Boston’s Partners Home Care Selects ViTel Net Home Telemonitors

Telehealth

by | Mar 1, 2006 | Telehealth, Vendor Watch

Following a selection process that has gone on for two years but intensified over the last six months, Partners Home Care announced that it has selected McLean, Virginia’s Visual Telecommunications Networks Inc. (ViTel Net) to bring telemonitoring services to the Boston agency’s patients. ViTel Net’s bedside telemonitor, the VitelCare™ Turtle 400, is a light-weight, portable monitoring device that delivers daily vital signs through a standard phone line to clinicians at a central location.

ViTel Net offers telemedicine applications and scalable, remote health monitoring equipment to home care and other healthcare providers. The Washington, DC-area company was founded in 1989. Partners Home Care (PHC) conducted a number of telemonitoring research trials over the last few years (see “Payers Encourage Telehealth Pilots“) that have demonstrated positive results for the agency’s patients. When it came time to select a long-term partner, however, the consensus was to move away from experimental prototypes toward a set of established products.

Partners Home Care is one of New England’s largest non-profit home care providers, providing certified, specialty, and private home care services throughout Eastern Massachusetts. The agency is a member of Boston’s Partners HealthCare, which serves over 140 New England communities. We spoke recently with home care president Marcia Reissig.

“With two years of research and testing prototypes, we knew what patients like and don’t like,” she told HCAR. “Our IS and clinical team that looked at home telehealth vendors kept that in mind as we reviewed a number of devices over the last 18 months. The ViTel Net Turtle stood out for several reasons. We liked its color display against a black background. We thought that would make it easier for older patients to read. And we liked that fact that it displays pictures as well as names and words of medications and medical devices. It was one of the few products we saw that our clinical and IS people both liked.”

Reissig added that the company itself was a factor in the decision, as well as its products. Some monitors that worked well or were otherwise attractive to clinicians were found to have too proprietary a technology foundation or were offered under a too-restrictive business model. “We will need a lot of customization so that our home telehealth system integrates with Partners HealthCare’s intranet and our home care applications,” she explained. “We liked that ViTel Net is privately owned and very engineering-oriented. During the selection phase, they were able to demonstrate some of their adaptation ideas for us, rather than just talk about them, so we felt they are small enough to be responsive to our needs. They were not the least expensive of those we saw but we thought they would fit our needs.”

Home care IT Director Cara Babachicos added that her department was primarily looking for a vendor that would be easy to work with, skilled enough to create complex interfaces to the parent healthcare organization’s sophisticated enterprise systems but flexible enough to customize its products to meet the home care department’s needs. “We already upload patient data to our system-wide dashboard so that Partners physicians can track patients online,” she said. “We want telehealth data to be available there too in order to alert physicians when vitals are problematic and they need to summon early responders to make adjustments.”

The IT Director added that her department’s goal was to find a way that data could be integrated with a server without creating too many data transfer challenges. “Telehealth data will have to be uploaded to a server and from there to Partners’ enterprise system through a firewall without creating problems,” she explained. “ViTel Net seems to have already figured out a way to set up an ISP email account to upload patient results.” The vendor, she added, has also agreed to set up a backup server and to make support available for extended hours in order to help minimize downtime.

Partners has purchased 35 units initially and will grow the program to 125 telemonitors within the next four to six months. The home care division is not separating from the systems’ remote monitoring effort with this vendor selection but will continue to work closely with Partners Telemedicine, a Partners HealthCare department under the direction of Dr. Joseph Kvedar with the mission of connecting healthcare providers and patients around the world through the use of communications technologies. Kvedar’s department will provide resources and expertise to support the home care project. “I speak with Joe at least once a week,” Reissig said. “He has assigned one of his people to home care full time as we get this project going.”

One aspect of the project that will be worth watching over time is one that will be conducted through member hospital Massachusetts General. With funding from Partners HealthCare, it will study the effects of telemonitoring on patients with chronic conditions but who are not homebound and therefore not Medicare-eligible. One of the most significant obstacles to home telehealth adoption is that the monitoring device must be removed from the home at the end of a Medicare episode, regardless of the fact that leaving it there would help to prevent the need for future episodes or even re-hospitalizations. If the Mass General study can prove cost savings from monitoring non-homebound patients, it may eventually influence DHHS or Congress to reconsider the way it funds home care services.
http://www.vitelnet.com
http://www.partnershomecare.org

What Home Health Agencies and Home Care Leaders Can Learn About Brands and Branding From the ‘Mayo Magic’

Admin

by | Dec 6, 2023 | Admin, Marketing

By Mary E. Maloney

What can you learn about brands and branding from an iconic company like the Mayo Clinic?

We daresay a lot

In this blog, we are going to first explore the “Mayo magic”—some key ideas about why Mayo Clinic has been named, again in 2023 as it has been so many times before, “among the best of the best” hospitals by U.S. News and World Report and listed as one of the “most trusted healthcare brands” by Beckers Hospital Review.

Then we will discuss the benefits of having a solid corporate brand like Mayo’s.

Finally, we will relate the branding principles established by this iconic corporate brand to why it is worthwhile to have a solid personal brand.

