End of an Era

by Kristin Rowan | Oct 25, 2024 | Advocacy, CMS, Editorial, Regulatory

by Kristin Rowan, Editor

NAHC President Bill Dombi Retires

Earlier this year, with the announcement of the merging of NAHC and NHPCO, Bill Dombi announced his retirement from his position as President of the Association. Shortly after that announcement, The Rowan Report interviewed Bill and asked about the ongoing litigation against CMS as well as his thoughts on his tenure at NAHC. At the time, Bill was not prepared to speak about his upcoming retirement.

Remembering the Past

This week, at his final Annual Convention & Expo as association President, Bill shared his vision for the future of home health and hospice. Bill shared the story of the first time he faced an adversary…way back in kindergarten. He met his first bully and it took only a day for him to stand up to his nemesis and fight back. His bully walked away with a broken nose and Bill spent time with his nose in a corner.

“I was smiling the entire time,” Dombi shared, “and learning that’s not the way to do it. You’ve got to go to law school instead.”

How it Began

A young litigator, bright-eyed and ready to take on the world, Bill was initially hired to tackle a lawsuit against the Medicare program for denying care that should have been offered. He walked into the office that day and found boxes upon boxes with thousands of patient records and denied claims. Bill had to comb through each of these to select the 12 best plaintiffs to be named in the case. The amount of information was overwhelming, he recalled. It got a little easier when he was able to add members of Congress to the plaintiff list.

Nearly 40 years have passed since that day. “That day that I said yes was the beginning of a stunning opportunity that I had to be a part of an incredible team of people,” Bill reminisced.

First Steps Forward

That day will live in NAHC history as the first day of Bill’s tenure with the association. He promised his wife and children they’d be in Washinton D.C. for “just three or four years.” They stayed for 37. This day led to his first case against Medicare, Duggan v. Bowen. A case that rewrote the Medicare home health benefit. “It’s not perfect, but it was a monumental move forward,” Bill stated.

A Career Marked by Achievements

While is Bill is often hesitant to take full credit for what he has accomplished, and regularly credits his team for the strides made for home health and hospice patients, there is no doubt that he has been a driving force behind NAHC’s momentum and a key player in its advances at state and federal levels.

Among Bill’s many accomplishments are:

Creating the Medicare Hospice Benefit. Today, one out of every two decedents have used hospice in the last 12 months of their life, which is an enormous increase since its launch.
The growth of the Medicaid program. The program went from having no home services in 1965, to being the largest home health program in the world.
Increasing access of care for pediatric patients, those receiving private duty nursing, the severely disabled and the elderly.
The transition of making hospital-at-home care permanent in Medicare.
Ever-growing technologies and improving the focus on in-home care.
Several lawsuits that Dombi led at NAHC against private insurers and others, to ensure that specific patients—including several with amyotrophic lateral sclerosis (ALS)—weren’t arbitrarily denied the coverage they needed.

“That’s where my heart, my soul is; that’s where my aggressiveness is born, representing those very vulnerable people.”

Bill Dombi

President Emeritus, National Association for Home Care & Hospice

Where it's Going

As Bill wrapped up his final appearance on stage as NAHC President, he made some predictions and shared his hopes for the future of care at home. “I see a future where we see a whole transformation of health care. A future where the minds, hearts, operations, payments, and everything else are focused arund a home care direction,” he shared, “Not everyone can or should receive care at home, but it would be the ideal default before someone is hospitalized or moved to a nursing facility.”

Bill’s more specific hopes for the future of care at home include:

Nursing school curricula specific to care at home
Physician education including care at home
The leaders of CMS and/or DHHS have backgrounds in or a deep understanding of care at home
Technology visionaries working on tech solutions for care at home
Every state of the union and Presidential debate includes a discussion on care at home

Dream Big

Bill openly admits that his “wish list” for care at home may be fantastical, but he will continue to encourage all those who work in the care at home industry to continue to fight to move in that direction.

“We have to stand ready and be capable of working in all forms to defend ourselves against being bullied around,” he said. In typical fashion, Bill’s statements brought the crowd to its feet. He fittingly exited the stage to a standing ovation with Tom Petty’s “I Won’t Back Down” echoing through the hall.

As the music faded on Bill’s tenure, The Alliance CEO Steve Landers offered, “Bill, we won’t back down. Just so you know, we’re not going anywhere.”

The Legacy Lives On

Bill may be retiring from his post as President of NAHC, but his accomplishments, his passion for care at home, and his legacy will live on. National Alliance for Care at Home has established The William A. Dombi Scholarship Fund at his alma mater, the University of Connecticut. Bill’s contributions to care at home can hardly be overlooked when the scholarship fund has nearly doubled its initial goal of $50,000.

Incoming and continuing students at UCONN who are majoring in political science can apply for the scholarship. The scholarship prioritizes awarding money to students focused on public policy and/or health care policy. Contributions to the scholarship fund can be made here.

On a Personal Note

I spoke with Bill briefly during this week’s national convention & expo. I couldn’t let the event pass without acknowledging his contributions personally. When I started working in the care at home industry nearly 16 years ago, I saw Bill speak at a convention. Most of what he said was beyond my limited knowledge of care at home at the time. But, when I introduced myself afterward, he was gracious and offered any assistance he could offer in the future. Since then, as I have delved deeper into the world of care at home, Bill has been a voice of reason, of passion, of resilience, and of steadfast commitment to advocating for the current and future recipients of care at home. He has impacted countless lives. For his guidance, for his character, and for his relentless pursuit of reform for care at home, I can only echo the sentiments of my colleagues and friends:

“Thank you, Bill, for everything.”

