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

New Training, New HH Compare

CMS

by | Sep 9, 2020 | CMS

CMS News: New Training, New HH Compare Home Health Quality Reporting Training September 01, 2020 Introduction to the Home Health Quality Reporting Program Web-Based Training The Centers for Medicare & Medicaid Services is offering a web-based training course for...

Medicare Dollars Flow Freely to MA Plans

Editorial

by | Aug 9, 2023 | Editorial

analysis by Tim Rowan, Editor

It is good to occasionally remind ourselves that 2023 is the year enrollment in Medicare Advantage reached a full half of Medicare beneficiaries. Originally conceived as a plan to control spending, MA does seem to be achieving that goal.

At what cost, however?

The Medicare trust fund pays insurance companies participating in the MA program a per-patient-per-month fee based on the company’s own declaration of each customer’s health and likely future needs. With those monthly payments, MA companies provide care as needed. Or at least they are supposed to.

Frequently, since the program began, whistleblowers have told the government that employees are rewarded for increasing a patient’s risk-adjustment, the clinical assessment that is supposed to be scored by a physician but is often instead scored through data mining. That practice involves employees searching through patient records, looking for signs of health conditions that would raise their assessment, and thus their value to the insurer. In other words, a class of crime that would earn an HHA a hefty fine if they did it with their OASIS assessments.

Evidence has been mounting lately that these insurance companies not only fudge the numbers to gather more than they should from Medicare, but they also provide as little care as they can get away with. Our industry is familiar with the penny-pinching MA companies practice when authorizing in-home care. The problem is larger than that.

String of Recent Accusations

  • The HHS Office of Inspector General issued a report revealing how Elevance, the company formerly known as Anthem, made $5.5 billion in profits in the first six months of this year, a 14.4% jump from the $4.8 billion in profits it made during the same period of 2022. The profits, OIG said, came mostly from denying care to Medicaid beneficiaries, care that their physicians had recommended.
  • The largest insurer, with 27 percent of the market, UnitedHealth’s investors were distraught in June when it appeared the company was spending too much on patient care. Their fears were calmed, however, when United reported revenue of $56.3 billion for 2Q 2023, compared to $45.1 billion in the same quarter of 2022.
  • Cigna is the target of a class action suit in California, in which it is accused of using an algorithm to deny care, overriding and sometimes ignoring physician recommendations.1

Last October, the New York Times summarized the problem with a list of recent government findings and accusations:

“Kaiser Permanente called doctors in during lunch and after work and urged them to add additional illnesses to the medical records of patients they hadn’t seen in weeks. Doctors who found enough new diagnoses could earn bottles of champagne, or a bonus in their paycheck.

“Elevance Health paid more to doctors who said their patients were sicker. And executives at UnitedHealth Group, the country’s largest insurer, told their workers to mine old medical records for more illnesses — and when they couldn’t find enough, sent them back to try again.

“Each of the strategies — which were described by the Justice Department in lawsuits against the companies — led to diagnoses of serious diseases that might have never existed. But the diagnoses had a lucrative side effect: They let the insurers collect more money from the federal government’s Medicare Advantage program.”

Comparison to Home Health and Hospice

Naturally, these examples reach into the hundreds of billions because MA covers hospital and physician claims, but the comparison to our sector is nevertheless valid.

Since payments to HHAs were first attached to patient assessments a quarter century ago, clinicians have gotten better and better at the task. OASIS assessments are more accurate and thorough than they used to be. Professional coders are more adept at identifying and sequencing appropriate diagnosis codes. AI-assisted tools entering the fray promise an enhanced level of accuracy. (See our product review of the most promising of these tools.)

From the beginning, more accurate assessments have always meant a 10 to 15 percent increase in an agency’s episodic payment over less accurate OASIS scores. Wary of being accused of upcoding, nurses have always been unnecessarily cautious with their intake assessments.

Upcoding Accusations

CMS has always responded to increasing accuracy with accusations of upcoding, even though the Medicare trust fund more often benefits from the above described undercoding habit. Regulatory adaptations have enshrined the fear of upcoding into an assumption that it will happen, with payments slashed in advance just in case it does.

When errors in assessments and claims are discovered by CMS contractors through sampling, the overpayment amount found in the sample is extrapolated to an agency’s entire patient census. The result has at times crossed the line into seven figures, with a payback demand that occasionally cripples the HHA.

Compare this practice to the gift given to MA companies that we revealed in these pages last February: “Government Lets Health Plans That Ripped Off Medicare Keep the Money” In researching that story, we found that CMS typically postpones its duty to audit the risk adjustment figures that MA plans submit annually. After getting more than a decade behind, they decided to write off overpayments to MA plans prior to 2018 and start auditing from that year forward.

As an additional gift they said they would demand repayments only on the amounts turned up in their sample dataset, without extrapolating to each MA’s total patient population as they do with HHAs.

What can one conclude from this comparison? Possibly that CMS is very good at policing millions of dollars but gets overwhelmed and gives up with amounts in the billions.

