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...

Insurance Industry Insider Instructs Providers

CMS

by | Sep 16, 2020 | CMS, Editorial

Insurance Industry Insider Instructs Providers September 16, 2020 by Wendell Potter (Adapted with permission from an article posted on the author’s Twitter feed. –Editor) My former colleagues in the health insurance industry claim they are waiving all costs of...

Medicare Advantage Is Neither Medicare Nor an Advantage

Admin

by | Feb 1, 2023 | Admin

by Wendell Potter

Medicare Advantage is a money-making scam. I should know. I helped to sell it.

Right now, well-funded lobbyists from big health insurance companies are leading a campaign on Capitol Hill to get Members of Congress and Senators of both parties to sign on to a letter designed to put them on the record “expressing strong support” for the scam that is Medicare Advantage.

But here is the truth: Medicare Advantage is neither Medicare nor an advantage.

And I should know. I am a former health-care executive who helped develop PR and marketing schemes to sell these private insurance plans.

During my two decades in the industry, I was part of an annual collaborative effort to persuade lawmakers that Medicare Advantage was far superior to traditional Medicare — real Medicare. We knew that having Congressional support for Medicare Advantage was essential to ensuring ever-growing profits — at the expense of seniors and taxpayers. We even organized what we insiders derisively called “granny fly-ins.” We brought seniors enrolled in our Medicare replacement plans to Washington, equipped them with talking points, and had them fan out across Capitol Hill.

Instead of joining with the corporate lobbyists in extolling the benefits of Medicare Advantage while obscuring the program’s numerous problems… Congress should work to lower the cost of health care.

 

Apology and Accusation

I regret my participation in those efforts. Over the 20 years since Congress passed the Medicare Modernization Act, the Medicare Advantage program has become an enormous cash cow for insurers, in large part because of the way they have rigged the risk-scoring system to maximize profits. As Kaiser Health News reported last month, the Center for Medicare and Medicaid Services estimated “net overpayments to Medicare Advantage plans by unconfirmed medical diagnoses at $11.4 billion for 2022.” That was for just one year. Imagine what the cumulative historical total would be.

The Medicare and Medicaid programs have become so lucrative and profitable for insurers that UnitedHealth Group, the nation’s largest health insurer and the biggest in terms of Medicare Advantage enrollment, got 72 percent of its health plan revenues in 2021 from taxpayers and seniors. In fact, all of UnitedHealth’s enrollment growth since 2012 has been in government programs. Enrollment in the company’s employer and individual health plans shrank by 370,000 between September 30, 2012, and September 30, 2022. Much of the $81 billion UnitedHealth collected in revenues in the third quarter of last year was subsidized by American tax dollars.

Members of Congress on both sides of the political aisle – and both sides of the Capitol – are at long last calling for more scrutiny of the Medicare Advantage program. Sen. Chuck Grassley has called for aggressive oversight of Medicare Advantage plans to recoup overcharges and was quoted in the Kaiser Health News story. As was Sen. Sherrod Brown, who said that fixing Medicare Advantage is not a partisan issue. As Rep. Katie Porter commented, “When big insurance bills taxpayers for care it never intends to deliver, it is stealing our tax dollars.”

I know that Democrats and Republicans alike care about the financial stability of the Medicare program. Instead of joining with the corporate lobbyists in extolling the benefits of Medicare Advantage while obscuring the program’s numerous problems, and in the process helping Big Insurance make massive profits, Congress should work to lower the cost of health care.

Medicare Advantage is a money-making scam. I should know. I helped to sell it. And I am going to continue working alongside patients, caregivers, and elected officials to address the problems.

 

Wendell Potter is the former vice president for corporate communications at Cigna. He is now president of “Business for Medicare for All” and author of bestselling books Deadly Spin and Nation on the Take.

commondreams.org/author/wendell-potter

 

©2023 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Common Dreams.org. Reprinted by permission 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

Connecticut Home Care Nurse Murdered

Clinical

by | Nov 8, 2023 | Clinical

Untitled Document

by Elizabeth E. Hogue, Esq.

Joyce Grayson, a home health nurse for Elara Caring, was murdered on October 28, 2023, in the home of a patient where she was providing services. Ms. Grayson was reported missing by a family member to the local police department. The family member was also able to track her last location to the home of a patient she was scheduled to visit at 8:00 a.m. on the day of her death. The patient resided at a halfway house for convicted sex offenders. Police have not yet formally identified a suspect in Ms. Grayson’s death.