# # #

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

National Alliance for Care at Home: An Interview with Dr. Steve Landers Part 1

by Kristin Rowan | Oct 25, 2024 | Admin, Advocacy, Regulatory

by Kristin Rowan, Editor

Alliance CEO Landers

For more than a year now, The Rowan Report has been providing updates on the merger between the National Hospice and Palliative Care Organization (NHPCO) and the National Association for Home Care & Hospice (NAHC). This week, we attended the first National Alliance for Care at Home (The Alliance) Annual Home Care and Hospice Conference and Expo. We had the opportunity to sit down with Dr. Steve Landers, inaugural Chief Executive Officer of The Alliance.

Dr. Steven "Steve" Landers

Dr. Steven Landers brings his almost 20 years of experience to The Alliance as its first CEO. Dr. Landers is a board-certified physician in family medicine, geriatric medicine, and hospice and palliative medicine. He has dedicated his career to seeking home- and community-based solution to traditional healthcare. His focus is on providing compassionate, dignified, and cost-effective care to patients.

Dr. Landers graduated from Case Western Reserve University School of Medicine, where he completed a geriatric medicine fellowship at the Cleveland Clinic.

Dr. Landers is no stranger to NAHC and NHPCO, having previously served on the board of directors for NAHC. He has met with Congress, state legislatures, CMS, and PAC officials, providing testimonies, discussing home care policy and regulation, and advocating for care at home.

Steve lives in Little Silver, New Jersey, with his wife, Allison, and their three sons. His hobbies include golfing, fishing, hiking, traveling, enjoying good food and watching horse racing. When he is not taking part in these activities, you can find him cheering on his sports teams — the Browns, Cavaliers, Guardians and Indiana Hoosiers.

Dr. Steven Landers: On the Record

The Rowan Report:

What do you know about the status of the ongoing lawsuits, going back to the 2024 final rule?

Dr. Steven Landers:

One, we should probably bring Bill [Dombi] into it because he’s truly a technical expert on it and I’m still getting up to speed on it. My understanding is there is no active lawsuit at the moment. We were asked to go back and take some additional administrative steps, which we’re doing. Then we’ll be able to evaluate what further legal paths are possible.

RR:

That leads me to, not a question, but an observation I’d like you to comment on, Steve. For 45 years, the organization has been run by attorneys and the emphasis in lobbying and advocacy has been ‘you need to stop this cut because it’s hurting businesses and also it’s hurting patients.’ The way you’re talking, you emphasize as you begin with how it’s hurting patients. And so I’m wondering if the organization being run by a physician and not an attorney indicates that different emphasis going forward.

Steve:

I certainly am going to do everything I can to tell the story of how policies impact patients and families. That will be part of what I try to do every single day using my experiences as a physician to do that.

RR:

Would it be exaggerating to say “new day, new emphasis” at The Alliance?

Steve:

Well, The Alliance is new in and of itself, so The Alliance is a new day for the industry, a hundred percent. We brought together two legacy organizations. The opportunity to have a stronger voice is very real and certainly I am going to bring a clinical perspective. I’m also a family caregiver. I have my own personal experiences with home care and hospice that have instructed how I think about these things.

And there is every opportunity here to get stronger, to try to make a bigger impact. I would not diminish the truly heroic work that’s been done by advocates within our associations in the past. There’s a lot of love and care that’s happening out in our country because of the leadership that’s been in place. But as you can see by some of the things that we’re talking about, we need to do better. We need to find another way to tell these stories to somehow get somebody to listen.

RR:

You recently released a statement about your position as CEO of The Alliance and your vision going forward. There was a commitment attached to that. Can you speak to that?

Steve:

Yeah, so that’s one of the things that I’m really happy we’re doing very early in our work with the Alliance. For membership, whether to join or to renew membership, we are requiring an attestation from our members around their commitment to quality and to compliance. We’re requiring any provider member to attest to having a program in place for quality and compliance. And we’re requiring that they attest that they monitor the OIG exclusion list and don’t take referrals for employees that are people that are on that list. Also for home health and hospice providers, we’re asking that they attest that they do their level best to participate in the Medicare Home Health and the Medicare Hospice Quality Reporting program.

In order to make a difference on behalf of our members and make a difference on behalf of the people that need care at home, we have to have as credible and high integrity of a voice as possible. And so this is just one simple step of additional things that we’ll consider going forward. We want to make sure that our alliance, our coalition is high integrity and has a deep commitment to quality and compliance.

RR:

It’s one thing to ask people to sign an attestation. It’s another to find the bad players and help CMS to get rid of them.

Steve:

And we’re right there as a partner in that. I think you’ll see more announcements from us in the future about what we’re doing to help with that. I mean, on one hand, we’ve made many proposals around fighting fraud and hospice in particular. If you followed the hospice policymaking, both Legacy NAHC and Legacy NHPCO over the last year have made many policy recommendations. And you’ll definitely see us both advocating for anti-fraud measures as well as having resources within our association to focus on those topics.

Interviewer 1:

Just to clarify, did either of the legacy organizations have this same kind of attestation?