Successful Brands Are Built on Trust

Perhaps the most important lesson to take away from Mayo Clinic is that the best brands are built on trust.

A February 2023 Business Insider article titled, Mayo Clinic CEO: Here’s Why We’ve Been The Leading Brand in Medicine for 100 Years, asks Mayo CEO Dr. John Noseworthy how the clinic built its reputation and manages to stay at the top.’

“I think it all comes down to our core value, which is that the needs of the patient come first,”; Noseworthy says in the piece, “I know that might sound kind of trite in today’s world, but our staff is extraordinarily committed. If you spent a day here, and you grab(bed) anybody at the Mayo Clinic and ask(ed) them, ‘what’s the purpose of your work?’; they would say, ‘to meet the needs of our patients.'”

In other words, patients come to Mayo because they can—and do—trust their needs will be served.

The Best Brands Are Consistent

Based on the Mayo example, the best brands are consistent. In the Business Insider article, Noseworthy explains how the Mayo brand is expressed the same way across the organization.

“In my role, what I hear every day from patients and family members is that the minute they step onto a Mayo campus, whether it’s in Rochester, Minnesota; Scottsdale, Arizona; Florida; or in our large integrated health system, they immediately sense that there’s something different,” he says. “They feel it right from the first person they speak with, and it’s the physicians, it’s the science, it’s the engineers and technologists. It’s that patient focus and a relentless focus on quality. This goes all the way from the heart surgeons down to the cleaning staff.

Iconic Brands Stand for Something Significant

A few years back, a woman I know took her young daughter to Mayo Clinic’s Rochester, Minnesota, location for treatment for epilepsy. Ask her what words came to mind when she thinks about Mayo today, and she’ll say: “research, specialists, world-renowned.”

Top brands know what they stand for—and then they deliver on it. For Mayo, this is serving people first, and especially people experiencing special health concerns.

“Founded more than a century ago by two brothers in the rural Midwest, the Mayo Clinic has built a world-renowned reputation as an exemplary network of clinics and hospitals that has become the preferred destination of patients with difficult-to-treat conditions,” reads the intro to a 2018 Q&A article published in Knowledge at Wharton, a business journal from the Wharton School of the University of Pennsylvania.

“As people live longer and have multiple different chronic diseases, the need for … advanced services will be ever greater,” says Larry Jameson, EVP of the University of Pennsylvania Health System, in the article.

The Benefits of a Strong Niche Brand

Being as famous and respected as Mayo would certainly be nice for any brand. But what are the deeper business benefits of having a strong brand in the home health/home care industry?

Qualtrics suggests that strong brands can capture greater market share, accelerate new patient acquisition through online rates and word-of-mouth marketing, and increase loyalty amongst a highly competitive set.

Here are some specific examples:

  • Having a strong brand can help an organization appeal to underserved or growing segments.
  • Having a strong brand that truly resonates with consumers can translate to patients promoting your organization through online reviews and social media mentions.
  • Having a strong brand can boost communication and help to create moments that matter with those the organization serves.
  • Having a strong brand creates “stickiness” and can mitigate employee turnover and improve retention rates. When employees feel like they are connected to an organization that is on-purpose, they are more likely to stay and to influence a healthy work culture.

Applying the Key Principles of Iconic Brands to Personal Branding

So how do these ideas we’ve garnered from an iconic brand translate into your personal brand?

As we have seen, consistently delivering on a brand promise helps people decide to do business with a brand. They trust that brand to deliver for them. At the end of the day, people do business with people if they have a choice.

Personal branding can help you excavate your very own brand manifesto and develop ways to tell others about it consistently and authentically. Being mindful of personal branding will help you answer mission-critical questions as: “What is my brand promise?” and “How consistently am I delivering on it?”‘

Personal branding can not only help you as a leader clarify what you stand for but also affirm it until you feel it with conviction. And it can help you to effectively deliver the same message about it in any situation—whether that’s the proverbial elevator, in an all-staff meeting, or in the field.

Imagine what your business would be like when everyone, whether it’s in the first 90 days or tenured staff, “owns” what they stand for and it aligns fully with your company core values.

You as a leader can

Knowing your “why” will also give you peace of mind to pursue your next act if you are in transition (on deck). Having a brand manifesto as your true north guide will enable you to more rapidly achieve your next career milestone and build your best exit strategy.

Once you get clarity, conviction and the ability to talk about your personal brand, maybe you’ll find yourself ranking on the Home Care Pulse 2023 Best of Home Care Awards or as part of the Modern Healthcare Hall of Fame.

Finally, a heartfelt thanks to all the healthcare leaders out there who are leading with purpose, no matter how tough it gets. It speaks volumes about your personal brand. You inspire us.

# # #

Brands and Branding Mary E MaloneyAn executive advisor, educator, speaker and author, Mary E. Maloney is the founder of Revealing Genius and the expert that accomplished leaders trust for positioning, messaging and brand strategy. A former CEO and CMO, Maloney guides healthcare C-suite leaders, founders and physicians to powerfully and strategically message their expertise and “why” so they lead with conviction and achieve their most coveted career goals. 

