Thursday, November 29, 2012

Predictive Modeling Software Helps Home Health Agency Decrease 30-day Hospital Readmissions by 35.9%

DAYTON, Ohio, Nov. 13, 2012 – Alternate Solutions HomeCare (ASH) directors reported a 35.9 percent average rate decrease in 30-day hospital readmissions from the third quarter of 2011 to the third quarter three of 2012. One factor directors at ASH attribute the dramatic decrease to, is the use of Medalogix predictive modeling software, which has enabled them to specify and streamline appropriate clinical interventions. 

“Medalogix analyzes existing patient data to pinpoint the top 10 percent of patients most at risk of readmission, so we know on an daily basis where to focus our clinical resources most heavily,” said Chad Creech, ASH chief development officer. “It’s a reality that warning signs can be missed by clinicians during weekly visits. Medalogix’s monitoring safeguards and helps us better care for our patients.”

Medalogix compiles existing clinical data that ASH already generates, like OASIS-C and patient records, and then utilizes a predictive algorithm optimized especially for Alternate Solutions. Clinicians then log into a clinical portal that is updated with new patient data and risk rankings every hour. These risk rankings detail which patients are most at risk, why they are at risk and what clinicians can do to successfully intervene. The system is designed to prevent trips to the Emergency Room and readmissions to hospitals.

“The information given to us by Medalogix each day allows us to look at patients differently,” said Tessie Ganzsarto, ASH president. “To know that much about your patients and their critical areas in near real-time allows us to be proactive and react much faster than we could in the past.”
Considering the Affordable Care Act (ACA) provision that grants Medicare the ability to withhold payment form hospitals if a patient is readmitted within 30 days, ASH’s 35.9 percent average rate decrease in 30-day readmissions is a critical advantage as agencies vie for patient referrals from hospitals who are acutely aware of the need to reduce their readmissions in order to avoid substantial penalties and fines. A few notable benchmarks detailing ASH’s readmission rates since partnering with Medalogix:
  •      Doubled ASH’s identification of at risk patients.
  •      Decreased ASH’s 7-day readmission rate by 50 percent in the first month of deployment.
  •      Drove ASH’s June, July and August readmissions rates 3 percentage points below the national average.
“Lowering readmissions is key to providing the best care possible to our patients and serving our hospital partners under pay for performance standards,” said Creech. “It’s been a major area of focus and the most recent data demonstrates our efforts are working.”

“Keeping patients healthy, at home and avoiding costly and unnecessary hospital readmissions to the hospital is our primary concern,” said Lisa Morrison, ACH chief clinical officer. “It’s been a combined and strategic effort that has helped us significantly reduce readmissions.”

ASH is employing several strategies to reduce readmissions and is more precisely targeting these interventions using Medalogix Risk Rankings. A few examples of these strategic patient interventions are:

  • Structuring staff bonuses around successfully lowering readmissions
  • Revitalizing patient treatment plans based on best practice standards
  • Implementing telephonic phone calls to at risk patients

“My motivation in developing Medalogix was to keep patients out of the hospital while simultaneously helping hospitals adjust to reform,” said Dan Hogan, Medalogix CEO. “These most recent readmission figures are encouraging as they show the plan is working.”


About Alternate Solutions Healthcare System: Founded in 1999 by Tessie and David Ganzsarto, Alternate Solutions is recognized as an industry leader in post-acute strategic partnerships. It has strategic partnerships with health care systems in Ohio, Illinois, Wisconsin and West Virginia, and is in conversation with several groups throughout the country to form more. Alternate Solutions has received numerous awards and recognitions for excellence its fields, including being ranked by HomeCare Elite™ in the top 1 percent of home health care agencies in the United States. The award is based upon an analysis of performance measures in quality of care, quality improvement and financial performance.

About Medalogix: Medalogix was formed out of the idea that homebound patients would benefit from a more in-depth analysis of the risks associated with their medications, and that home care agencies, when armed with that analysis, would be better able to remediate that risk.  A litany of studies has shown that patient outcomes are far better the longer a patient can remain in the home.  It is Medalogix’s goal to assist home care agencies with the process of identifying those patients on their census that are most at risk of requiring unplanned hospital care.  The company combines its knowledge of medication risk with a home health are agency’s own clinical data to build a predictive modeling capability that is more accurate than any other risk assessment toolset on the market today.

