Patient Relationships Drive Satisfaction

by Kristin Rowan, Editor

Caregiver Motivation

HHAeXchange recently conducted a survey of more than 3,900 caregivers. The company set out to understand caregiver motivation and to use this information to increase caregiver satisfaction and improve outcomes.

Highlights

This data highlights the motivations of caregivers to improving health and wellness for their patients

Caregiver Motivation Relationships
Caregiver Motivation client care
Caregiver Motivation Survey Training
Insights Survey Top Tools<br />
Insights Survey Top Motivators<br />

From HHAeXchange

While the challenges and demands of being a caregiver still remain – low compensation, feelings of stress and exhaustion, and risk of catching infectious diseases – this survey shows that caregivers remain committed to their work to improve the lives of their patients. As more individuals seek homecare options, the homecare industry must continue to evolve to ensure caregivers are given the resources and recognition they need to remain motivated and focused on patient care.

Stephen Vaccaro, President, HHAeXchange

For more details and information about the study, see the HHAeXchange press release.

Kristin Rowan, Editor
Kristin Rowan, Editor

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. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

NAHC NHPCO Town Hall

by Kristin Rowan, Editor

The Alliance

On June 18, 2024, the National Association for Home Care & Hospice (NAHC) and the National Hospice and Palliative Care Organization (NHPCO) announced they had met in Washington D.C. to formally sign an affiliation agreement between the two organizations. After 18 months of meetings, conversations, and compromises, the two groups announced their “Alliance” would be the leading authority of the care at home community.

Bill Dombi Ken Albert Town Hall Alliance

During the opening keynote address at the NAHC Financial Management Conference in July, Bill Dombi, President of NAHC and interim President of The Alliance, and Kenneth Albert, Chair of the Transition Board of Directors overseeing the merger, spoke about the progress they have made.

Albert spoke of the thoughtful consideration the board and members of both organizations have put into this change. They are focusing on the biggest concerns of home health and hospice providers both now and in the future. The unification will create one voice as they advocate for home health and hospice in Washington D.C.

New Leadership

Albert and Dombi shared the stage at the NAHC Financial Management Conference about the ongoing search for a CEO of the new organization. According to Albert, there were some candidates who were very excited about the role, but whom the board did not feel there was a great fit. Contrarily, there were candidates the board eagerly wanted to move forward with who declined to continue the process. According to Dombi, the search has gone outside care at home as they look for the right fit from qualified candidates from multiple industries. Both agreed that they felt the search was close to over and they should have an announcement about the new CEO, and possibly the new name, sometime in August of this year.

New Resources

The conjoined organization promises more than just new leadership. Currently under construction is a new logo and website to encompass both groups. Dombi alluded to new resources for providers, training for quality care, and other tools for the industry. While the organization’s name and leadership are forthcoming, the website is projected to launch sometime in the spring of 2025. 

Operating as One

Since the announcement of the merger last year, and even before the deal was inked, NAHC and NHPCO have already been integrating. Dombi told The Rowan Report in a previous interview that the two groups have already been lobbying together, working on policy together, and integrating the management of the two associations. 

The Last NHPCO Conference and the First Alliance Conference

September, 2024 marks the final standalone event for the NHPCO. The 2024 NHPCO Annual Leadership Conference runs September 16-18, with a pre-conference September 14-15 in Denver, CO. The conference will have on-demand access until December 31, 2024. NAHC members will receive member rates to the NHPCO conference. 

The “2024 Home Care and Hospice Conference and Expo” will be the last conference held solely by NAHC, but we are seeing quite a few hospice companies on the exhibitor list and expect this to be a sneak peek at future conferences. The national conference is scheduled for October 20-24, 2024 in Tampa, Florida. This will also mark the final conference for Bill Dombi as President. Dombi announced earlier this year that he will retire at the end of 2024.

NAHC NHPCO Alliance Town Hall
NAHC NHPCO Alliance Town Hall

Town Hall

With quite a few remaining unanswered questions about the future of the two organizations, NAHC and NHPCO hosted a virtual Town Hall on July 31, 2024. With more than 250 association members from both groups in attendance, Bill Dombi and Ben Marcantonio, interim-CEO for NHPCO, along with Kenneth Albert and Melinda Gruber, Vice Chair of the Transition Board of Directors.

Naming "The Alliance"

Albert mentioned that there has been some success using the term Alliance, but it is not a long term solution. The finalization of the name is awaiting some trademark issues to be ironed out and that announcement, which they had hoped to be able to make in July, is coming soon.

CEO Search Update

Gruber thanked the search committee and recruiting firm for their work on the CEO search. Gruber reiterated that they are nearing the final selection phase and after board approval, an announcement will be made. 

Website

Ben Marcantonio, current interim CEO of NHPCO and future CIO of The Alliance confirmed that the new website will allow access to both legacy websites (the current NAHC and NHPCO websites). The new website will have a preliminary version this fall with a fully completed version next spring.

Members of either organization will have full access to the preliminary version of the website this fall. Currently, members can only access information from their own organization, but Marcantonio stressed that if there is information you need, they can help you access it.

Integration

There are eleven committees working together to integrate the two associations. advocacy, programs, education, and HR are a few of these workgroups that each have two to three high priority goals that will most effectively bring about the integration of the two groups. Work plans are now in place to create significant integration by the end of the calendar year. 

Policy and Advocacy

Bill Dombi presented an updated on the joint policy and advocacy issues The Alliance is undertaking. “What stands out for the immediate term has been how the resources have been employed of the two legacy organizations under the banner of The Alliance, focusing on hospice and palliative care,” Dombi said, “In a matter of weeks we saw significant regulatory and legislative action taking place.”

Hospice

The Hospice Final Rule 2025 has undergone an intense review and indepth analysis by members of both teams. The rule will have “tremendous impact” under the Medicare hospice program.

According to Dombi, the two organizations have come together to jointly fund a research project for the Special Focus Program to understand the impact and targeting. Dombi is hopeful that U.S. Representative Earl Blumenauer’s (D-OR) discussion draft will serve as a stepping stone for Hospice reform.