Steve:

No, this is new. The impact of the legacy organizations cannot be questioned. It’s been amazing. But, it’s a new day and we are looking at ways to increase our impact. So, this is a new part of our membership process that we feel strongly about to just take another step to ensure that our coalition, our membership, is of the highest integrity possible. We are walking the walk and talking the talk with respect to quality and compliance.

RR:

Thank you, Dr. Landers

This article is part 1 of 2 interviewing Dr. Steven Landers. Read the rest of the interview here.

# # #

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

An Interview with Dr. Steven Landers, Part 2

by Kristin Rowan | Oct 25, 2024 | Advocacy, CMS, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

Medicare Advantage is Killing Us...Literally

This is part 2 of 2 in the interview with Dr. Steven Landers. You can read part 1 here.

Medicare Advantage article by Dr. Landers

Earlier this week, Dr. Landers published an article in the NAHC Report. The article cited three studies and analyses on the number of enrollees in both Medicare and Medicare Advantage who do not receive the care to which they are entitled. During our recent interview with Dr. Landers, he addressed this article.

Dr. Steven Landers: On the Record

The Rowan Report:

You wanted to address something you recently wrote. Is this the same topic you mentioned the opening session, or is this something else?

Dr. Steven Landers:

No, this is a focused piece on the emerging research that we’re seeing around when people miss out on home health. It’s a life and death issue. I want to be sure that we, as an alliance, I, as a physician, and us, as advocates, that we are conveying that these issues around home health cuts and barriers are potentially deadly. This is not a trivial matter. It’s not an administrative or technical financial issue. It’s about people’s lives.

RR:

The article mentioned a study that said that the numper of people not getting the home care that they’re entitled to is almost double with Medicare Advantage enrollees over traditional Medicare.

Steve:

That was from a study that’s referenced there from a few years ago. The Partnership for Quality Home Health Arcadia Analysis that came out this year actually showed that those trends are worsening. We know that they’re not getting the needed care in Medicare Advantage and traditional Medicare.

In both cases it’s too high, but it’s higher in Medicare Advantage. It’s more common that people don’t get the prescribed care in Medicare Advantage. And we also know that that’s going up in both traditional Medicare and Medicare Advantage. The access has gotten worse because of the Medicare home health policy and because of the way that Medicare Advantage has grown and handled these issues.

Interviewer:

I guess the big giant question is what do we do, especially when margins for both traditional Medicare and Medicare Advantage are so low?

Steve:

One, we’ve got to start improving access to home healthcare. And the way that we do that is we end this march of payment cuts that are being set forward by Medicare. I mean, right now the leaders of Medicare are in their rulemaking process and they have choices to make. They can either do things that reverse this trend and put us on a path to better access or I think continuing these cuts will hurt beneficiaries.

And the other piece is the Medicare advantage front. We need more scrutiny and evaluation and potentially oversight here to make sure Medicare Advantage beneficiaries have access to high quality home healthcare.

“The results of this study demonstrate that among MA members referred to home health after acute hospitalization, those who did not receive home health services experienced higher mortality and lower readmissions than those who received these services.”

Unfulfilled Home Health Referrals Lead to Higher Mortality Among Medicare Advantage Members

Elan Gada, MD, Paul Pangburn, MHA, Chris Sahr, MS, MBA, Chad P. Schaben, MPH, Richard Young, MS

RR:

Where does the problem lie?

Steve:

People don’t get home health when it’s prescribed and mortality rates are substantially higher. There could be [anecdotal] reasons that this is happening. I’ve tried to think of them. I can’t really come up with them when you see it in three different analyses, especially one done within the Medicare Advantage plan. They have great data. It was well thought out and this is serious business and it really should be a kitchen table discussion for families like ‘what’s going here?,’ because obviously home healthcare is a beloved service that families care deeply about.

We’ve seen home care become a presidential campaign issue because it’s good policy and also because the folks running, Vice President Harris, who brought it up, and former President Trump, who chimed in sort of a me too, being enthusiastic about the concept. They’ve got to know that this polls well, that the families care about this stuff.

Editor Emeritus Tim Rowan provides an analysis of the study from UnitedHealth Group here.

# # #

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

UnitedHealth Group Sees Q3 Growth

by Kristin Rowan | Oct 18, 2024 | CMS, M&A, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

UnitedHealth Group Earnings Show Strong Q3 Revenue Growth

For most of 2024, and even going back into 2023, The Rowan Report has written about UnitedHealth Group and its acquisitions, its over diagnosing patients for financial gain, its dropping of Medicare Advantage plans, and, of course the Change Healthcare cyberattack.

Despite all the negativity, UnitedHealth Group continues to grow. The company’s revenue grew more than 9% over last year’s Q3 numbers. Even after the cyberattack, Optum grew by more than $2 billion. According to UnitedHealth Group CFO John Rex, the growth is due to an increase in both the number and type of care services offered. Optum operates three subsidiaries, OPtum Health, OptumRx, and OptumInsight, with total revenue of $63.9 billion.

CyberAttack did not Impact Earnings

According to the Q3 financial statement, per share earnings of $6.51 include the cyberattack impacts. The annual adjusted net earnings outlook for 2024 is between $27.50 and $27.75, in line with earlier projections. The 2024 net earnings outlook reflects both the selling of South American properties and the impacts from the Chnage Healthcare cyberattack. Net earnings outlook is $15.50 to $15.75 per share.

More UnitedHealth Group Acquisitions on the Horizon

UnitedHealth Group CEO Andrew Witty said the company is using a five pillar growth strategy. They will continue to spend money acquiring companies for United Healthcare, value-based care, pharmacy businesses, financial services, and what he called “technology-ed opportunities.