Marketing to Assisted Living Facilities without Violating Anti-kickback Laws

Part 2: Utilization of Post-Acute Services by Residents of Assisted Living Facilities (ALF’s): Renting Space

Elizabeth E. Hogue, Esq.
Office: 877-871-4062
Fax: 877-871-9739
Twitter: @HogueHomeCare

As the number of years in which they have been in business increases, ALF’s are more eager to help their residents “age in place.”  ALF’s often view availability of services from post-acute providers; including Medicare home care, private duty home care, hospice, and home medical equipment (HME); as essential to allow them to achieve this goal.  While ALF’s want to encourage utilization of these types of services by residents, ALF’s cannot lose sight of the fact that the healthcare industry is highly regulated.  With ever-increasing emphasis on fraud and abuse compliance, ALF’s and post-acute providers cannot afford to violate the law.  How can ALF’s encourage the use of services available from post-acute providers by residents?  What are the potential legal pitfalls that ALF’s and post-acute providers must avoid?

A key legal pitfall for arrangements between ALF’s and post-acute providers includes violations of the federal anti-kickback statute.  This statute provides, in part, as follows:

(1) Whoever knowingly and willfully solicits or receives any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind--

(A)  in return for referring an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part under this subchapter, or

(B)  in return for purchasing, leasing, ordering, or arranging for or recommending purchasing, leasing, or ordering any good, facility, service, or item for which payment may be made in whole or in part under this subchapter,

shall be guilty of a felony and upon conviction thereof, shall be fined not more than $25,000 or imprisoned for not more than five years, or both.

(2) Whoever knowingly and willfully offers or pays any remuneration (including kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind to any person to induce such person

(A)  to refer an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part under this subchapter, or

(B) to purchase, lease, order, or arrange for or recommend purchasing, leasing, or ordering any good, facility, service, or item for which payment may be made in whole or in part under this subchapter,

shall be fined not more than $25,000 or imprisoned for not more than five years, or both..."

A kickback occurs when a provider makes referrals to another provider and then something flows back from the provider that receives referrals to the provider that makes referrals.  The application of this statute to arrangements in which post-acute provider receive referrals from ALF’s is clear.  ALF’s make referrals to post-acute providers.  If something flows back from post-acute providers to ALF’s, there may be an impermissible kickback.  An example of such a potential kickback occurs when post-acute providers rent space from ALF’s from which they received referrals.

There are, however, a number of exceptions or “safe harbors” to the above statute.  The next article in this series will focus on how ALF’s can meet the requirements of the space rental safe harbor so that post-acute providers can rent space from ALF’s in order to enhance the provision of services to residents.

©2012 Elizabeth E. Hogue, Esq.  All rights reserved.

Reprinted with Permission.  

No portion of this material may be reproduced in any form without the advance written permission of the author.

Tuesday, November 27, 2012

Palliative Care Today: Impacting quality of life in home health care hospice

By Chris Willis, MSW, LSW
OneOnOne Hospice Solutions

One of the fastest growing home health care programs in our country is Palliative Care.  Hospitals, home health agencies, hospices, and long term care organizations are starting Palliative Care programs.  This trend is demonstrated as the National Hospice Organization, which was formed in 1978, changed its name to National Hospice and Palliative Care Organization in 2000. 

There seems to be some confusion as to ‘what is palliative care?’ Whether seeking the answer from the many resources in the medical and care communities on online with the internet, each source states it a little differently.  

NHCPO  defines Palliative Care as “treatment that enhances comfort and improves the quality of an individual’s life during the last phase of life.”

In the 12 ½ years spent with one of the premier hospices in the state of Arizona, I have come to define palliative care as “a service that provides patient driven care to individuals diagnosed with a serious, chronic or terminal condition.” This definition grew from our experiences with patients who were seeking care that would assist and empower them in a manner and route that was specific to them. Today, more home health and hospice agencies are creating palliative care services and programs within their current care offerings to ensure that no one is left without the services they need. This type of care benefits the patient as well as your agency by providing a unique supportive angle that offers a follow-up opportunity which improves conversion rates.