Home Health

The ongoing battle in Congress against CMS is gaining momentum. Dombi said there is a “tremendous amount of support” in Congress to role back the authority of CMS to institute rate changes and rate cuts under the Patient Driven Groupings Model (PDGM). “We have gained a seat at the table, which really helps,” Dombi said. We are continuing with litigation challenging Medicare’s validity of the regulation which has set all these rate cuts in motion.

Medicaid Home and Community-Based Services

The Final Rule modified in a positive way the 80/20 requirement. “We agree with the intentions of improving the status of direct care workers who positively impact so many lives. But in the absence of additional funding, it’s very very difficult to support this rule,” Dombi said. The modification stepped back from the more “draconian” interpretation, but The Alliance is not yet satisfied with the result. There is talk of a joint lawsuit challenging the validity of that rule.

Private Duty

The Private Duty Home Care world, one of the less regulated in the industry, is gaining a lot of attention from Fair Labor Standards as well as Non-Compete Laws. There is currently a joining of forces around solutions that will help Private Duty in the workforce arena, more specifically the Credit for Caring Act, which is gaining some traction, and would offer some financial support for family members who are paying for home care services directly.

The Alliance Needs You

Bill Dombi’s final statement in the Town Hall meeting centered on advocacy. He called for everyone who was in attendance and every member of both legacy organizations to join the fight. Everyone needs to part of that team of advocacy.

Final Thoughts

There is much more news to come out of these to associations as we near the end of 2024, and still more through the first quarter of 2025. The Rowan Report expects additional announcements to be made at both the NHPCO and NAHC annual conferences and we will be there to update everyone on the progress and statements coming out of those two meetings. 

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Kristin Rowan, Editor
Kristin Rowan, Editor

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. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

2025 Hospice Final Rule

by Kristin Rowan, Editor

2025 Hospice Final Rule Update

On July 30, 2024, CMS issued its final rule for the 2025 Hospice Final Rule Update (CMS-1810-F), with updates to HQRP and HOPE. The rule also finalizes a proposal to change the statistical area delineations. This will impact the hospice wage index. The rule includes clarifications on the hospice election statement and notice of election as well as clarifying language around hospice admission and certification of terminal illness.

Wage Decrease for Some Hospices Assigned to a New Area

The change in area delineations will have a negative impact on some hospices. They will see a decrease in payments based on their new area. However, CMS emphasizes that, regardless of the area change, the maximum change is a 5% decrease from the 2024 wage index, as there is a 5% cap on any decrease to the wage index. 

2025 Hospice Final Rule Routine Annual Rate Setting Changes

Just one month after proposing additional deduction to the home health payment rate, the 2025 hospice final rule increases the base rate by 2.9%. This is an aggregate of a 3.4% inpatient hospital increase and a 0.5% productivity decrease. The quality data reporting requirement remains. Hospices that do not submit quality data would still see a 4% decrease in payment rates, yielding an aggregate 1.1% decrease. The payment update also includes an aggregate cap of $34,465.34 per individual per year.

Hospice Quality Reporting Program (HQRP)

The new rule includes two new process measures to HQRP:

    • Timely Follow-up for Pain Impact
    • Timely Follow-up for Non-Pain Symptom Impact 

These two measures are expected to begin in 2028 and address hopsice care delivery documentation on whether a follow-up visit occurred with 48 hours of the first assessment. The measures include visits where there was an impact of moderate to severe symptoms, both with and without pain.

Adoption and Implementation of HOPE

Hospice Outcomes and Patient Evaluation (HOPE) will replace the current Hospice Item Set (HIS) structure. The gradual roll-out will begin in FY 2025 and will collect data at different time points throughout a hospice stay. In contrast, HIS only collected data at admission and discharge.

New or expanded categories of HOPE relative to HIS include:

Hospice Payment Rule 2025

Changes to CAHPS Survey

CMS conducted an experiment in 2021 surrounding the Hospice CAHPS Survey. Based on those results, the final rule will implement these change to the survey:

    • The addition of a web-mail mode (email invitation to a web survey, with mail follow-up to non-responders).
    • A shortened and simplified survey.
    • Modifications to survey administration protocols to include a pre-notification letter and extension of the field period from 42 to 49 days.
    • The addition of a new, two-item Care Preferences measure.
    • Revisions to the existing Hospice Team Communication measure and the existing Getting Hospice Care Training measure.
    • The removal of three nursing home items and additional survey items impacted by other proposed changes in this rule.

Hospice Special Focus Program (SFP)

The SFP allows CMS to monitor those hospices that are identified as poor performers based on quality indicators from the CAHPS surveys. Additional oversight from CMS will “enable continuous improvement” for those hospices identified. The four measures used to determine poor performance are Help for Pain and Symptoms, Getting Timely Help, Willingness to Recommend this Hospice, and Overall Rating of this Hospice.

According to CMS, the final rule includes changes to the Overall Rating of this Hospice measure. CMS states that these changes are not substantive and will not impact the SFP algorithm. “CMS adjusts measure scores for mode of survey administrations, so the introduction of a new mode should not impact measure scores.” 

NAHC previously submitted comments to CMS stating that some aspects of the Hospice Special Focus Program are flawed and need to be adjusted for accuracy and fairness. NAHC/NHPCO has created a research project to understand the impact and validity of the Hospice Special Focus Program.

2025 Hospice Final Rule Conditions of Participation and Payment Requirements

There are language discrepancies in existing hospice requirements for medical director and physician designee, physician member, and payment requirements for the certification of the terminal illness and admission to hospice care. Therefore, CMS is making technical changes to the CoPs by adding the physician mmever of the hospice IDG as someone who can review technical information and provide certification of life expectancy. 

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Kristin Rowan, Editor
Kristin Rowan, Editor

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. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

HHAeXchange: An Interview with Paul Joiner

by Kristin Rowan, Editor

Paul Joiner Talks to The Rowan Report

The care at home industry changes seemingly daily with new regulations, HH agencies opening and closing, more people qualifying for Medicare, technological advances like artificial intelligence, and the list goes on. Since 2008, HHAeXchange has been part of the change and growth of the industry. This week, The Rowan Report sat down with CEO Paul Joiner to discuss HHAeXchange’s recent changes, upcoming changes, and acquisitions. 

