home Care Overtime Case

Coverage & Access SCOTUS To Hear Case on Home Care Workers' Wages, Overtime
[Mar 27, 2007]

The Supreme Court on April 16 plans to hear oral arguments in a case that could determine whether federal minimum wage and overtime laws apply to home care workers. In the case, Evelyn Coke, a 73-year-old immigrant from Jamaica, filed a lawsuit against New York-based Long Island Care at Home to challenge regulations that exempt home care workers from the laws.

The Supreme Court agreed to hear the case after the U.S. 2nd Circuit Court of Appeals overturned the regulations, which the court said conflicted with the congressional intent. Congress in 1974 amended the Fair Labor Standards Act to extend federal minimum wage and overtime laws to household workers but exempted baby sitters and "companions" for the elderly and those with illnesses. In 1975, DOL proposed regulations to implement the revisions to the law that exempted home care workers. In a brief, Long Island Care argued that the regulations were consistent with congressional intent because some lawmakers had raised concerns about the need to reduce costs.

Thursday, April 05, 2007

Canada home care spending reaches $3.4 billion

Canadian Government spending on home care grew from $1.6 billion in 1994–1995 to $3.4 billion in 2003–2004, an average annual growth of 9.2%, according to a new report from the Canadian Institute for Health Information (CIHI).

In comparison, over the same time period, total government health spending increased by an average of 5.7% per year. Public-Sector Expenditures and Utilization of Home Care Services in Canada: Exploring the Data is CIHI’s first comprehensive report on public-sector spending on home care services—a combination of health care and support services provided in the home instead of in an institutional setting. Between 1994–1995 and 2003–2004, government home care spending per person increased on average by 6.1% per year after adjusting for inflation, while total government health spending per person increased by 2.7% per year.

Home care spending represented 4.0% of total government health spending in 2003–2004.The number of patients using government-subsidized home care increased from 23.9 per 1,000 in 1994–1995 to 26.1 per 1,000 in 2003–2004, representing an average annual increase of 1.0%. Over the study period, spending on home care increased faster than the number of patients did, suggesting that in general, home care users each consumed more resources in 2003 than they did a decade previously.

Care Pilot announces first vertical search engine for Home Health Agencies

For Home Health Agencies:

With eight in ten Internet users, or more than 110 million adults, going online for health information, CarePilot represents a new way for individuals to connect with local health services. Just as "Baby Boomers" have used the Internet to manage their communication, financial, shopping, entertainment, and travel-related activities, CarePilot believes that they will also turn to the Internet to research, select, and connect with home health providers.

Home health agencies are invited to create accounts and update their profiles on Agencies can create "Enhanced Listings" with personalized descriptions of their services and secure prominent placement within CarePilot's search results. CarePilot's "Patient Access Program" allows agencies to safely and securely receive detailed patient requests online and communicate with caretakers.

"CarePilot is an excellent resource for individuals as they begin to research their home health options," said Steven Nerayoff, President of New Jersey-based Freedom Eldercare, one of the largest private comprehensive geriatric care companies in the country. "By delivering relevant information in a user-friendly manner, CarePilot will help people make more informed decisions regarding home care."

For more information, visit