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
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

 

1 https://sharylattkisson.com/2023/08/class-action-suit-filed-against-cigna-over-alleged-use-of-algorithm-to-review-reject-patient-claims/

 

OIG Crackdown on Employees Ineligible to Work for Medicare

CMS

by | Nov 15, 2023 | CMS, Editorial, Regulatory

Dear Friends,

I have some news that may be upsetting. Frankly, that is my intention, to frighten you into action.

In August, a Home Health provider in New York paid an $$866,339.25 fine for violating the “Civil Monetary Penalties Law.”* The Chinese-American Planning Council Home Attendant Program had employed an individual, in connection with the New York State Consumer Directed Personal Assistance Program (CDPAP), who was excluded from participation in the New York Medicaid program and was not eligible to furnish services under the CDPAP.

Georgia provider Agape Hospice Care paid $250,993.97 in penalties, the specific amount it had paid in salary and benefits to two unlicensed nurses.

If this law is unfamiliar to you, it is the requirement that you may not employ any individuals who are not eligible to work within the Medicare system.*

This is only one example of a new OIG crackdown!

  • Bridges MN, a non-profit with services to the disabled, was fined $150,171.96 for employing a single excluded individual.
  • Vicki Roy Home Health Service paid a $38,000 fine for employing one excluded caregiver.
  • Providence Health System-Southern California, doing business as Providence Little Company of Mary Medical Centers, which includes two hospitals, agreed to pay $141,562 in connection with the employment of an excluded emergency services technician from Aug. 8, 2016, to June 5, 2019. (Note that this person was employed for nearly three years without the health system knowing, as they are required to know, that he or she was excluded.)
  • Joseph Health Personal Care Services, doing business as Nurse Next Door, agreed to pay $32,244 in connection with the employment of an excluded constant care attendant from Nov. 2, 2017, to Aug. 8, 2019.

My friends, the list goes on and on, and these are just the Home Health agencies:

  • Serenity Home Healthcare Services Agreed to Pay $146,000
  • Professional Home Health Care 2: $77,000
  • Chinese-American Planning Council Home Attendant Program: $866,000
  • Visiting Angels of Rhode Island: $158,000

I learned of at least 25 other healthcare providers that were fined under this law. Clearly, the HHS OIG is on the warpath. This is not a regulation you are wise to ignore.

That is why I write you today. I have found an affordable service that performs monthly OIG exclusion screening for you. Doing it yourself would require a dedicated FTE and hours of painstaking work.

I would be honored if you would accept my introduction to the company that provides this service. If the fines I listed above grabbed your attention, you can see that a service of this type is like an insurance policy that costs a fraction of the disaster it can prevent.

The company is called Carosh Compliance Services. The monthly service is called “OIG Express.” I know and trust the founding CEO, Roger Shindell. To contact Roger and learn more about this necessary service, use this link: https://oig.hhs.gov/faqs/exclusions-faq/
Sincerely,

Tim Rowan
Editor Emeritus
The Rowan Report
Tim@RowanResources.com

Medicare Advantage Dominated November News

CMS

by | Dec 6, 2023 | CMS, Regulatory

by Tim Rowan, Editor Emeritus

MA Plans Continue to Exaggerate Patient Conditions for Profit

Medicare Advantage for Profit

As we reported in October (More MA Plans Caught Inflating Patient Assessments, 10/11/23), insurance companies operating Medicare Advantage plans routinely pad the patient assessments that set their monthly revenue from the Medicare Trust Fund. Worse, CMS bowed to industry pressure earlier this year and agreed not to extrapolate the amount of the fraudulent payments, as it does with Home Health and Hospice overpayments (Government Lets Health Plans That Ripped Off Medicare Keep the Money, 2/22/23).

Now, we hear that the HHS OIG has totaled its 2023 audits and announced it found over $213 million in padded Medicare Advantage overpayments so far this year. In its latest semiannual report, covering fraudulent patient assessments between April and September, the OIG said it recovered $82.7 million. Total recoveries would have been higher except for that CMS ruling that prevents the agency from extrapolating payments before contract year 2018.

Will SEC Allow Cigna/Humana Marriage?

Early last month, Bloomberg broke the news that Cigna was in talks to sell its Medicare Advantage business to Health Care Service Corporation, the parent company of BCBS in Illinois, Texas, New Mexico, Montana and Oklahoma. Should that sale be approved, it would remove an obstacle to Cigna’s rumored desire to merge with Humana.

Though approval is uncertain — the SEC has squashed more than one similar attempt under both the current and former Presidents — it would create what Axios called “another Titan” that would rival UnitedHealth Group and CVS Health in size. CVS acquired Aetna in 2018. It would also combine two Pharmacy Benefit Managers, giving the new entity control of a third of the market, which would be equal to the market share owned today by CVS.