Cashé Software

On June 18, 2024, HHAeXchange announced the acquisition of Cashé Software, a Minnesota-based solution for homecare operations and billing. The merging of these two companies yields expanded ability to help homecare providers and billers with compliance, streamlined billing, and optimized workforce management.

Generations Homecare System

Just three weeks later, on July 8, 2024, HHAeXchange announced the acquisition of Generations Homecare System, an all-in-one homecare agency management software solution that connects care teams, simplifies daily tasks, and maintains compliance. This pairing aims to drive innovation and excellence in homecare.

Minnesota Office and Call Center

Ten days after the acquisition of Generations, HHAeXchange announced the opening of a new office and call center in Bloomington, MN. The office will offer localized, skilled agents to provide timely, efficient, and responsive customer support. This location will also be a home base for HHAeXchange employees who work remotely in the area and will provide job opportunities and growth in Bloomington.

Paul Joiner: On the Record

Paul Joiner became the CEO of HHAeXchange in March of 2023. Joiner came to HHAeXchange after serving as CEO in the substance abuse and mental health space. We sat down with Paul this week to talk about his position, the recent acquisitions, and future plans for HHAeXchange.

The Rowan Report:

HHAeXchange has gone through significant change and growth just in the last couple of months. Can you tell us about some of the plans you made for HHAeXchange?

Paul Joiner:

A lot of the growth was keyed up when I came on board. I just took it to the finish line. Implementing growth effectively required some changes. There is some pressure in this industry to evolve quickly.

RR:

What are some of the challenges you faced?

Joiner:

The current issues of recruiting, onboarding, retention, and training put a lot of pressure on technology solutions. And the pace of that change makes it harder for tech solutions to keep up.

Paul Joiner, CEO, HHAeXchange

Paul Joiner, CEO, HHAeXchange

XRR:

Did that drive the strategy behind your recent acquisitions?

Joiner:

Looking at strategy in the context of current challenges: finding people who understand the space and finding knowledge applied in technology is not easy to find or to develop organically. Then we find businesses like Cashé where we like the people, their position, their geography, and they have pieces that will help us build toward our vision of being the leader in Medicaid homecare and driving value and efficiency.

RR:

What does acquiring Cashé do for HHAeXchange?

Joiner:

Well…I can’t tell you, because it’s part of a strategy that comes with a bigger reveal. But I can tell you that acquiring Cashé is part of our technology lift. They have built a new technology with modern architecture. We will use that as a starting point to provide an additional offering in the marketplace. Cashé enables us to build faster, and innovate faster. While we continue to invest in HHAeXchange, Cashé gives us a head start on modern tech that can be added to our current offerings, or sold as a stand-alone solution.

RR:

And what about Generations?

Joiner:

Generations is a great business that has put business logic and rules into their technology. They also have a geographical presence where HHAeXchange does not.

RR:

How did this rapid growth of two acquisitions and a new call center impact HHAeXchange?

Joiner:

Taking on this much change created the need for improved communication across three organizations. That communication helped us provide a better narrative for Cashé and Generations employees who may have been a little nervous about the change.

RR:

You must have some really great teams in those three organizations to navigate these changes.

Joiner:

We have a great team. There are a lot of people we’ve brought on board in the last two years as we continue to grow along with the incredible team of people who have been at HHAeXchange much longer. We’re comfortable dealing with scale, size, and complexity, so the changes didn’t overwhelm us.

RR:

What does future growth look like for HHAeXchange?

Joiner:

We will probably continue to acquire companies. Maybe not multiple companies in a matter of weeks, but we will continue when the opportunity arises. The spirit behind our strategy is to focus on what our customers need. We are in a position in the market to have a big responsibility to be good stewards, help our customers, caregivers, and agencies, and improve the quality of life for patients.

HHAeXchange is focused on getting the right technology into the hands of caregivers. We’ve already done EVV and point-of-care well. Can we make a difference now in how they are onboarded and scheduled? Can we make a difference in billing and how they’re getting paid? That requires acquisitions and investing organically.

RR:

Any final remarks on what the future holds for HHAeXchange?

Joiner:

Part of our vision board is building a community of caregivers through technology. The good agencies are trying to figure out how to think as much about the caregiver as they do for the people receiving care. Turnover and training is so hard, so we need to invest in our caregivers.

We also need to be a better supplier of data to arm agencies and health plans with the data they need so they can have useful discussion around the date and how they’re supporting caregivers. I’m sad sometimes because agencies don’t get enough financial support for their effort. The industry can be doing more for their caregivers.

We take our responsibility to do the right thing seriously. Because of this, we are investing in the space and we want more options so we can be better for the industry. Our intention is to make a difference.

RR:

Thank you, Paul for talking with us today. 

About HHAeXchange

Founded in 2008, HHAeXchange is the leading technology platform for homecare and self-direction program management. Developed specifically for Medicaid home and community-based services (HCBS), HHAeXchange connects state agencies, managed care organizations, providers, and caregivers through its intuitive web-based platform, enabling unparalleled communication, transparency, efficiency, and compliance. For more information, visit hhaexchange.com or follow the company on TwitterLinkedIn and Facebook.

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Kristin Rowan, Editor
Kristin Rowan, Editor

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. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

BREAKING NEWS: Warren, Cassidy React to Supreme Court Ruling

by Kristin Rowan, Editor

The Background

Senators Warren and Cassidy react to the landmark decision by the Supreme Court in Loper Bright Enterprises v. Raimondo. That decision effectively overturned the Chevron Doctrine, which gave deference to federal agency decisions in interpreting ambiguous statutes. Eliminating the Chevron Deference puts more responsibility on federal agencies to show reason behind their interpretations. Likewise, it requires Congress to be less ambiguous in its wording of statutes. This decision would impact CMS’s ability to create their own definitions of terms when calculating reimbursement rates, implementing rules.