©2023 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only.

editor@homecaretechreport.com

 

 

MedPAC Report Slammed for Telling Truth About MA Abuses

Regulatory

by | Jan 24, 2024 | Regulatory

Untitled Document

Analysis by Tim Rowan, Editor Emeritus

P

erennial Home Health enemy MedPAC angered a different group last week by releasing a status report on insurance companies participating in the Medicare Advantage program.1

 

The report details the way in which giant, for-profit, health insurance companies improperly increase per-customer payments by upcoding their health assessment at enrollment, and then slash costs by denying coverage for healthcare services that traditional Medicare would have honored. MedPAC was also critical of the practice of requiring prior authorizations, backed up by utilization review algorithms that are supposedly intended to “minimize furnishing unnecessary services” but which effectively increase denials for necessary care.

According to the report, MedPAC expects CMS to pay MA plans $88 billion in 2024. 

On January 12, a meeting to discuss the report ended in what one reporter politely described as “a kerfuffle.” Other witnesses to the meeting chose to describe it as a shouting match.

“One member, Brian Miller, MD, MPH, of Johns Hopkins University in Baltimore, accused panel leadership of issuing a negative status report on MA plans’ market dominance, saying it had been ‘hijacked for partisan political aims to justify a rate cut to Medicare Advantage plans.’

“Miller said the analysis … ‘appears to be slanted to arrive at a foregone conclusion in order to set up and provide political cover’ just before the Centers for Medicare & Medicaid Services prepares its annual rate notice for MA plans, expected in coming weeks. ‘The chapter reads like attack journalism as opposed to balanced and thoughtful policy research.'”2

Report authors fired back, citing numerous ways MA plans generate higher revenue, including enrolling people who are relatively healthy, known as favorable selection. They then vigorously scan patients’ medical histories and charts to code for health factors that generate higher per-capita payments, known as coding intensity, often spending less on services. Coding intensity is also the difference between a risk score that a beneficiary would receive in an MA plan versus in fee-for-service. Though MA plans skew toward healthier enrollees, MedPAC found that MA risk scores are about 20.1% higher than scores would be for the same beneficiaries had they enrolled in Fee For Service Medicare.

 

Namath, Walker, Shatner and Brokers

Criticism of MA plan behavior did not only come from MedPAC commissioners and report authors. For example, Lynn Barr, MPH, founder of Caravan Health, which was acquired by CVS Health through its acquisition of Signify Health, exposed what the annual TV ads do not make clear, that their 800 numbers go to brokers, not to any one plan.

“This is not the big, lovely, glowing success that everybody says it is. And we continue to create policies that drive people into these plans. Medicare allows money paid to MA plans to be used for broker commissions as high as “$600 to recruit them, plus $300 a year every year that they stay in the MA plan.

“We have allowed MA to buy the market, and that is why MA is growing. It’s not because the quality’s so great. People don’t love the prior auth, people are leaving their plans a lot. Aside from Medicaid, Medicare is the least profitable payer for doctors. And at the same time, we give all this money to the plans. It’s unconscionable.”

Adding to the “kerfuffle” with a powerful anecdote, Stacie Dusetzina, PhD, of Vanderbilt University Medical Center in Nashville, Tennessee, noted that even cancer patients often have trouble getting necessary care because of the plans’ limited networks. She referenced a January 7 NPR story3 about an MA enrollee who could not get the cancer care he needed from his MA plan, and could not get out of the plan without facing 20% in expensive copays. In all but four states, supplemental plans that could pick up the difference can reject patients with costly conditions.

“When you are 65 and aging into the program,” Dr. Dusetzina summarized, “you are healthy at that time and may not be thinking about your long-term needs. [If you did], it would push you to think harder about the specialty networks that you may or may not have access to when the MA plan is making your healthcare decisions.”

 

1 A 30-page slide presentation is available to the public at medpac.gov/wp-content/uploads/2023/10/MedPAC-MA-status-report-Jan-2024.pdf. The complete report is available only to MedPAC commissioners. The charts on slides 26 and 27 show how MA plans learned to pad profits in 2018 and increased the practices exponentially since then.

2 Cheryl Clark, MedPage Today January 16, 2024 medpagetoday.com/special-reports/features/108275

3 npr.org/2024/01/07/1223353604/older-americans-say-they-feel-trapped-in-medicare-advantage-plans

 

Tim Rowan

 

Tim Rowan is a 30-year home care technology consultant who co-founded and served as Editor and principal writer of this publication for 25 years. He continues to occasionally contribute news and analysis articles under The Rowan Report’s new ownership. He also continues to work part-time as a Home Care recruiting and retention consultant. RowanResources.com; Tim@RowanResources.com

 

 

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report.homecaretechreport.com One copy may be printed for personal use: further reproduction by permission only. editor@homecaretechreport.com

Patient Care in the Palm of Your Hand

Product Review

by | Feb 14, 2024 | Product Review, Vendor Watch

By Kristin Rowan, Editor

For those of us who didn’t grow up with a smartphone in our pockets and every tool imaginable available on the internet, mobile apps are still a bit of a mystery and a marvel. There are 25 categories of mobile apps, including gaming, finance, education, business, dating, travel, and health. Development, testing, and execution of an app that actually works is difficult, time consuming, and expensive, so it may seem out of reach for most small businesses. Last week, we spoke with the creators of an app that not only coordinates care for your patients and families, but makes it seem like you have your own agency app.