In 2017, a proposed merger between Cigna and Elevance Health, formerly Anthem, was struck down in court. A proposed merger between Humana and Aetna was also canceled in a federal court the same year. Large, powerful insurers, and the PBMs they own, have come under increased scrutiny from federal regulators.

The Biden administration has already launched a warning shot, indicating it will be scrutinizing private equity acquisitions in health care. In September, the Federal Trade Commission sued private equity firm Welsh, Carson, Anderson & Stowe after it bought up nearly all of the anesthesiology practices in Texas and then, with competition removed, began to jack up prices. FTC chair Lina Khan made it clear the suit was intended to send a message to all consolidation attempts that might harm patients.

United to Change Prior Authorization Policy

According to a November 27 policy update from UnitedHealthcare (UHC), the payer is updating its Home Health prior authorization and concurrent review process for services that are delegated to Home & Community Care, the payer’s home care division.

The updated policy, which are set to take effect January 1, will affect United’s Medicare Advantage and Dual Special Needs plans in 37 states, a UnitedHealthcare news release stated.

In Summary

  1. Start of care visits still do not require prior authorization.
  2. Providers must notify Home & Community Care of the initiation of home care services. UHC encourages providing notice within five days after the start of a care visit to help avoid potential payment delays.
  3. Before the 30th day, providers must request prior authorization for days 30 to 60, by discipline, and provide documentation to Home & Community Care.
  4. For each subsequent 60-day period, providers must request prior authorization, by discipline, and provide documentation to Home & Community Care during the 56- to 60-day recertification window.

UHC says it will respond to questions about the prior authorization approval process at HHinfo@optum.com

In related news, in its annual investor conference call, the company projected “revenues of $400 billion to $403 billion, net earnings of $26.20 to $26.70 per share and adjusted net earnings of $27.50 to $28.00 per share” for 2024. Cash flows from operations are expected to range from $30 billion to $31 billion.

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
Tim@RowanResources.com

©2023 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

 

 

CMS is Already Hurting Home Care and Now MedPAC Wants to Make it Worse

CMS

by | Dec 13, 2023 | CMS, Regulatory

by Kristin Rowan, Editor

Last week, MedPAC met for their December meeting to discuss “Assessing payment adequacy and updating payments.” Hospice services and Home health care services were each presented separately to Congress and commissioners are set to review the key indicators and discuss updates to Medicare payment rates for 2024.

The findings presented to Congress gave me whiplash.

Hospice Services

  • There is ‘mixed evidence’ on whether hospice reduces Medicare expenditures, but is has important benefits for beneficiaries
  • 2021 saw a 6% increase in hospices, mostly in for-profit agencies
  • Hospice use rates are down overall, but MedPAC blames the effects of the pandemic on death rates and patterns of care
  • Hospice use continues to shift from SNFs to in-home care
  • In 2020, 18.6% of hospices exceeded the payment cap
  • MedPAC recommends the cap be wage adjusted and reduced by 20%

See the full Hospice Services presentation to Congress here.

Opinion

Of the 18.6% of hospices that exceeded the payment cap in 2020, 17.2% of those were also in the highest bracket of hospice providers with stays longer than 180 days. The payment cap is not enough to cover patients who need hospice care for longer time periods, even though the requirement for hospice care is expected death within 6 months. If hospice is intended to care for a patient for 180 days, shouldn’t the payment cap be equal to 180 days of care? If a hospice provider is caring for a patient for longer, shouldn’t they get paid more?

MedPAC is convinced that lowering the cap would only impact those hospice providers who have the longest stays. However, if those hospices can no longer provide care because the payment cap has been reached, it will fall to other providers to continue care, stretching the already overworked hospice nurses even thinner.

Home Health Care Services

  • The Bipartisan Budget Act (BBA) of 2018 prompted CMS to implement PDGM and required MedPAC to review PDGM in its first year of operation
  • BBA 2018 changes must be budget neutral
  • CMS issued a $2 billion one-time reduction for overages and a 3.925 percent permanent reduction
  • The decline in the number of Home Health Agencies continues
  • The number of FFS beneficiaries declined, but the per capita use of HHS increased
  • The median Medicare margin (profit) for efficient providers is 28.4 percent, but only 14% of HHAs met cost and quality criteria
  • The median Medicare margin indicates Medicare payments are too high

Opinion

This makes about as much sense as the new phenomenon “dog math.” 14% of all Home Health Care agencies are considered efficient. On average, those who are efficient have a 28% Medicare profit margin. Among 133 industries reporting gross profit margins across the U.S., a 28% profit margin puts Home Care Agencies at number 104 out of 133, much lower than the average or median profit margins of every other industry.1 The all-payer margin is about 12%, making them the second least profitable industry in the U.S., coming in only slightly higher than auto manufacturers. The smallest HHAs have a profit margin just under 6%. MedPAC’s stance seems to be that if an HHA is making enough money to barely survive, they are making too much money.

See the full Home Health Care Agency presentation to Congress here.

 

©2023 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Home Care Technology: The Rowan Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com