Senator Elizabeth Warren Reacts

Warren Chevron Bill

Senator Elizabeth Warren (D-MA)

Less than one month after the U.S. Supreme Court decided the case that overturned Chevron Deference, Senator Elizabeth Warren (D-MA) introduced a bill in the Senate that would override the Supreme Court’s decision and establish Chevron Deference as law.

“Giant corporations are using far-right, unelected judges to hijack our government and undermine the will of Congress,” Warren said. According to Warren, the pending legislation, “The Stop Corporate Capture Act”, will stop corporate interest groups from using their own interpretations of statutes over the judgment of Congress or expert agencies.

Senator Cory Booker (D-NJ) called the Supreme Court decision “an egregious power grab from the US Supreme Court.”

Warren asserts that the overturning of Chevron Deference would put more power in the hands of industry-backed lobbyists who already have more negotiating power than the general public. This assertion is contrary to the majority opinion from Chief Justice John Roberts, who wrote, “Courts must exercise their independent judgment in deciding whether an agency has acted within its statutory authority.”

Increasing Congressional Authority

In addition to making Chevron Deference law, the Stop Corporate Capture Act would also:

Modernize and Reform the Regulatory Process

    • Streamline the White House’s review period for regulations, creating a 120-day time limit for review.
    • Authorize agencies to reinstate rules that are rescinded by Congress through the Congressional Review Act.
    • Reform agencies’ cost-benefit analysis to emphasize public benefits of a rule, including non-quantifiable benefits like promoting human dignity, securing child safety, and preventing discrimination.

Empower and Expand Public Participation in Rulemaking

    • Create an Office of the Public Advocate to help members of the public participate more effectively in regulatory proceedings.
    • Strengthen agency procedures for notifying the public about pending rulemakings.
    • Provide the public with greater authority to hold agencies accountable for unreasonable delays in completing rules. 
    • Require agencies to respond to citizen petitions for rulemaking that contain 100,000 or more signatures.

Increase Transparency and Protect Independent Expertise in Rulemaking

    • Require all rulemaking participants to disclose industry-funded research or other related conflicts of interest.
    • Require any submitted scientific or other technical research that raises a specified corporate conflict of interest be made available for independent public review. 
    • Bring transparency to the White House regulatory review process by requiring disclosure of changes to draft rules during that process and the source of those changes.
    • Require agency officials to provide justification when the regulatory review process ends with a rule being withdrawn.  
    • Establish financial penalties for corporate special interests that knowingly submit false information during the rulemaking process. 

Senator Bill Cassidy Responds

At the same time that Warren introduced her bill overriding Loper v. Raimondo, Senator Bill Cassidy (R-LA) introduced the “Upholding Standards of Accountability (USA) Act of 2024.” Cassidy’s bill takes the removal of the Chevron Deference further than simply overturning the previous ruling. According to the description, the USA Act imposes additional accountability in agency rulemaking. 

Senator Cassidy is the ranking member of the Senate Health, Education, Labor, and Pensions (HELP) Committee. He stated, “For decades, the executive branch has exploited Chevron deference to increase its power beyond what Congress intended, all while skirting congressional oversight. Now, with Chevron deference overturned, Congress must work to rein in the executive branch and hold it accountable to the people and their elected representatives.”

Cassidy Chevron Bill

Senator Bill Cassidy (R-LA)

Decreasing Agency Authority

The direct impact of the Supreme Court decision is that federal agencies do not get preferential treatment when interpreting a statute. Cassidy’s bill requires the head of any federal agency signing a major rule to testify before the committee of jurisdiction within 30 days of the rule’s publication.

Additionally, the bill would:

    • Require each person nominated to a Senate-confirmed position to testify before the committee of jurisdiction prior to Senate confirmation; 
    • Improve cost-benefit analyses by requiring federal agencies to conduct retrospective reviews of such analyses for major rulemakings within five years of each rule’s effective date; 
    • Clarify that federal agencies are permitted to communicate with Congress at all times regarding proposed rules; and  
    • Require timely, substantive responses to congressional oversight from federal agencies. 

Cassidy Challenges Existing Rules

Immediately after the Loper v Raimondo decision, Sen. Cassidy sent a letter to the U.S. Secretary of Education Miguel Cardona asserting that the Education Department has established rules outside of the authority given to it by Congress. He specifically alluded to the new Title IX rule. Cassidy asked Cardona, “How will the department change its current practice to enforce the laws as Congress writes them, and not to improperly legislate via agency action?”

Given Cassidy’s position in the Senate HELP Committee and his previous statements on medical debt, the multitude of bills he introduced on transparency, accountability, and decreasing authority, this is likely not Cassidy’s last attempt to challenge agency rules.

Likely Outcomes

Senator Warren's Bill

There are ten co-sponsors of Warren’s bill and a long list of endorsing organizations. Despite that, experts say the bill has only a slim chance of passing in an election year in the Senate, where Democrats currently have a narrow majority control. The bill is even less likely to pass in the Republican controlled House of Representatives. 

Senator Cassidy's Bill

Similar to Warren’s bill, Cassidy’s bill has a low likelihood of passing. The Democrat majority in the Senate may dismiss the bill before it ever reaches the house. In 2023, the 118th Congress passed only 34 bills, the lowest number in decades. With only a few months remaining for the Congress, and the focus turning to a new Democratic nominee, passing this, or any other, bill seems improbable.

Final Thoughts

Regardless of your political affiliation, the overturning of the Chevron Deference is good news for home health, hospice, and palliative care. This ruling puts more pressure on CMS to justify its reasoning for certain decisions it has made. Senator Warren’s bill threatens the advantage given to the home health industry related to NAHC’s senate and house bills and pending lawsuits. Senator Cassidy’s bill ensures federal agency oversight and requires CMS to rationalize their decisions and prove budget-neutrality.

We will continue following these and other Chevron Deference related stories.