The Story

Dr. TJ Patel, PT DPT, grew up in India, where he studied physical therapy. After landing his dream job, he started to notice a lot of patients returning to the hospital because they got an infection or just didn’t know how to care for themselves. There was no one providing care after discharge; there was no concept of home based care. Patel soon learned that if he was passionate about home-based care he needed to move to a country that had the infrastructure already built because it didn’t exist there.

Dr. Patel moved to the U.S. and received his masters in kinesiology and doctorate in physical therapy. He was working in home health within a week and did 27,000 home visits in his fifteen year tenure. During this time, Patel noticed that in healthcare, “the right hand does not talk to the left hand.” Communication was a huge pain point and Patel set out remedy that.

By combining care management, care delivery, and what the patient wants into one centralized location, it creates connectivity to all care providers for a patient. Thus, Care Coordinations was designed.

The Concept

Care Coordinations is a tech solution for an impactful experience for patients, caregivers, and families. It opens the lines of communication between the parties customized for each patient.

Patient Channels include all caregivers associated with the patient. Users both inside and outside the organization can be added to the channel. Each patient channel is a secure, private channel for all internal and external care providers. The patient channel can include smaller groups within the channel.

Care Circles include the primary agency caregiver, patients, and family members. The app allows for unlimited two-way communication that protects the personal information of the caregiver. This removes the need for the caregiver to use a personal cell phone or give the patient access to personal information like social media profiles. The two-way communication inside the app is HIPAA compliant, unlike standard text messaging.

Group Channels are non-patient specific for other members of your agency to feel connected, especially in a remote working environment. Department specific group channels for marketing, sales, or HR can also be created. Management functions allow for one-way communication to all employees, anonymous employee surveys, and read-only access to all other channels.

CAHPS Survey

The patient and family experience is captured in the CAHPS survey and impacts agency reimbursement rates. Care Coordinations includes a mock CAHPS survey for patients and families that goes out before the CAHPS survey. The agency can make any needed adjustments to the patient and family experience prior to the actual CAHPS survey, improving scores and reimbursement rates.

Additional Features

Care Coordinations integrates directly with EMRs to upload an episode of care.

Robust read-receipts allow you to see if caregivers have seen a notification inside a communication channel.

Phone and video call capability inside the app adds additional secure communication.

Remote patient monitoring is built in with integrations with more than 500 devices to monitor blood pressure, pulse ox, weight, blood sugar, and temperature.

Direct communication to the agency allows the patient or family to notify the agency in the event a caregiver does not show up for an appointment.

Similar to the user experience with Uber and Lyft, the map feature alerts the patient that the caregiver is in route and estimates time of arrival with a pictogram of a car.

Optional 24/7 functionality to allow the patient to contact the agency after hours. Your call center can input details of the call into the app for real-time updates and assist with reaching other family members in case of an emergency when calling 911 is not necessary.

Post-visit surveys are customizable and can help struggling caregivers to improve and recognize high-performing employees.

The Good, The Bad, and The…Just kidding, there’s nothing ugly

Overall, we found the Care Coordinations app to be useful and well-designed. The app is charged on a per patient basis, making it more cost effective to include multiple care providers in one patient channel for increased connectivity. The available integrations, ability to upload files and videos, HIPAA compliant communication, and familiar messaging structure all point to ease of adoption.

As we’ve noted before, many home health nurses are technology adverse and will fight against the adoption of anything new. Care Coordinations stresses the legality of HIPAA compliant communication and not using your personal cell phone as selling points for nurses. Still, we know this isn’t always enough to convince a steadfast (read stubborn) care provider. Caregiver benefits and a gamified system to track timeliness, survey results, and other metrics may add some incentives for those harder-to-convince nurses.

The Uber-like experience for the patient and family to see where the caregiver is and when they will arrive is a great feature. On the flip-side, there is no tracking of the caregiver on the agency side. With increased reports of workplace violence in home-based care, a feature that allows the caregiver to alert the agency of any change in schedule, without constant tracking of caregiver movements, would allow the caregiver and agency some peace of mind.

I found Care Coordinations to be robust and detailed. Current EMR integrations include Axxess, Kantime, and HomeCare HomeBase, all through Worldview. Direct integrations are in the works. As Care Coordinations adds features and integrations, we are bound to hear more from and about them.

# # #

Kristin Rowan

Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report.homecaretechreport.com One copy may be printed for personal use: further reproduction by permission only. editor@homecaretechreport.com

Cyberattack Interrupts Pharmacy Operations

Admin

by | Mar 6, 2024 | Admin, CMS, Regulatory, Vendor Watch

By Kristin Rowan, Editor

**March 6, 2024 Update** As the previously reported cyberattack on Change Healthcare continues, the US Department of Health and Human Services issued a statement on March 5, 2024 outlining immediate steps CMS is taking to assist providers. CMS is strongly encouraging Medicaid and CHIP plans to waive or relax prior authorization requirements. They’ve also urged providers to offer advance funding to providers.