Meanwhile...

While UnitedHealth Group and Optum post higher revenue and cash flow and their shareholders se an increase in per share earnings, subscribers to UnitedHealth insurance plans are losing. Monthly premiums and annual deductibles for Medicare Part B increased from 2023 to 2024. Part B standard premiums are expected to increase by almost 6% in 2025. For seniors with higher income, the adjustment amount will go up to $74 per month, making monthly premiums jump to $259. The base beneficiary premium for Part D also increased in 2024 and will again for 2025.

Keeping it in the Family

Effective September 1, 2024, UnitedHealthcare started requiring prior authorization for Medicare Advantage member to receive PT, OT, and ST services when performed outside of the home. Not surprisingly, United Health owns multiple practices that offer PT, OT, and ST at home. Those services don’t require prior authorization. UnitedHealth Group is enjoying higher revenue, higher net income, and is funneling the money from insurance premiums back into its own pocket.

Go for the Gold

This announcement came just after UHC announced a gold card program to reduce prior authorization requirements. The gold card program started October 1st and was supposed to reduce the prior authorization request volume for provider groups. Providers groups who are in-network, have a minimum number of prior authorizations for two years, and have at least a 92% approval rate qualify for gold status.

Final Thoughts

Home health agencies are struggling to survive with lower payment rates from Medicare plans and operating in the negative under Medicare Advantage plans. Physician practices, surgery centers, urgent care, and pharmacy benefit managers are operating under UHC for even greater profits. More patients are seeing delays in care due to increased prior authorization requirements, unless the patient is seeing a caregiver owned by UHC. Shareholders are getting increased per share revenues. Perhaps there’s a solution hidden in the math there somewhere.

# # #

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

Not All Superheroes Wear Capes

by Kristin Rowan | Oct 18, 2024 | Partner News, Vendor Watch

by Kristin Rowan, Editor

Some Superheroes are Software Solutions Providers

In August, I had the pleasure of attending the Kantime Superheroes for Success user experience. In the year since I’ve taken over The Rowan Report, I’ve only attended two user events, but I have been an event producer since 2016. The Kantime team delivered a top-notch event that took great care of its attendees.

Education

Of course, there was a fair bit of education centered around the Kantime solution. This was not unexpected, nor unwelcome, as many of the attendees were agency owners actively seeking a new software solution. However, the educational sessions were balanced between Kantime and industry information.

Guest speakers addressed the Home Health Final Rule, the Hospice CAP, Red Flags to spot turnover risk, pediatric care, and more. These breakout sessions followed the opening day general session with Bill Dombi, NAHC President, who provided updates on regulatory issues and the merging of NAHC and NHPCO.

Table Talk and Learning Labs

A unique feature of the Kantime Experience were the open table talk sessions and learning labs. KanTime experts were available to sit with software shoppers to provide insight into each of the Kantime lines of business. For agency owners and executives who are shopping for the right EMR, talking to users rather than sales people is often a good way to get in-depth information in an honest forum.

Vendors

The general session room was lined on three sides with vendors of many kinds. There were AI solutions, educational companies, billing experts, and more. What was especially nice about this event was the amount of time provided to speak with the vendors throughout the day.

Closing in Style

The team at Kantime not only provided candid talk about software updates and integrations with partners, but also planned a top-notch Happy Hour and Game Night mid-way through the event. Attendees arrived in superhero costumes from Batman to Obi-Wan. Arcade games, carnival food, costume contest, and DJ rounded out the night. We even caught Bill Dombi and his wife in a spirited round of air hockey.

Final Thoughts

After attending this event, user experiences and user group meetings have a high bar set for them. I look forward to seeing what other software solutions providers have in store. From an agency perspective, I spoke with many of the attendees about the experience they had. All of them expressed how helpful the event had been in helping them in the decision-making process. Regardless of the software you are considering, attending a user group meeting or experience is a recommended route to gain valuable insight from other agencies who are already using the software you are considering.

A big thank you to the team at Kantime for their invitation and hospitality. I can’t wait to see what they come up with for 2025!

# # #

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

Vendor Watch: An Interview with Stephen Vaccaro

by Kristin Rowan | Oct 18, 2024 | M&A, Vendor Watch

by Kristin Rowan, Editor

The Future of HHAeXchange

Earlier this month, we announced that HHAeXchange acquired Sandata. This announcement came not long after the announcements that they had acquired Cashé and Generations. Last week, The Rowan Report sat down with Stephen Vaccaro, President of HHAeXchange to talk about this latest acquisition and what it means for HHAeXchange going forward.

Stephen Vaccaro: On the Record

The Rowan Report:

Stephen, thank you for meeting with me today. I’m sure you are quite busy with this latest news. What can you tell us about the acquisition of Sandata?

Stephen Vaccaro:

We’re very excited about all of the changes we’ve made this year. We were excited about Cashé and Generations, and we’re excited about Sandata. Sandata is larger, in scale, than the other two. They operate at the state level, in managed care, and with providers.

RR:

How will this acquisition impact what HHAeXchange is doing?

Stephen:

HHAeXchange recognized the need for more standardization in the industry. It’s been so fragmented for so long. We need better data and better insights to deliver better care. The combined footprint of HHAeXchange and Sandata puts us in the position to deliver on that.

RR:

What immediate changes should we expect to see?