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Kristin Rowan, Editor
Kristin Rowan, Editor

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. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Recruitment, Retention, and Reward: Product Review

by Kristin Rowan, Editor

Caregiver Recruitment, Retention, & Reward

The workforce shortage, caregiver burnout, after effects of the pandemic, and the advent of “quiet quitting” have impacted home care agencies’s ability to fully staff and care for their patients. Hiring new caregivers is not always an options. Agencies must put time and effort into recognizing, rewarding, and retaining their existing caregivers and clinicians.

The Rowan Report recently came across a company that is helping agencies do just that and we had an opportunity to sit down with their founder.

How it Started

Victor Hunt’s grandmother was a career nurse who started her own home care agency. However, the operation was too hard for her to handle on her own. She made the difficult decision to close the agency and go back to shift work. Victor realized that we need more home care agencies. But, he knew there had to be a way to help the people who have “home care heart” and can provide great care. There had to be an easier way.

Home Care Immersion

Before Victor and his team could address the difficulties faced by home care agency owners, they first had to understand them. With his co-founder Dan, Victor embedded himself into home care agencies. They took shifts, followed schedulers and recruiters, and experienced the problems up close. During this process, they got to know one agency in particular and one caregiver who was a rockstar. She picked up shifts, did training, contributed the company culture, visited patients in the hospital, and had referred more than 100 caregivers to the agency. In short, she was the home care clinician all agency owners want.

Her Name was Ava

Using this rockstart clinician, Victor and Dan set out to create a system that could turn every caregiver into an “Ava” and make every agency one that caregivers like Ava would want to work for. The mission of Victor’s and Dan’s company is to “make home care agencies destination employers.”

The Problem Statement

Home care agencies suffer from high turnover rates and performance challenges. THere is a lot of legwork that needs to be done to fill in the gaps and fix what isn’t done well. According to Victor, it comes down to a challenge of engagement and morale. Being a home care clinician is a lonely and thankless task. Caregivers can feel stuck in their career track unless they are actively pursuing higher credentials. The problem home care agency owners face is:

“How do we engage employees so their work feels recognized and meaningful?”

The Solution is Ava

The Ava team surmised that in order for caregivers to feel valued and appreciated, something had to give. The question, they wondered, was whether it would be margins or administrative overhead. AI was at the center of these conversations. But, traditional EMRs limit the implementation of AI solutions.

Recognition and Rewards

Because EMRs limit AI applications, Ava is an app but is also a stand-alone system that operates in a mobile browser. No download is required for use, yielding an 85-90% adoption rate within agencies offering Ava.

Ava connects to the existing EMR first to import data. Then, agency owners create their own rule sets. This offers incentives and engagement around specific metrics the agency wants to see. Examples include attendance, timeliness, number of hours, documentation, and completed training. 

Ava will then assign, track, and reward milestones based on the rules set for the agency. Clinicians earn points that can be redeemed directly from the Ava store with more than 100 participating vendors. Agencies can also add internal rewards like branded merchandise, PTO, and raffle tickets. Rewards can be redeemed in $5 increments. 

Recruitment, retention, and reward AVA

Communication

Ava includes automated messaging to recognize employees without taking valuable time away from administrators. The app sends recognition texts to all staff to congratulate clinicians for reaching certain benchmarks. Announcements can be sent by email or SMS to all employees at once. Additionally, Ava includes HIPAA compliant two-way communication between agency and staff.

Additionally, administrators can create groups within the system to send mass reminders to specific people. For example, you may create a group that includes all employees whose driver’s license will expire in the next 60 days. Within that group, reminders are sent to ensure updated information is added to the employee file. The system updates automatically each week, adding and removing employees from the group based on the criteria created. 

Surveys are a great way to keep a pulse on the level of commitment and satisfaction your employees have. Studies suggest that engagement is a large factor in why employees leave their workplace. Ava includes pre-built survey templates but also allows you to crete a survey using an AI query. The survey questions and answers are customizable, can be “required”, set to “read only”, and can include a comment box to gain additional insights. Administators can filter survey responses to only see a certain type of answer.

Marketing

Recruitment, retention, and reward AVA

Referrals from employees is not a new concept. However, it is not always a visible part of your recruiting strategies. Ava has a referral bonus program with automated milestones. The bonus program spreads the referral bonus out across multiple agency milestones. 

Ava also allows for manual tracking of Google Reviews or any other event or milestone where clinicians can be measured, tracked, and rewarded. 

Customizable on Multiple Fronts

In addition to the custom survey questions and benchmarks, Ava includes custom naming conventions to track clinicians. One agency uses the term “activity tag” to categorize achievements. If your agency already uses different terminology, that can be added to the system. 

Currently, Ava operates and switches between seven different languages. Additional languages can be added to the system and Ava can support those as well. 

Recruitment processes are also customizable. Agencies can give candidates access to the system during the hiring process and they can earn points for attending the interview, completing onboarding paperwork, finishing the first training shift, or other measures. This allows the agency to reward a new employee with, for example, a coffee gift card by the end of their first day. 

Track and Reward Your Top Employees

When your agency finds an exemplary employee, the unicorn, the “Ava”, keeping them becomes a top priority. Finding and training new employees is costly and time consuming. It is far easier and less expensive to reward your current high-achievers.

Badges

In addition to daily, weekly, and monthly goals, Ava has a tier system called “Badges.” Badges are long-term drivers of engagement, satisfaction, and success. The current badges are Orange (Avas brand), Silver, and Gold. There are points multipliers at each level. 

Once an employee reaches a badge level, they have to maintain a consistent 90% goal completion rate in daily, weekly, and monthly goals in order to maintain their badge level. Loss aversion to lowering back down a level encourages a high completion rate of other tasks. 

Training

Caregivers and clinicians should be constantly learning to stay ahead of the newest trends and technologies in the industry. Ava includes learning management system (LMS) integrations with several of the top training companies in the industry. Clinicians can access learning modules through the app or browser and can earn rewards by completing training modules based on individual agency settings. 

Reporting

Reports within the system go beyond badges and benchmarks. The system consolidates reporting from various data sources and allows you to see your business health at a glance. These reports can help catch burnouts before they happen, focus performance improvement plans, and automate process than can save an agency hundreds of thousands, if not millions, of dollars per year.