According to feedback from NAHC members, the impact of this cyberattack on home health and hospice providers has remained minimal. However, for those experiencing delays in claims processing and payments, some providers are unable to meet payroll or pay for patient care items.

**February 29, 2024 UPDATE** We’ve just been contacted by a home care agency out of Charlotte, NC who told us, “For our home care agency we can’t submit claims for VA clients (ChangeHealthcare [sic] has been totally taken off line), and we aren’t having remittance records from Optum feed through ChangeHealthcare [sic] to Wellsky.”

February 28, 2024

The news broke last week that another cyberattack is impacting healthcare. This time, it is Change Healthcare, a division of UnitedHealth Group, that processes insurance claims and pharmacy requests for more than 340,000 physicians and 60,000 pharmacies. In response to this attack, UnitedHealth Group separated and isolated the effected systems, causing delays in claim payments and backlog pharmacy orders.

The attack was first reported on February 21, 2024 and the outage is still ongoing. Former FBI cyber official and current adviser for cybersecurity and risk at the American Hospital Association warns that the longer this outage persists, the worse it will get and it will start to impact patient care. UnitedHealth Group claims that fewer than 100 pharmacy orders and claims have been interrupted across its insurance and pharmacy plans. But, at least on health insurer is claiming a 40% drop in claims since the system went down.

Source of the Attack

Initially, UnitedHealth Group blamed an unknown “nation state” for the cyberattack. The FBI found no evidence of this and has since named Blackcat ransomware gang culpable in the attack. Blackcat ransomware gang has attacked numerous hospitals and the FBI seized their website and servers in December, 2023. Blackcat accessed the Change Healthcare system through vulnerabilities in the ConnectWise ScreenConnect remote desktop and access software.

Implications

The American Hospital Association has urged all healthcare organizations that work with Optum, Change Healthcare, and UnitedHealth Group to weigh the risk of the connection to Change Healthcare against the possible clinical and business disruptions cased by severing that connection.

Health-ISAC anticipates additional cyberattack victims in the coming days. ConnectWise has alerted its users to the remote code execution flaw and has urged all users to update immediately to prevent attacks.

Point of View

This is not the only story this week about UnitedHealth Group. Backlogged pharmacy orders, healthcare claims, and payments, add further credence to the Antitrust probe filed this week by the Justice Department, investigating UnitedHealth and Optum. Should one healthcare group have this much influence over insurance, physicians, pharmacies, and home care?

# # #

Kristin Rowan

Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report.homecaretechreport.com One copy may be printed for personal use: further reproduction by permission only.

 

editor@homecaretechreport.com

 

 

 

Sources:

Fox. February 22, 2024. Change Healthcare Experiencing a Cyberattack. Retrieved from: https://www.healthcareitnews.com/news/change-healthcare-experiencing-cyberattack

Fox. February 27, 2024. Change Healthcare Cyberattack Still Impacting Pharmacies, as H-ISAC Issues Alert. Retrieved from: https://www.healthcareitnews.com/news/change-healthcare-cyberattack-still-impacting-pharmacies-h-isac-issues-alert

Pashankar & Tozzi. February 28, 2024. Change Healthcare Cyberattack is Still Disrupting Pharmacies, Other Providers. Retrieved from: https://finance.yahoo.com/news/change-healthcare-cyberattack-still-disrupting-211913516.html

Satter & Bing. February 26, 2024. US Pharmacy Outage Triggered by ‘Blackcat’ Ransomware at UnitedHealth unit, Sources Say. Retrieved from: https://www.reuters.com/technology/cybersecurity/cyber-security-outage-change-healthcare-continues-sixth-straight-day-2024-02-26/

 

Is the Covid Boost for Telehealth Over?

Clinical

by | Apr 11, 2024 | Clinical, Editorial, Telehealth

by Tim Rowan, Editor Emeritus

In 2020, doctors flooded telehealth companies with requests for help caring for patients reluctant to leave home to come to their appointments. Following suit, many Home Health agencies that had never considered investing in home telehealth before, opened up their wallets to acquire equipment, from simple wearables to high-end, HIPAA-compliant video systems.

In addition to the need to provide care at a safe distance, many HHA leaders knew the added service would attract the attention of hospitals desperate to discharge recovering Covid victims as well as non-Covid patients. Some HHAs established relationships with hospitals they had not had before, given the chance to demonstration Home Health’s unique advantages over extended hospital stays and discharges to institutions such as SNFs that had become virtual death sentences during the height of the pandemic.

All Things Must Pass

With the introduction and widespread free availability of Covid mRNA vaccines, the death rate graph line began to tilt downward. Then came the discovery that the SARS-CoV-2 and its variants are transmitted through the air and not through unwashed surfaces. People stopped disinfecting their counter tops after unloading groceries. And they started in-person doctor visits again. Patients returned to allowing nurses into their homes.

In regions where vaccination and booster rates were high, hospitals found themselves with more and more empty beds. They took down tented treatment centers in their parking lots and sent refrigerated trailers back to trucking companies. Desperation referrals to Home Health tapered off, as did the need for virtual visits.