Stephen:

Sandata as a brand will continue to exist, just under the HHAeXchange brand now. We have no plan to make any changes to the technology or the teams. We’ve spoken to the state and managed care clients and they are excited about this as well. They will continue working with the teams they know and the technology they know.

RR:

Do you anticipate more changes down the road?

Stephen:

Over the next six to twelve months, we will evaluate the technology to assess where it can be put to best use. We expect to see some thoughtful consolidations that are well thought out and communicated to all. We have no plan to get rid of Sandata or make anyone leave the platform. As we are consolidating these technologies, we’re taking the expertise of each of these great organizations into one integrated platform. We think what you’ll see is the new standard for homecare management, driving innovation and efficiency across the industry. This, in turn, helps deliver better care in the home.

RR:

I spoke with Paul Joiner, HHAeXchange CEO, after the acquisition of Cashé and Generations. At that time, he told me that those acquisitions were part of a larger strategy that comes with a bigger reveal. Now that the big reveal has happened, what can you tell us about the future of HHAeXchange?

Stephen:

We are focusing on operational efficiency so caregivers can focus on care and better outcomes. The message we want to share is that we are ensuring that there’s flexibility, inclusiveness, scalability within homecare management solutions to any stakeholder. We will never be the single solution for everyone, but we aim to be the best solution to adapt to regulatory changes and emerging trends and make sure that we’re building trust and confidence and demonstrate the commitment that we’re making to ensure best in class software. We believe the path we’re on is transformative for the industry.

RR:

It sounds like there may be more announcements in the future. I’m excited to see what you do next. Thank you for talking with The Rowan Report.

# # #

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

Home Care Patient Dies in Care: Aide Arrested

by Kristin Rowan | Oct 10, 2024 | Clinical, Regulatory

by Kristin Rowan, Editor

Elderly Patient Needs 24-hour Care

In Polk County, FL, an 86-year old man, identified only as Mr. Anderson, was hopsitalized and diagnosed with congestive heart failure. In addition to receiving care from Good Shepherd Hospice, his family hired round-the-clock care through Assisting Hands. The home health aides were caring for Mr. Anderson in 12-hour shifts.

Night Shift

Beatrice Taylor arrived for her night shift at 9 p.m. She noted that Mr. Anderson and his wife were already in bed, but not sleeping. Shortly after the day aide left, Taylor fell asleep on the couch in the living room of the patient’s home. Company policy states she was responsible for the patient’s care and should not have been sleeping.

An Avoidable Tragedy

Taylor was awakened by a “thump” coming from the bedroom. She entered the bedroom to investigate and found Mr. Anderson lying on his side, on the floor, with his head wedged between the nightstand and the bed. Taylor told investigators that she tried to help him back into the bed. He told her not to touch him, so she left him there and went back to sleep on the couch. She did not call 911, as was the policy of Assisting Hands in the event of an emergency. Nor did she call her agency or anyone else to assist.

Four Hours Later

Taylor woke up somewhere between 3:45 a.m. and 4:53 a.m. that morning. At some point, she called her parents and had a 36 minute conversation. During that conversation, she decided to check on the patient and found him still on the floor, but now unresponsive. It was her parents who suggested she call 911.

Contrary to both her parents’ urging and her employer’s policy, Taylor still did not call 911. Instead, she called Assisting Hands and left a message through the company portal. Taylor finally called 911 at 5:37 a.m., more than four and a half hours after Mr. Anderson fell.

The implanted pacemaker found during autopsy showed that Mr. Anderson was still allive at 1:oo a.m. when Taylor initially found him. The autopsy also concluded that he would have survived if Taylor had called 911 right away. His official cause of death was positional asphyxia with pre-existing health conditions listed as contributory causes.

Not actual image from story

Company Policies Broken

During the course of their investigation, detectives reviewed the Assisting Hands employee policies. That investigation uncovered several policies that Taylor violated:

If a patient falls, home aides are required to seek help which may entail calling 9-1-1. Home aides must notify the company as soon as the patient is safe
Home aides are not permitted to sleep during their assigned shift unless it is a “live in” shift
Home aides are required to submit care notes using the company portal throughout their shift to ensure assigned services are being followed appropriately.

The 911 call that Taylor placed at 5:37 a.m. should have been placed at 1:00 a.m.
Assisting Hands confirmed to detectives that this was not a “live in” shift
No information was provided as to whether Taylor submitted care notes during the shift.

Arrested Development

Taylor worked for Assisting Hands for eight months, but did not show up for her shift following the incident with Mr. Anderson. Assisting Hands has since terminated her employment. She was a licensed home health aide, but does not have a medical license, nor is she a nurse.

Taylor was arrested by detectives and made several statements about her innocence. She insisted she had done nothing wrong saying she, “didn’t kill that man.” A paramedic who responded to her 911 call overheard Taylor on the phone say, “he was old anyway so what does it matter.” Taylor remains in custody at the Polk County Jail and is being held without bond.

Polk County Sheriff

“The complete disregard for Mr. Anderson’s life by the person who was employed by his family is completely outrageous, and egregious. I believe someone who was not even being paid to look after this elderly man would have immediately dialed 9-1-1 under these circumstances. Her behavior and attitude are simply deplorable. Mr. Anderson’s family members are in our prayers.”