Limitations

Like most software solutions, the first iteration of a usable system is never the last version. Ava has already integrated with WellSky and can access several other EMRs. As they continue onboarding customers, the team at Ava is very open to the suggestions of their users and will continue adding features.

Some current limitations we noticed in our intial demo:

The badge system has only three levels. Longer term employees may want to see higher badge levels to maintain motivation. Victor noted that AI systems can help add account-specific customizations.

The app is designed for caregivers and clinicians. There is not currently a model for back-office administrators and support staff. While some customization could make the app usable for the back-office, it is not designed with them in mind.

Mass messaging through email or SMS is limited to one-way, read-only communication. There is an option to add “likes,” but currently there is no option for a group or individual to respond, even privately to a company-wide announcement.

The two-way communication is limited to internal staff. Employees cannot communicate with patients from the app to advise them of their arrival time, reschedule an appointment, or ask questions before an appointment.

The manual tracking of Google reviews is not scalable.

When The Rowan Report sat down with the team at Ava, we asked about some of these limitations and additional ideas for future iterations of the program. Victor and his team have already hired at least one person to focus on new feature requests.

Final Thoughts

Gamification is not a new concept in many industries. In fact, most of us probably have a memory of a teacher or parent with an activity board to earn stars for tasks completed. We’ve been unknowingly using gamification for many years. 

Smart phones, advancing technologies, and AI have increased the adoption of gamification and is infiltrating the care at home world quickly. The ongoing workforce shortage will make implementing these types of gamified systems even more important for an agency’s financial well-being. 

Ava may not be the first of its kind, but it has shown innovation and ingenuity in it application. If your agency is looking for ways to reward employees, needs to stand out among rival employers, is looking to reduce administrative costs, or needs a simpler way to see reports and statistics from multiple sources, Ava may be a viable solution. 

We see great things coming with future iterations of the app and the software and I’m sure this is not the last we will here of Ava. For more information, visit joinava.com.

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Kristin Rowan, Editor
Kristin Rowan, Editor

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. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Chevron Deference Derailed

by Kristin Rowan, Editor

Chevron Deference

“A government agency must conform to any clear legislative statements when interpreting and applying a law, but courts will give the agency deference in ambiguous situations as long as its interpretation is reasonable.”

This statement followed the unanimous (minus the three who did not take part in the decision) U.S. Supreme Court decision in the Chevron U.S.A., Inc. v. National Resources Defense Council. The case is known for establishing the extent to which a federal court should defer to a government agency’s interpretation of an ambiguous statement when constructing statutes.

Breaking Down Chevron Deference

For those of you who don’t have a law degree, here’s what that means:

  • When a statutory term (required by law) is not explicitly defined and explained by Congress, there is room for interpretation
  • When a government agency interprets that statutory term, the interpretation may come under question
  • As long as the interpretation is not arbitrary (random), capricious (impulsive or unpredictable), or contrary to the statute (opposite the intent when put into practice), federal courts should give more weight to the government agency’s interpretation than to any other interpretation

Implications

At the time, the Supreme Court argued that if Congress leaves a term open to interpretation, it is either stated openness to interpretation, or an implied openness to interpretation. If a statute is implicity open, the intent of Congress is to allow a government agency to create provisions and regulations from that statute as they see fit. 

No one foresaw the impact this ruling would have on commerce and regulation in the U.S. To date, the Chevron Doctrine has been cited nearly 18,000 times in federal court decisions. The application of a statute based on agency interpretation could no longer be questioned or changed by judicial review.

Chevron Deference in Home Health

Since the advent of the PDGM model, CMS has calculated payment rates based on its interpretation of budget neutrality. The National Association for Home Care and Hospice has disputed the validity of both the interpretation of budget neutrality and the formulas used to calculate it.

Last year’s 2024 CMS Proposed Rule cut payment rates even further with a 2.890% Budget Neutrality permanent payment rate adjustment and a temporary rate adjustment to account for alleged overpayments from 2020-2022.

The lawsuit filed against CMS in response to the 2024 Final Rule was dismissed. NAHC began pursuing an administrative review with CMS. However, CMS has already stated that their final position is that budget neutrality has been calculated within the law. 

NAHC Comment: 2023 CMS Rule

“That proposal also fails logically in that it puts care access in severe jeopardy in applying a budget neutrality reconciliation methodology that takes PDGM-induced behavior changes to assess what otherwise would have been expended by Medicare in the absence of PDGM. In doing so, CMS fully fails to meet its obligation to ensure that the transition to a new payment model is budget neutral.”

  1. NAHC Comment Source

Chevron Deference Repealed

In a landmark ruling on Friday, June 28. 2024, the Supreme Court removed the power of federal agencies to interpret laws and ruled that the courts should rely on their own intrepretation of ambiguous laws. Justice Elena Kagan, who dissented the ruling, predicts this change “will cause a massive shock to the legal system.”

Chief Justice John Roberts explained in his opinion that the Chevron Deference is inconsistent with the Administrative Procedure Act (APA). The APA is a federal law which contains instructions for courts to review actions by federal agencies. According to Roberts, the APA directs courts to decide legal questions using their own judgment. Therefore, he noted, agency interpretations of statutes are not entitled to deference. “…it remains the responsibility of the court to decide whether the law means what the agency says,” concluded Roberts.

NAHC to Refile Lawsuit after Chevron Deference Repeal

2024 Final Rule

In April, 2024, the lawsuit filed against CMS regarding the methodology for calculating budget neutrality was dismissed. Now, NAHC can refile the lawsuit and force CMS to justify its decision to enact repeated reimbursement cuts for home health.

In an interview on Wednesday, Bill Dombi told The Rowan Report, “This improves the chances of success for our lawsuit. CMS is going to have to support their regulatory interpretations going forward. Congress is going to have to offer more detail in its legislative language, leaving less to being open to interpretation.” Regarding the PDGM lawsuit, CMS argued that the law was clear and the agency’s interpretation was valid. The overturning of Chevron Deference allows the possibility of arguing that CMS’s interpretation of the law is flawed. 