As the director of a hospice Palliative Care Program, explaining palliative care was a frequent occurrence. These discussions were not just with patients and their support systems, but also with countless medical professionals who were seeking and learning more about how our services were supporting their patients’ needs. Palliative care affords an agency the opportunity to truly honor the comfort approach “the patient way” by supporting them on their life journey. Also, palliative care bridges the gap by allowing you to bill for your services if deemed medically necessary, regardless if a patient is eligible to utilize their hospice or home health benefit.

A Palliative Care Program gives your agency the ability to provide bio-psycho-social support, knowledge and resources to an individual and their support system by a designated team of professionals, as defined by your agency and license(s). For the patient and their support system utilizing a palliative care program, it assures them that they have others to accompany them on their life path, to keep them informed of what to expect, and to prepare and support them with open and honest discussions about their disease process. Whether seeking aggressive or comfort care, or both, the patient has the ability to choose. For an agency with a complete palliative care program, it reinforces their company’s commitment to providing “comfort as the patient defines it,” while leveraging themselves with their community partners.

OneOnOne Hospice Solutions was created so that we may assist, empower, and strengthen agencies and their teams as they define their individual palliative care programs.  Through our experience we have learned that you need these four key components to create a successful Palliative Care Program:

1.       A tracking system enhanced by an agency’s current intake system to ensure that “no one is left behind.” This includes policies and procedures, intake system analysis and needs assessment tools to differentiate services offered by an agency,
2.       A marketing toolbox specific to your service area, which includes internal and external needs, assessment tools, market trends, referral and intake forms, policies and procedures and more,
3.       A commitment for side-by-side support from creation to launch by a trained palliative care professional to agency leaders and team members; and finally,
4.       A community partnership initiative derived from key influencers in the service area to ensure the delivery of complete and seamless compassionate care to patients and their support systems.

Palliative care is an ever-growing and changing service that reflects the needs of patients and their support systems. Although relatively new, a comprehensive palliative care program should be seriously considered by every home health care and hospice company as a way to care for their communities in the future and differentiate their service offerings.

About the Author: Chris Willis, MSW, LSW is a social worker, educator, marketer and leader with over 20 years of Healthcare experience, Chris’ extensive knowledge in elder care has built her expertise in providing resources and solutions that meet individual needs. Chris recently joined the OneOnOne HomeCare Solutions team through the newly-formed OneOnOne Hospice Solutions Division, designed to assist individuals and agencies to enhance hospice and palliative care services. She is a proud graduate of The Ohio State University.

Wednesday, November 14, 2012

Retain Your Records for Ten Years

The Medicare Conditions of Participation require home health agencies to retain their records for five (5) years after the month the cost report to which the records apply is filed.  Our friends at Boyd & Nicholas, The Cost Report People (R), tell us that the Accountable Care Act has new provisions that extend that. 
The ACA added a new record retention requirement to maintain for seven (7) years from the date of service ordering and certifying documentation for home health. That documentation includes written and electronic documents relating to written orders and certifications and requests for payments for home health services, which is a large part of the record.
We recommend that agencies retain records for 10 years since that is how far back the federal government can go to look for false claims filings.

Saturday, November 10, 2012

How Are Medicare Cuts Affecting Your Agency?

By Stephen Tweed

Last week I was speaking at the NAHC annual conference in Orlando on the subject of "Serving More Patients."  We had a terrific audience and engaged in some great conversations.

One of the questions I was asking home health agency leaders as well as some of our colleagues who provide financial services for home health agencies is about the financial performance of home health in general.  The responses I received indicated to me that many agencies are feeling the pinch more this year than last year from the Medicare cuts in reimbursement.

This message was reinforced as looked at the third quarter 2012 financial results from the Big Four publicly traded home health companies.

Almost Family reported third-quarter net income of $4.1 million, down from $4.8 million or 17% from a year earlier. Revenue for the quarter fell to $85.1 million from $86.2 million or 12%.

Amedisys reported that revenue from services increased by 1.4% to $375.6 million while net profit by 19.2% compared to the third quarter of 2011.

Gentiva reported total net revenues of $424.4 million, a decrease of 6% compared to $449.7 million for the quarter ended September 30, 2011.