This horrible news reminds of steps that staff members and providers can take to protect their staff members:

  • Staff members should be sure of the locations of patients’ homes and have accurate directions. · Employees should contact their supervisors in the event of threatening circumstances.
  • During visits, employees should remain alert and watch for signs of possible violence; such as verbal expressions of anger and frustration, threatening gestures, signs of drug or alcohol use, or the presence of weapons.
  • When employees are verbally abused in patients’ homes, they should ask the speaker(s) to stop. If verbal abuse continues, caregivers should leave patients’ homes and notify their supervisors that they have done so. · If possible, caregivers should identify more than one exit from patients’ homes and keep a clear path to at least one of them.
  • All employees should read or reread The Gift of Fear by Gavin de Becker and take action when their instincts tell them that they should be fearful. · Management should develop a written policy of “zero tolerance” for all incidents of violence, regardless of source. The policy should include animals! The policy must require employees and contractors to report and document all incidents of violence, no matter how minor. Emphasis should be placed on both reporting and documenting. Employees must provide as much detail as possible. The policy should also include “zero tolerance” for visible weapons when caregivers are present in patients’ homes. Caregivers must be required to report the presence of visible weapons.
  • Agencies should develop quality indicators that improve efforts to protect staff. Indicators in quality and safety standards should include patient assault and other instances of violence or threatened violence. The results of these indicators should result in violence prevention plans and training programs in de-escalation of violence.
  • Data systems should be strengthened to monitor the exposure of staff members to aggression. More resources should be invested in measuring aggressive events and specific factors that resulted in exposure, such as patient type.
  • Ongoing education should be provided to protect staff. Education should focus on intentional actions that staff members must take to recognize, document, and counter threatened or actual violence.

The Connecticut General Assembly recently passed a law to increase protection for healthcare workers that does not include home care providers. Now lawmakers are calling for extension of the legislation to include home healthcare staff. Martin Looney, President Pro Tempore of the Connecticut State Senate told the CT Mirror: “More and more care is going to be provided in a home setting, which is generally a good thing. But if that is true, we need to make sure that the people who are providing that care are safe.”

Amen to that, Mr. Looney! Let’s get to it!

©2023 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.

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

 

 

NAHC Fights for Home Health on Capitol Hill

Admin

by | Jan 31, 2024 | Admin, CMS, Regulatory

By Kristin Rowan, Editor

The National Association for Home Care and Hospice joined other advocacy groups this month on Capitol Hill to fight against the looming pay cuts from CMS. Some members of Congress joined the fight for “common sense policies” to expand access to care in the home for Americans.

Rep. Adrian Smith (R-NE-3), who spoke at the event, decried moves against home health, saying “there are cuts looming that are not based on reality” and “we want to make sure reimbursement policies are reflective of the actual realities.” Smith is also the representative who introduce the “Homecare for Seniors Act,” H.R. 1795, which would allow the use of Health Savings Accounts (HSAs) to be used for home care.

Rep. Terri Sewell (D-AL-7) has a personal connection to home care and spoke about how her mother cared for her father through a series of strokes he suffered. She expressed strong opinions about payment reductions that could see home health lose as much as $20 billion dollars over the next ten years. Sewell called the idea “frightening” and said, “I am a big fan of making sure that my constituents have access to quality, affordable health care.”

The Medicare program has admitted that home health is not just a bringing of great care and not just a more cost effective way to provide care, but is a service that provides dynamic value. Care in the home has decreased overall costs by $3.2 billion dollars just in the small segment of value-based payment model test cases. Patients who receive care in the home are re-admitted to the hospital 37% less frequently than those who do not and are 43% less likely to die than patients who do not receive care at home. Still, CMS is looking at additional pay cuts which bring the total payment reduction down 13.72% since 2019. The costs of everything else have increased in that time. According to the U.S. Bureau of Labor and Statistics, the average cost of living has increased 22% since 2019. NAHC President Bill Dombi said, “Where we’re headed in 2024 is that half of all home health agencies will be operating in the red with the cuts facing them in the Medicare program. It’s not a recipe for continued access to care.”

Dombi, along with many others, is predicting that 50 percent of agencies will be operating in the red after the next round of payment reductions and that without a reversal of these pay cuts we could see the end of care at home altogether with a collapse of the home health payment system.

The advocacy event on Capitol Hill helped raise awareness of the plight of care at home among some policymakers, but more help and advocacy is needed. Please, take a few minutes to click the link below and tell your members of Congress to support the Preserving Access to Home Health Act of 2023.

# # #

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

 Please GO HERE to tell your members of Congress to support the Preserving Access to Home Health Act of 2023