80/20 Rule

Dombi also explained that the Ensuring Access to Medicaid Services rule, also known as the 80/20 rule, was “drawn out of a whole cloth.” Previously, there were limited avenues available to challenge this rule. The repeal of Chevron Deference significantly improves the ability to challenge the 80/20 rule. The argument now, Dombi told The Rowan Report, is “Does CMS even have the authority to do this?”

More to Come

The Rowan Report anticipates more news coming out of Washington D.C. and the NAHC office regarding the 2024 pay cuts and the 80/20 rule. We will provide ongoing updates and information as it becomes available.

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Kristin Rowan, Editor
Kristin Rowan, Editor

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. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

A New Path for Recruitment and Retention

by Kristin Rowan, Editor

Recruitment and Retention amidst the national workforce shortage is not a new topic for The Rowan Report. We have feature articles dating back months, even years, talking about how you can recruit the top talent in the industry and keep the best employees you have. A lot of companies look at wages as the driving force for retention of great employees. While there is some merit to that idea, wages are not always the strongest indicator of employee satisfaction. In fact, happy employees say it would take a substantial (more than 30%) raise to get them to leave a great workplace.

The reality for many home health agencies (HHAs) is that higher wages are not always possible with the rising costs of everything else and the lower reimbursement rates from CMS. HHAs have to be creative in their recruitment and retention strategies and find new ways to engage their staff. Incentivizing staff outside of wage increases is becoming a standard part of recruitment and retention strategies and we’ve seen several of these companies popping up recently. And we’re not the only ones who have noticed.

The Rowan Report met with the team at Ava and will have a product review for you next week. In the meantime, you can read the press release from Wellsky here.

About Wellsky

Recruitment and Retention Wellsky Ava

Wellsky, a leading home health technology company, has been focusing on patient-centered coordinated care. The software for home health includes intake, scheduling, care delivery, claims management, analytics, and more. Recently, Wellsky has included caregiver retention as part of their platform, in a partnership with Ava.

About Ava

Ava is a home-care-focused employee management solution that personalizes your employee incentives and sends automated reminders to your staff. Together, Wellsky and Ava created “TeamEngage”, using Ava’s platform connected directly to your workflows. WellSky Team Engage promises to improve retention, incentivize productivity, capture engagement insights, and allow you to hire more efficiently.

Recruitement and Retention Ava Stats

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Kristin Rowan, Editor
Kristin Rowan, Editor

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. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Generative AI Comes to AlayaCare

by Kristin Rowan, Editor

Generative AI and Artificial Intelligence are taking the world, and the care at home industry, by storm. Not surprisingly, there are only a few companies that are doing AI well. We’ve started reviewing the best of of them. So far, each company doing AI well has a unique solution to a pain point in home care. No two companies are approaching or using AI the same way. This week, we’d like to re-introduce you to a company we’ve reviewed before that has a new Generative AI app launching soon.

History

Practically a household name in home care, AlayaCare is a 10-year-old software company that started as a mobile workforce platform. Like many of us, once Adrian Schauer, Co-Founder and CEO, spend some time in the care at home world, he was hooked. He shifted the focus of AlayaCare to the care at home space. With parents in their 80s, Adrian found a lack of inspiring software in the industry in Canada and he felt like that was an important problem to solve.

“Care workers are doing God’s work, and they are not getting the support they deserve,” says Schauer. In Canada, where AlayaCare started, agencies combine home health and supportive care. Because of this, the largest patient base on the AlayaCare platform is on the supportive care at home side, but they now operate within home health as well.  Since 2021, AlayaCare has added hospice to their network with the acquisition of Delta Health. 

AI Comes to AlayaCare

Through many iterations of the software, AlayaCare has advanced with new technological capabilities. Now, AlayaCare is embracing artificial intelligence; more specifically, Generative AI. Schauer explains that the purpose of their new AI technology is “to enable the type of care we want our loved ones to receive at home.” 

The new GenAI app was demoed in September of 2023 and is still in Beta testing. AlayaCare is anticipating an end-of-summer launch of the product.

Introducing...Layla

Layla is an in-app digital assistant, built on top of GenAI. It’s large language model allows the user to conversationally interact with the data in the system. It also includes a constrained internet search component. From the conversation, it can determine whether the user is seeking internal or external information.

Layla’s data exploration does more than just extracting data. The GenAi platform allows Layla to provide operational support around key metrics for employee retention.

Layla Generative AI AlayaCare

Agency Support

AlayaCare has determined some key factors in employee retention:

  • Utilization
  • Quality shifts
  • Qualified Hours
  • Recurrent shifts
  • Average weekly clients
  • Weekday hours vs weekend hours

Focusing on these factors, Layla provides improvements in onboarding, scripting information, data migration, and scheduler use of time.

Features

Visit Optimizer

AI generated, automated scheduler that takes into account route management, skill matching, daily hours, and schedule optimization to optimize care and reduce time from referral to first appointment.

The scheduling automation includes push notification capabilities to send schedule updates to clinicians in real time. As each week’s schedule is created, Layla can send a push notification to each clinician. It asks them to verify their availability and confirm the next week’s schedule.

Additionally, Layla considers environmental factors such as pets, neighborhoods, and other family members in the home.  According to AlayaCare users, the Visit Optimizer offers up to a 98% decrease in time required to fill visits, 35% improvement in visit fulfillment, and 35% improvement in data quality.

Notable

Notable transforms notes from patient visits, forms, and client records. Then, it uses AI to review, compile, categorize, and tag all the notes. 

From this information, Notable compiles an activity of daily living (ADL) for each client, including whether and why a task was completed. This information is also moved to the risk dashboard. The risk dashboard shows the whole population, the risk of that population, identifiable trends, risk level, and whether the risk has remained stable over time. All of this information is compiled into a single risk dashboard with customizable reports. 

Additional security measures for Notable include a grounded model to reduce the risk of AI hallucination and ensuring no PHI leaves the dashboard.

Employee Retention Dashboard

Several factors impact employee retention.  Among the top reasons for employee dissatisfaction are pay and benefits, inconsistent hours, and safety concerns. The current workforce shortage means keeping your best employees is more important than ever. With a quick snapshot of your employee satisfaction and engagement, you can address concerns earlier and improve turnover rates.