Grady Judd

Sheriff, Polk County Sheriff's Office

Risk Fall

In 2021, more than 38,000 older adults died from falls. This is the leading cause of injury death for adults aged 65 and older. The death rate increased 41% between 2012 and 2021. You can read more about the risk of falling and what one company is doing to help prevent falls in our accompanying article this week, an interview with Dr. Ann Wells of InnovAge.

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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

National PACE Awareness and National Fall Prevention Month

by Kristin Rowan | Oct 10, 2024 | Advocacy, Clinical

by Kristin Rowan, Editor

New Fall Prevention Study: An Interview with Dr. Ann Wells

Fall Prevention Month

September was National Fall Prevention month. Accidental falls are the number one cause of injury and death among adults over the age of 65. Fall Prevention month attempts to raise awareness on preventing falls, reducing the risk of falls, and helping older adults live without the fear of falling. The National Council on Aging also promotes advocacy on behalf of fall prevention funding and offers training and other materials to help prevent falls. Read our complimentary article this week about a nurse charged in the death of a patient who fell here.

National PACE Awareness Month

September was also PACE Awareness Month. The Program of All-Inclusive Care for the Elderly )PACE) is a Medicare and Medicaid program that helps seniors with long-term care needs to live independently and age in place. The program includes an interdisciplinary team of professionals working together to coordinate care. There is no co-pay, deductible, or coverage gap and the amount paid each month doesn’t change, no matter what care services the patient needs. All Medicare and Medicaid services are covered as well as medically-necessary care and services that are not typically covered. Coverage includes prescription drugs, doctor care, transportation, home care, checkups, hospital visits, and nursing home stays when necessary. Access more information about PACE here.

InnovAge has been tapped to participate in a fall prevention study. The study is conducted by LeaHD, a research and training center established in partnership with Brown University, Boston University, and University of Pittsburgh in the Center on Health Services Training and Research. The Rowan Report sat down with Dr. Ann Wells, Chief Quality and Population Health Officer of InnovAge. Dr. Wells said of the study, “[it] will help us better understand the multi-faceted factors contributing to falls among seniors and develop intervention strategies tailored to their unique needs.”

Dr. Ann Wells, Chief Quality and Population Health Officer

Rowan Report:

Dr. Wells, thank you for taking the time to speak with me today. Why don’t we start with a little background on you. How did you come to be involved in elder care and PACE programs?

Dr. Ann Wells:

By trade, I am in internal medicine doctor, focused on the geriatric population. I have spend 20 years in medical leadership working in population health. Population health is the approach to healthcare that evaluates and improves outcomes in subgroups with similar needs and the populations as a whole through team care and analytics. Through my work in medical leadership and population health, I was approached by InnovAge to be part of their leadership team.

RR:

You mentioned the PACE program. What do you think is the key difference, or differences, between PACE programs and other types of senior care?

Ann:

The PACE model is health care’s best kept secret and we don’t want it to be a secret anymore. Most patients and families don’t want institutional care. 86% of seniors value remaining in the communities in which they live.

In order to qualify for PACE programs, the patient has to qualify for nursing home levels of care. The program delivers services designed to help them stay in the community. PACE leverages an 11-member interdisciplinary team that includes a primary care provider, a registered nurse, a driver, a master-level social worker, PT, OT, a dietician, a PACE center manager, a home care coordinator, and a personal care attendant. The team coordinates care for medication, medical care and transportation with wrap-around social support and in-home support to help with bathing, shopping, and dressing. They also coordinate specialty care, make appointments with contracted specialists, provides transportation and a chaperone if needed, sends medical records in advance of the appointment, and gets notes back from the specialist.

Participants can come to a center for primary care, PT, or OT. They can also enjoy the center for socialization and activities. Patients provide permission to talk to each caregiver to make sure they are getting the care they need. Almost 90% of patients are dual-eligible. Roughly 10% are Medicaid only. The small remainder are Medicare only and pay the difference out of pocket.

RR:

There is a lot of information about the PACE program that I didn’t know before. Thank you for that. Can you tell us a little about InnovAge?

Ann:

InnovAge is the largest provider of the PACE program based on number of participants. They are both a delivery arm and a health plan. InnovAge administers care from 20 centers in six states.

RR:

And what your role is as Chief Quality and Population Health Officer?

Ann:

The Clinical Value Initiative aims to ensure the company is managing revenue and participant expenses including risk adjustments, ensuring the most accurate risk score, resource management, payment integrity or a claims audit process, and network optimization. Through these initiatives, the average inpatient rate for hospital admissions was 5.5% and the average time from enrollment to placement in a nursing home is three years. These initiatives and the PACE program are reducing hospitalizations for participants and keeping patients in their homes and in their communities longer.

RR:

September was National Fall Prevention Month. The number of injuries and deaths due to falls among seniors over age 65 is staggering. But, InnovAge, using the PACE model, has reduced falls. How does that program work?

Ann:

Any fall that has a major fracture is very difficult to recover from. InnovAge leverages the STEADI program. Stopping Elderly Accidents, Deaths, and Injuries (STEADI). This program includes screening, assessing, and intervening.

Screening

All participants are asked intake questions to screen for risk. Have you fallen in the last year? Do you have a fear of falling? Statistically, once a patient has fallen once, the risk is much higher for another fall.

Assessing

At enrollment, and again yearly, the patient receives an in-home assessment with an environmental safety evaluation. We look at things like lighting, rugs, grip bars, ramps, a non-slip rug in the bathroom. PACE arranges for installation and payment for any items they might need to lower the risk of falls. OT & PT conduct yearly evaluations as well. Do they need a walker? Do they have proper footwear? Have they had a recent eye screening and do they have glasses? They also evaluate leg strength and balance. If there is a deficit, the patient can do PT at the center.