Isaac Newton said every action has an equal and opposite reaction. If that holds true in the healthcare business as it does in physics, the reaction to Covid easing is seen in Remote Patient Monitoring tech companies. According to Fierce Healthcare, the New York Stock Exchange told one RPM company, Amwell, formerly known as “American Well,” to raise its stock price or be delisted. Fierce added detail about the company’s woes:

“Despite decimating its workforce at the end of 2023 to cut expenses, the company still projects a 2024 loss between $160 million and $155 million amid incremental revenue growth. The company’s market cap was a stone’s throw from $6 billion at the height of its valuation, when shares were trading for more than $42 each. Amwell shares were trading at $0.72 as of market close on April 5, giving the company a current market cap of about $208.6 million.

Another market leader fared no better, Fierce Healthcare found. “Telehealth giant Teledoc, which has been in operation for 20 years, has struggled in the stock market and is facing headwinds as the virtual care market has become crowded with digital health players. Shares dropped 22 percent in February as the company missed fourth-quarter revenue estimates and offered a downbeat forecast for the rest of the year.”

Teledoc’s 15-year CEO, Jason Gorevic, resigned last week after the company reported a net loss of $220 million for 2023, following 2022’s historic loss of $13.7 billion, mostly from a write-off related to the plummeting value of its ill-advised Livongo acquisition. According to Fierce Healthcare, Teladoc shelled out $18.5 billion for the digital chronic condition management company, a record in digital health.

Gorevic’s rationale that the telehealth field has become too crowded may not be far off. Last July, Becker’s Hospital Review published an industry survey titled “280+ Telehealth Companies to Know.” The list included a half dozen names we recognized from past Home Health conferences, including Health Recovery Solutions, AMC, Vivify, and FoneMed.

Do Hospital Woes Translate Down to Home Health?

Making comparisons between telemedicine companies that focus on hospitals and physicians and those who focus on post-acute providers is hampered by the fact that few in our sector are publicly traded and do not share their numbers. UnitedHealth, which acquired Vivify in 2019 and assigned it to its Optum division, does not separately report Vivify revenue.

Health Recovery Solutions, one of the best-known names in post-acute RPM, is privately held by its founding CEO and seven investors. Its most recent influx of $800,000 occurred in January, 2022, making it impossible to determine whether it was motivated by investor confidence or the need for cash as Covid began its decline.

Analysis

This publication has promoted the advantages of remote patient monitoring for its entire 25-year existence. We have covered startups and established tech companies offering every technology from PERS to Zo monitors to automated phone calls, in-home cameras and microphones. We have followed the evolution of two-way communications and vital sign detectors from tabletop devices to tablets and smartphones. We have even tested a few robots. We have seen HHAs experience great success, and we have seen devices collecting dust on shelves.

Throughout, we have maintained that, when selected, implemented, and deployed properly, monitoring patients 24/7 instead of once or twice a week can improve patient outcomes, boost agency reputation, and, more often than not, produce a healthy ROI. The end of the latest pandemic may mean the end of demand for Remote Patient Monitoring systems, but that would be unfortunate.

Tim Rowan, Editor EmeritusTim Rowan is a 30-year home care technology consultant who co-founded and served as Editor and principal writer of this publication for 25 years. He continues to occasionally contribute news and analysis articles under The Rowan Report’s new ownership. He also continues to work part-time as a Home Care recruiting and retention consultant. More information: RowanResources.com or Tim@RowanResources.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

HOPE is on the Way: Part 1 – Outcome Measures

Clinical

by | Apr 11, 2024 | Clinical, CMS, Regulatory

By Beth Noyce, RN, BSJMC, HCS-C, BCHH-C, COQS
Home health & hospice consultant

The Hospice Outcome Patient Evaluation is a step closer to implementation.

After four years of considering options, the Technical Expert Panel (TEP) has finished its work that will inform future Hospice Quality Reporting Program results. The TEP considered quality measures to include in hospice’s future assessment tool and best choices for risk adjustment and exclusion.

The panel convened in 2019 “[we are] committed to improving the quality of care given to hospice patients,” says the 2022-2023 TEP Summary Report: Hospice Quality Reporting Program. The panel aimed to ensure that hospice quality measures are meaningful for hospice beneficiaries, transparent to hospice providers, and useful to consumers. They considered quality measures from both HOPE and claims data.

“From day one it was very clear Medicare wanted to make this a very different experience for hospice teams and make it a more valuable thing for consumers,” says Dr. Jeff McNally, Hospice Medical Director at Utah’s Intermountain Hospice,” describing his participation on the HQRP TEP. “I was actually encouraged and inspired by it,” he says. “It was the first time I had first-hand experience working with any kind of CMS entity.

“The reality is some clinicians in the field and leaders don’t have the best things to say about CMS,” he explains, but “whatever we were considering we always circled back to whether it would be burdensome to the clinical team and would it be valuable to consumers.”

The panel initially planned to meet multiple times in person, with two meetings per year and potential virtual meetings as needed. “Then COVID hit,” Dr. McNally says. “It slowed the process considerably. We never did meet again in person.”