The employee retention dashboard highlights satisfaction scores, client capacity, scheduled hours, number of unique clients, overall turnover rates, turnovers by location, and more.

“Having a tool to predict employees who may be disengaged or dissatisfied prior to this happening is invaluable,” said Lee Grunberg, President & CEO, Integracare. “With the dashboard and algorithm behind it, we can see a caregivers’ satisfaction or engagement trend over time, and deploy preventative measures to reduce the likelihood that they’ll resign. It has empowered our coordinators to be much more retention-driven.”

On Deck for Layla

I spoke with Adrian Schauer, Co-founder and CEO of AlayaCare, during the online demo. “My passion project is…Layla. The people in your agency should be building relationships and making decisions. Anything else should be done by automation.” 

AlayaCare is currently in a high growth mode to build marketshare across the personal care and skilled sides of the marketing. Schauer’s goal is to elevate a level above their existing capabilities with home based care providers. This includes how payers are set up, how EVV is operating, lobbying, and advocacy. 

For Layla, AlayaCare is working on the GenAI capacity for chart completion by voice. Layla would use the conversational language model it already has to recognize and understand the conversation during a home visit and transcribe the conversation into notes, visit documentation, care plans, and codes.

Final Thoughts

As AI becomes more commonplace across care at home, we are scrutinizing AI platforms for safety, identity protection, accuracy, and ethical use. If you are looking for an AI solution for your business operations, we caution you to use discretion in your use of AI and thorougly vet the AI platform prior to adoption. We will continue to provide updates when Layla launches later this year. But, for now, it looks like we’ve found one more technology platform that is using AI the right way.

Kristin Rowan, Editor
Kristin Rowan, Editor

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. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

The Future of Care at Home

by Kristin Rowan, Editor

Home Nurses are joining unions. The advent and unionization of Hospital-at-Home (H@H) is changing the care at home landscape. Large hospital systems across the country have engaged in H@H studies and launched H@H programs, providing hospital-level ambulatory services in their communities. As H@H continues to take a foothold in the healthcare landscape, what do those changes mean for care at home?

Hospital at Home Popularity

Most of the existing H@H programs are operating under a CMS waiver. A few of the H@H programs use a private pay model. The CMS waiver needs to be extended in order to continue the programs. As many H@H organizations are pushing for CMS to extend the waiver, they are looking to patients for advocacy.

A recent survey by Vivalink showed that 84% of U.S. individuals over the age of 40 are interested in H@H monitoring after a hospital visit so they can return home sooner. 77% of respondents said they would trust a recommendation that included at-home monitoring. Respondents who had been hospitalized three or more times in the past 12 months were more interested in H@H programs than those who had been hospitalized less.

Massachusetts Ambulatory Nurses Unionize

On May 20, 2024, 33 ambulatory nurses from Martha’s Vineyard Hospital (MVH) filed with the National Labor Board to join a union that is already active within the hospital, the Massachusetts Nurses Association (MNA). The MNA currently represents 23,000 hospital workers from 85 healthcare facilities across the Commonwealth of Massachusetts. The hospital denied the request to join the union. The group of ambulatory nurses joined MVH through an acquisition of a physician’s group. Therefore, those nurses were not recognized under the existing collective bargaining agreement.

Hospital-at-Home Nurses at Mass General Unionize

The Hospital-at-Home nurses at Mass General Brigham (MGB) have unionized in the hopes of influencing the future of in-home acute care. They are also hoping this will encourage more people working in home healthcare to join unions. In the last seven months of 2023, almost half of all registered nurses working in home health care and non medical care at home left their jobs within a year. One registered nurse from MGB said she hopes HaH nurse unions become more common as HaH expands across the country.

The clinicians in the MGB home care segment are hoping to follow the H@H group into unionization soon. The home care segment, which includes home health, palliative, and other care at home services, are currently voting on whether to unionize.

Hospital-at-home nurses unionize at Mass Gen

Among the listed reasons for considering unionization are changes in expectations on productivity, and wages. Some of the more recent changes at MGB were rolled out across the company and did not take into consideration the territories and limitations that care at home clinicians have. More than 400 clinicians are in the care at home side of MGB and they have all received ballots to vote on unionization.

Home Health Unionization

hospital-at-home changing home health unions

The nature of care at home clinicians is disparate. Therefore, it is difficult to organize them into one cohesive group. Recently, though, more home health workers are looking to service workers and healthcare workers unions for better pay, better working conditions, and more buy-in on the day-to-day operations of the agency.

Opponents of unionization among home health clinicians argue that pay rates are largely set by CMS reimbursement rates. Employers may want to raise rates but are unable to do say because they accept Medicare and Medicaid. Home health unions could force employers to pay more than the set CMS rates.

CMS Response to Union Backlash

Otherwise known as the 80/20 rule, CMS responds to agencies worried about unionization with a mandate to pay their workers 80% of total Medicaid payments. Some agency owners say the proposed rule ignores the low reimbursement rates and further burdens agencies that are barely making a profit now. It is unlikely that CMS will see the unionization of home health clinicians as a reason to increase reimbursement rates. Experts advise agencies to start working on contract negotiations within the VBPM, to engage in risk-sharing and cost-benefit analyses with all parties within the VBPM. For example, Remote Patient Monitoring (RPM) is Medicare reimbursable, but not through home health use. However, a home health agency can share the benefits of RPM when it is billed through an approved provider for Medicare reimbursement. These strategies can lower overall care costs, increasing the share of reimbursement flowing to HHAs.

Maximize VBPM with Technology

Technologies available today include RPM, generative AI for data analytics, automated scheduling, and apps for secure communication, among others. Technology can lower overhead costs, allow you to eliminate some FTEs, and provide added value to providers during contract negotiations. If you don’t already have a robust tech-stack, look at some of our most recent product reviews, or contact The Rowan Report for more information about technology adoption consultations.

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Kristin Rowan, Editor
Kristin Rowan, Editor

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. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com