In addition to the in-home assessment, we conduct a root cause analysis if there is a fall to determine why they fell and what they need to prevent a future fall. Clinical pharmacists also evaluate medicine regiments and optimize medications to reduce or eliminate side effects and improve safety.

Intervention

When there is a patient at high risk for a fall, due to any of the factors we find in the screening and assessment, we employ some intervention. PERS units, emergency alert pendants and wristwatches, are provided for high-risk patients. Units with fall detection and emergency activation buttons place automatic calls to a call center. The call center will try to contact the patient and send an ambulance if they can’t be reached or need assistance.

RR:

InnovAge has recently been selected to participate in a national study for the prevention of falls. Tell us about that study and how InnovAge will participate.

Ann:

LeaHD approached InnovAge to help improve their training for chronic care. InnovAge has a population that aligns with their research. The research topic is to evaluate whether they can predict risk of falling with new enrollees. From there, we will assess whether we can create more tailored interventions to lower risk. The hope is that the study will inform us, as an industry, what we should be asking a new patient to determine their actual risk of falling. In turn, the study will inform caregivers on how they can identify high risk patients and prevent future falls.

RR:

What is the timeline and goal of the study?

Ann:

The study will run for one year, starting in October, 2024. There is a data scientist working on the project who will conduct and write the study. We are hoping to publish sometime in 2026. The goal is finding interventions; gaining insight on which systems can be executed to reduce the risk.

RR:

That sounds fascinating. I can’t wait to read the results of the study. Is there anything else about InnovAge that you’d like to share?

Ann:

Just that our mission is to help seniors live independently in the community and to advocate for the PACE model of care. We are excited to have three new centers – one in California and two in Florida. The goal is to spread the PACE model and grow the individual centers. InnovAge is the largest provider of PACE based on number of patients enrolled. We are dedicated to expanding and serving more seniors across the country.

RR:

Thank you, Dr. Wells for your time and your insight. It’s been a pleasure talking with you. Please stay in touch and keep The Rowan Report updated on the progress of your study.

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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

CMS Ransomware Attack: Breach of PII

by Kristin Rowan | Sep 27, 2024 | Admin, Breaking News, CMS, Regulatory

by Kristin Rowan, Editor

CMS Ransomware Attack

In mid-2023, a planned file transfer went awry when Clop claimed to have breached hundreds of companies that they later listed on a data leak site. Among the companies listed were Shell, UnitedHealthcare Student Resources, The University of Georgia, and Putnam Investments. Also compromised were government entities including the U.S. Department of Energy. According to Clop, data from military sources, children’s hospitals, and other .gov sites was also copied. The ransomware group alleges they deleted all information from government, military, and children’s hospital sites.

Unfortunately, there is no way to confirm whether all that information was indeed deleted. Earlier this year, Change Healthcare suffered a similar widespread breach that caused massive payment delays for months. CMS provided guidance during those delays.

Underreporting of Attack

Many of the companies impacted by this attack chose to disclose the breach rather than negotiate with the ransomware attackers to retrieve the stolen data. When Bleeping Computer reached out to those companies immediately following the attacks, a number of them indicated that only a small number of people were effected and that no financial or identifiable information had been stolen. It seems, now, though that not all companies involved in the attack were on the initial list.

Wisconsin Physicians Service (WPS) health insurance corporation was among the companies not listed when news of this attack was first published. WPS provides Medicare administrative services to CMS, including handling Medicare Part A/B claims. In the first week of September, nearly 3-1/2 months after the attack, CMS and WPS started notifying beneficiaries whose protected health information (PHI) or other personally identifiable information (PII) may have been stolen during the attack.

1,000,000 Notifications

On July 28, 2023, CMS estimated 612,000 Medicare beneficiaries may have had PHI and/or PII exposed in the breach. That number has increased to almost 1 million. CMS and WPS are sending notifications to more than 950,000 people whose information has been compromised. The letter explains further:

May 31, 2023, MOVEit disclosed the breach to the public and released a patch.

June 2, 2023, WPS notified CMS of a data breach that occurred sometime between May 27 and May 31, 2023.

According to WPS, they applied the patch but did not observe any evidence of any files having been copied.

July 28, 2023 CMS sends an initial letter to beneficiaries whose information may have been affected.

May 2024, WPS acted on new information that led them to discover copied files from before the patch was deployed.

Of the portion of breached files that WPS studied, none were found to have personal information.

June 8, 2024, a different portion of the files showed personal information was contained in those files. This information includes:

Name
Social Security Number or Individual Taxpayer Identification Number
Date of Birth
Mailing Address
Gender
Hospital Account Number
Dates of Service
Medicare Beneficiary Identifier (MBI) and/or Health Insurance Claim Number

Note: in the initial letter sent to beneficiaries in July of 2023, CMS also listed Healthcare Provider, Prescription Information, Insurance Claims, Policy Information, Subscriber Information, Health Benefits, and Enrollment Information as possibly having been leaked. These items were removed from the list in the September 2024 version of the same letter.

For those who received this notification, CMS and WPS offered a complimentary year of credit monitoring from Experian. CMS also advised members to request their free credit report from each of the credit reporting companies.

The letter also informed members that they would soon receive a new Medicare card with a new Medicare Number. 946,801 people received this notice.