The HQRP TEP met eight times over four years, virtually after the initial meeting. McNally described participants as coming to each meeting prepared with data and proposals for HOPE measures for which they would request input from panelists.”

From TEP recommendations early in their work, Abt Associates developed two outcome measures and two process measures in harmony with hospice’s central tenet to manage symptoms:

  • Process measures:
    • Timely Reassessment of Pain Impact
    • Timely Reassessment of Non-Pain Symptom Impact
  • Outcome measures:
    • Timely Reduction of Pain Symptom Impact
    • Timely Reduction of Non-Pain Symptom Impact

“The most important [recommendations] were some of the outcome measures about symptom management,” McNally explains. “What should we be helping agencies show that they’re doing well? And how do we do that? Deciding which ones, and how many symptom management measures to use and the most valuable way to show it in a fair way.”

During the past two years, TEP members prioritized which of the risk-adjustment factors suggested by Abt. Associates should apply to outcome measures and which exclusions should apply to both outcome and process measures.

The report describes risk adjustment as using statistics to exclude “confounding factors,” or elements that are outside of a hospice’s control, from calculations that could make a hospice’s performance appear either better or worse than it is. In essence, risk adjustment increases the fairness in outcome-measure calculations while exclusions do the same for both outcome and process measures.

For the outcome measures being considered, the report says that the “TEP broadly agreed that risk adjustment is very important because it accounts for external factors outside hospices’ control and more accurately reflects the quality of care provided.”

Judi Lund Person, Principal of LundPerson & Associates, LLC, agrees. “The discussion of risk-adjustment factors is vitally important to the success of upcoming process measure implementation,” says Lund Person.

Determining which risk-adjustment factors to bring to the table was not easy. “There were some nuance things that we hashed out to try and decide how to weigh some factors in risk adjustment” for outcome measures, McNally explains.

Exhibit 5 (below) summarizes the TEP’s rankings of risk adjustors suggested.

While the TEP’s priorities seem clear, the discussion concerning each risk adjustor was more complex. The TEP broadly agreed that the most important risk-adjustment factors are age and diagnosis. Some diseases are more difficult to manage than others, and patient condition tends to decline with age regardless of provider activity. Therefore, the TEP recommended that CMS adjust for these factors to ensure that common external factors do not adversely affect reported hospice care quality.

Here’s part of the nuance – the TEP also raised concerns that how well other patients with certain diseases or of certain age groups are treated might be valuable to some patients and their families seeking care for someone of the same age group or condition. Panelists fretted over possibly obscuring that information for consumers seeking hospice care by adjusting for those risk factors.

Living situation as a risk adjustor ranked as important to TEP members because hospices have no control over what level of assistance is available to patients. Similarly, site of service ranked high as a risk adjustor because, said some panelists, care is delivered very differently across settings, and patients and/or caregivers tend to provide higher hospice satisfaction ratings for hospices in home settings than for those in facilities,” according to the report.

Lund Person, who is also former Vice President of Regulatory and Compliance at the National Hospice and Palliative Care Organization (NHPCO), notes that the TEP recognized living situation and site of service as “important” risk adjustment recommendations.

“Identifying site of service will help to distinguish between care at home and care in a facility,” she says. Also vital, she continues, “is the recommendation from the TEP to consider length-of-stay as a risk-adjustment factor, including the differences between a 4-day length of stay and a 6-month length of stay.”

One TEP member cautioned that using payment sources, IV therapy, and risk of hospitalization as risk adjustors might tempt some hospices to use them to distort a hospices’ apparent care quality.

TEP members did not recommend using as risk adjustors gender, clinical symptoms, functional status and management of care needs. They did not discuss why they rejected gender, but several agreed that using clinical symptoms would not be of value because of their high correlation with diagnoses. Because hospice providers typically see hospice patients decline in ADL and IADL abilities, and hospice goals are focused on comfort rather than functional improvement, functional status was on the TEP’s “Do Not Include” as a risk adjustor list. And finally, one TEP member strongly opposed adjusting for patients’ medication management, supervision or safety assistance needs (management of care needs), explaining that “the public and CMS should hold hospices accountable for planning around oral medication, injectable medication management, and supervision and safety assistance,” the report says.

The TEP did suggest that using some risk adjustment factors as part of the HQRP could assist hospices internally with quality improvement while others would be more valuable to patients and families. For example, Patients and families would benefit from more straightforward risk adjustment that helps them select a hospice,” the report says, “including factors such as diagnosis. For publicly reported data used to select a hospice, the TEP suggested using demographic factors (including age but excluding gender), socioeconomic factors, living situation, and diagnoses.”

Dr. McNally hopes eventually to use HPRP data to promote Intermountain Hospice’s care. Intermountain Hospice is part of Intermountain Health, a health care provider with presence in multiple states. “You can’t take the current metrics to doctors’ offices and families to show anything meaningful,” he says. “It’d be great to have metrics we could take to our neurology docs and other docs,” he says. “I really think we provide better care and more options when patients stay within our system.

This article is the first in a series about implementation of HOPE. Next week, Beth Noyce shares details from the panel as it evaluated process measures.