LHC Group reported
  • Net service revenue for the third quarter of 2012 was $158.9 million, compared with $153.4 million for the same period in 2011... an increase of 4.2%
  • Net income attributable to LHC Group for the third quarter of 2012 was $6.3 million, compared with a net loss attributable to LHC Group for the third quarter of 2011 of $38.0 million, which included a $45.0 million after tax charge related to the company's settlement with the Department of Justice. 
 As a result of the downturn in their home health business, these companies have added other services that show more revenue growth or better margins.

Almost family has put renewed emphasis on their personal care business (private duty) with revenue rising to $19 million after their acquisition of Cambridge Home Health Care in Akron Ohio.

Amadisys CEO Bill Bourne commented on his company's performance in areas beyond home health.   "Overall, we were pleased with bottom line results for the quarter and remain on pace to meet our earnings plans for the year. Job and investment tax credits benefitted quarterly results. Operationally, we displayed our second consecutive quarter of positive year-over-year episodic admissions growth, continued to grow our managed care business and our hospice average census was up considerably.

During the quarter, Gentiva acquired three agencies to expand the Company's geographic coverage and leverage its existing home health and hospice capabilities in given markets.  In July 2012, the Company acquired Advocate Hospice based in Danville, Indiana.  In August 2012, the Company acquired Spokane, Washington based Family Home Care, which provides both home health, hospice, and private duty services, and North Mississippi Hospice which is based in Oxford, Mississippi

LHC Group provides  home health, hospice and private duty locations in its home-based division and long-term acute care hospitals in its facility-based division.

These results and financial reports indicate that many home health agencies have recognized the need to diversify their revenue streams, adding hospice, private duty home care, and other related services.

In 2012, we have seen significant increases in requests for assistance in developing business growth strategies for hospice and private duty arms of successful home health agencies.   In fact, we've done more work in the hospice sector in 2012 than we have in a number of years.

So what does this all mean?

Home Health Care has always been a challenging business with financial ups and downs on a seven year cycle.  This downturn has been on a slightly shorter cycle that in the past - 4 years - and is mostly due to the political upheaval in Washington and the early effects of the Affordable Care Act. 

Looking forward, it appears that home health care will continue to be negatively affected for the next couple of years, and companies will continue to seek other revenue streams in hospice and private duty. Meanwhile, the private duty marketplace has slowed its growth because of the general economy, the volatility of the stock market, and the dramatically increasing competition. 

The good news is that we are an amazingly resilient industry sector, and we will recover.  I've been speaking, writing, and consulting in home health, hospice, and private duty home care since 1982.  I've seen four major economic challenges in 1989, 1997, 2008, and now 2012.  After each one of these disruptions, the industry came back stronger, growing faster than before.  We'll come back from this one as well.  The question is, "How many agencies will go out of business this time?"

Three Things You Can Do

1.  Serve More Patients.

Now is the time to shore up your market share by developing and implementing new strategies for sales, marketing, and public relations.  The competition is hungrier than ever, and you can't grow by doing the same old same old.

2.  Refocus Your Leadership Team

Leading is easy when business is good and cash is flowing.  Leadership becomes more difficult when competition increases, growth slows, and margins erode. Now's the time to refocus your team, assess your strengths, and make sure you have the right people on the bus.

3.  Put More Focus on Other Revenue Streams

I've worked with hundreds of home health agencies that have hospice and private duty home care.  Most home health agencies do a lousy job in the private duty sector.  I've written many times about "The Four Big Barriers to Success."  But the big thing is to pay attention to your private duty business.  Put the right person in charge, give them some autonomy, and invest in growing the business.   


Monday, November 05, 2012

Proposed Settlement May Extend Coverage to More Medicare Home Health Patients

Elizabeth E. Hogue, Esq.
Office: 877-871-4062
Fax: 877-871-9739
Twitter: @HogueHomeCare

A proposed settlement in a nationwide class-action lawsuit may provide coverage for skilled nursing care and therapy services to Medicare beneficiaries who do not show a likelihood of medical or functional improvement.  The lead plaintiff in the case is Rosalie Glenda R. Jimmo of Bristol, Vermont.  She has been blind since childhood and her right leg was amputated due to complications of diabetes.  She is in a wheelchair.  Ms. Jimmo is joined in the lawsuit by another plaintiff, Ms. Rosalie J. Berkowitz of Stamford, Connecticut.  Ms. Berkowitz has multiple sclerosis.  The Medicare Program denied coverage for skilled nursing and physical therapy on the grounds that she showed no improvement as a result of these services.