CMS Ransomware Attack Victims Not Notified

On September 24, 2024, Bleeping Computer reported that on the same day CMS sent more than 900,000 letters to members, they also reported to the Department of Health and Human Services that the total number of people with information stolen was 3,112,815. CMS explains the difference by saying the larger number includes Medicare beneficiaries, people who are deceased, and people who were covered by other providers but whose information was included in WPS data collection used for provider audits in their role as Medicare Administrative Contractors (MACs).

New MBIs and What it Means For You

According to a blog post dated September 26, 2024 from SimiTree, starting in mid-October, CMS will issue new Medicare cards with new Medicare Beneficiary Identifiers to the 946,801 Medicare beneficiaries who were previously identified as at risk and were notified of the breach. This may cause undue delays and other issues for home health and hospice providers.

Claim Rejection

If these beneficiaries use their existing MBI after the new one has been issued, providers could see rejections on NOAs, NOEs, OASIS submissions, and claims.

Urgent Reverification

Providers will need to reverify eligibility and update patient records in their EMR systems. Because providers were not notified of which beneficiaries were impacted, agencies will need to verify MBIs for every Medicare patient.

Possible Disruption

The full impact of reassigning MBIs to nearly 1 million Medicare beneficiaries is not yet known. Medicare has not clarified what will happen with claim processing for patients whose MBIs change during the claim processing for active patients. There are possibilities for delayed processing, delayed payments, and incorrect denial of services or payments due to the volume of MBIs changing at once.

How to Prepare

Our friends at SimiTree have some suggestions for how home health and hospice providers can prepare in advance for the MBI change coming around October 15-16, 2024.

Take Immediate Action – start reverifying eligibility for all Medicare patients now
Update Systems – ensure your EMR and other solutions in your tech stack are updated and ready to handle the changes
Train your Staff – make sure everyone on your team knows this change is coming and teach them new verification procedures so their patients aren’t left without care

CMS has not issued a statement about the impact of the MBI changes, but this story is ongoing and we will continue to monitor and report on any updates from WPS and CMS as well as look for additional information on the changes expected with the new MBIs.

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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

Another One Bites the Dust

by Kristin Rowan | Sep 20, 2024 | CMS, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

Essentia Drops Medicare Advantage

Essentia Health is an integrated health system with locations in Minnesota, North Dakota and Wisconsin. The health system offers 285 different services across more than 1,700 locations. They employ more than 2,700 doctors. Essentia also includes 14 hospitals, emergency care, same-day care for mental health crises, and multiple specialties.

This is all to say that Essentia Health is not a small player. They contract with the largest payers in the industry.

Re-Evaluation

Recently, the health system began re-evaluating its participation in some Medicare Advantage plans. According to the chief medical officer for population health at Essentia, Cathy Cantor, M.D., M.B.A., too often deny or delay care. Cantor said in a statement:

“This was not a decision we made lightly. The frequent denials and associated delays negatively impact our ability to provide the timely and appropriate care our patients deserve. This is the right thing to do for the people we are honored to serve.”

Essentia informed patients that they will no longer be an in-network provider for MA plans through UnitedHealthcare (UHC) or Humana beginning January 1, 2025. The health system claims that UHC and Humana delay and deny approval of care at more than twice the rate of other Medicare Advantage plans. They are encouraging its patients to choose a different plan during open enrollment that is in-network with Essentia.

UHC Responds

UnitedHealthcare responded to the press release that Essentia issued. According to their statement, the two parties extended their contract just this past July. Negotiations included a number of items on which they agreed to collaborate, but Medicare Advantage was not specified among them.

“Essentia Health didn’t raise concerns regarding its participation in our Medicare Advantage network until last week. We have since met with Essentia on Sept. 9 and are committed to working with the health system to explore solutions with the goal of renewing our relationship. We hope Essentia shares our commitment toward reaching an agreement.”

Following Suit

Essentia’s departure from Medicare Advantage is just one in a recent mass exodus.

Sanford Health of South Dakota ended its Humana MA participation due to “ongoing challenges and concerns that negatively effect patients including ongoing denials of coverage and delays in accessing care.”

HealthPartners out of Minnesota announced over the summer that “UnitedHealthcare delays and denies approval of payment for MA claims at an exceptionally high rate…up to 10 times higher than other insurers…. After over a year of being unable to persuade UnitedHealthcare to change their practices, we’ve determined that we can no longer participate in the UnitedHealthcare Medicare Advantage network.”

Mercy, the official medical provider of the St. Louis Cardinals, announced its year-end departure from the Anthem Blue Cross Blue Shield network. This includes all Medicare Advantage, ACA marketplace, and managed Medicaid plans. They cited administrative tasks that create a barrier to timely, appropriate patient care. Mercy also complained that Anthem has raised its rates for patients and employers, increased its profits, and still has not raised reimbursement rates to providers. Like Essentia, Mercy is encouraging its patients to consider whether the health care plan they choose during open enrollment will list Mercy as one of its in-network providers.

Final Thoughts

CMS reimbursement rates, Medicare Advantage denials, payment delays, and other interruptions are impeding patient care. As Tim mentions in his editorial this week, we are in an election year and we urge you to research how each party might impact our industry.

If more providers and payors continue to drop Medicare Advantage from their offerings, will we see more patients returning to traditional Medicare plans with an affordable Medicare Supplement or MediGap coverage? One can only hope!

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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