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©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

 

HOPE is on the Way: Part 3

CMS

by | Apr 26, 2024 | CMS, Medicare Advantage, Regulatory

By Beth Noyce, RN, BSJMC, BCHH-C, COQS
CHAP-certified home health & hospice consultant

This is part 3 of the 3 in the series, outlining the discussions and implications in adopting new outcome and process measures for Hospice care. The final segment addresses future process and outcome measures that the board discussed, but did not yet implement. Read Part 1 on Outcome Measures and Part 2 on Process Measures.

The TEP discussed potential future process and outcome measure concepts that Abt Associates presented to the panel as well.

The process measures included:

  • Education for Medication Management
  • Wound Management Addressed in Plan of Care
  • Transfer of Health Information to Subsequent Provider
  • Transfer of Health Information to Patient/Family Caregiver

Hope-based outcome measures were:

  • Patient Preferences Followed throughout Hospice Stay
  • Hospitalization of Persons with Do-Not-Hospitalize Order

Developing education for medication management as a process measure was a popular concept, and the top priority of the recommended measures with the TEP as they “broadly agreed that CMS should develop this measure,” the report says, citing “a significant need for training in medication management for patients and their caregivers.” They recommended that the measure weigh more heavily when care is provided in a home setting than in a facility setting because hospices are unable to control facility training and hiring practices. One panelist commented that including the phrase “during today’s visit” in the measure is important.

Whether CMS should further develop the process measure addressing wound management in the plan of care was less straight-forward, as panelists provided varied feedback. They generally agreed that this measure is important, as having a record of wound management addressed in the plan of care can hold the staff accountable for treating the wounds. But some members recommended measuring wound management with outcome measures rather than process measures. One panelist cited potential problems from patients’ deterioration over time and another noted that the time frame of this measure is important, and encouraged recording the process of getting care in place once a wound is identified.  The panel agreed CMS should carefully define the measure’s specifications.

Because standard practice for most agencies is, when a patient is discharged live, to transfer health information to the subsequent provider and to the patient and family or caregiver, TEP members expressed that the two measures were likely to “top out,” meaning they would almost always be marked “Yes,” making them of no value in differentiating between hospice providers. The group generally discouraged developing these process measures.

The group strongly rejected any merit in developing two outcome measures concerning Patient Preferences Followed Throughout Hospice Stay and Hospitalization of Persons with Do-Not-

Hospitalize Order. The report says “Multiple TEP members described situations in which patients who had preferred not to be hospitalized changed their minds when a crisis occurred. Patients’ preferences and unexpected crises are usually out of the hospice’s control. Although it is still important for hospices to ask patients about their preferences as part of patient-centered care, the TEP did not believe these two items would be practical measures of a hospice’s care quality.”

Dr. McNally expects that Abt. Associates will apply the HQEP TEP’s suggestions to the HOPE tool.

“Oh yeah, they did it,” he says. “Abt would come to a specific meeting with information, data, suggestions, and specific information about how these things would be measured. We’d give feedback. Then they’d come back to the next meeting having incorporated our suggestions,” he explains. “All of us felt very much heard and responded to. It didn’t feel in the least bit perfunctory.”

Whatever specific measures are eventually included in the HOPE tool, Lund Person sees value in its implementation. “Hospice providers have had a woeful lack of outcome measures for hospice patients, which has made the evaluation of quality hospice care based only on process measures and the family’s evaluation of hospice care in the CAHPS® Hospice Survey, she explains. “Implementing HOPE will begin to identify outcome measures that can be compared between providers.”

Lund Person warns of potential challenges as well. “The selection of risk adjustment and stratification must be carefully done to minimize bias and maximize effectiveness of measures,” she says. “In addition, hospice providers have been awaiting the release of the HOPE tool with significant anxiety about content and administrative burden.”

Dr. McNally is confident the HOPE tool will be a healthy change for hospices.

“A lot of my role as a medical director and hospice physician is supporting our nurses,” he says. “They do 95% of the work. I really would like to see this not be burdensome for our hospice nurses. I’m looking forward to seeing what the [HOPE tool] beta testing translates to in our own hospice world.” He added “What I would hope to see is that the tool feels user-friendly to the hospice team, the people who have to use it, and that it also provides useful information to patients and families.”

NAHC’s Wehri says that standardizing processes through the HOPE tool is the key foundational element for the hospice industry. “High quality care is driven by reducing variance through standardized processes, Wehri writes. “Also, CMS will have a better idea of how the type of population a hospice serves impacts some of the clinical care.” This small glimpse into hospice variances that CMS does not currently have could be very helpful in future policy and payment decisions, according to Wehri. “What CMS finds in terms of differences between hospices and their care for patients may be a bit of a surprise to CMS,” she says.  “I hope they are pleasantly surprised with the overall quality of care that is revealed.”

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Beth Noyce provides education, consulting, mentoring, compliance assessments and auditing services to home health and hospice agencies and their clinicians in several states. She also now provides patient and family guidance concerning hospice and home health services. Beth loves teaching and helping others succeed. She also makes available recordings of much of her education for her clients’ convenience.

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com