The proposed settlement means that CMS will rewrite the Medicare coverage manual to allow for payment for services if they are needed to maintain the patient’s current condition, or to prevent or slow further deterioration, even if patients’ conditions are not expected to improve.  This significant change in coverage may mean that many more patients may be eligible for the Medicare home health benefit.  The proposed settlement was negotiated with attorneys from both the Justice Department and the Department of Health and Human Services (HHS).  The proposed settlement has been submitted to the judge in the case in the Federal District Court in Vermont and is now awaiting approval.  If approved, the changes in coverage will apply to both fee for service Medicare and Medicare Advantage Care patients. 

If the proposed settlement is approved by the Court, the Court will certify a nationwide class of more than 10,000 Medicare beneficiaries.  The members of this class’ claims for services under the Medicare Program were denied before January 18, 2011, when the lawsuit was filed.  The plaintiffs in the lawsuit argued that statutes and regulations governing the Medicare Program do not require beneficiaries to show that their conditions are likely to improve.  Provisions of the Medicare manual and other guidelines of the Medicare program used by Medicare contractors to process and pay claims erroneously establish more restrictive standards that were never intended. 

If finalized, this change in policy is likely to be welcomed by home health agencies.  Over a period of many years, agencies have been stymied in their efforts to provide services to patients like the plaintiffs and similar patients across the country.  The historic lack of coverage for services to such patients has caused home health agencies to confront difficult legal, economic, and ethical dilemmas.  Even if agencies could afford to continue to provide substantial free services to such patients, it appeared that the provision of free services violated applicable prohibitions of the Office of Inspector General (OIG) of HHS regarding the provision of free services to patients that exceed $10.00 at a time or $50.00 in the aggregate during a calendar year.  Agencies would welcome relief from difficult dilemmas and an opportunity to provide care to as many patients as possible. 

Stay tuned for news about whether this proposed settlement is finalized and resulting changes in coverage!

©2012 Elizabeth E. Hogue, Esq.  All rights reserved. 

No portion of this material may be reproduced in any form without the advance written permission of the author.  

CMS Issues Waivers for Hurricane Sandy Relief

In emergencies such as Hurricane Sandy, the Centers for Medicare and Medicaid Services (CMS) responds with flexibilities set in place by statute, ensuring that the most vulnerable populations receive the care they need.

On Nov. 1, CMS held a special Open Door Forum on Hurricane Sandy and the special flexibilities given to CMS in circumstances like natural disasters. CMS policy experts described how CMS can assist agencies in exercising these flexibilities and waivers. Policy experts explained a 1135 Waiver and provided guidance on program flexibilities during an emergency.

Here is a link to a resources page with up to date information on the waivers granted for home health and hospice in those states affected by Sandy.  

CMS releases Medicare Home Health updates for 2013

The Centers for Medicare & Medicaid Services (CMS) has issued a final rule to update the Home Health Prospective Payment System (HH PPS) rates for Calendar Year (CY) 2013. Payments to home health agencies are estimated to be virtually unchanged next year, decreasing by approximately $10 million in CY 2013 (about 0.01%).   This reflects the net effect of a 1.3 percent home health payment update, an updated wage index, an update to the fixed-dollar loss (FDL) ratio, and a case-mix coding adjustment intended to offset coding changes unrelated to changes in patient health needs.

Here's a link to the CMS Fact Sheet. 

At Leading Home Care, we will continue to gather facts and data about how these changes are affecting home health agencies across the country.   During our visit to the 2012 National Association for Home Care Meeting in Orlando, it was pretty evident how much the 2012 cuts have negatively affected home health agencies across the country. 

Thursday, November 01, 2012

Fabulous New Health Care Commercial - Stethoscope

A friend sent me a link to this new commercial called, "Stethoscope."  He said, "Please don't play this until you have great sound.  It's really great.  It's not political, and you'll love it."

So I clicked on the link, and here's what I found.


What do you think?