Urgent Plea to Safeguard Your Caregivers

by Kristin Rowan | Feb 6, 2025 | Admin, Caring for the Caregiver, Clinical

by Kristin Rowan, Editor

Care at Home Worker Safety is not Optional!

I will rarely present an editorial piece that is based only on my opinions. I hold a few about care at home in general, but at least attempt to use statistics, facts, and history to support my positions. This is one area where the facts and numbers are all there, but using them is not as effective as sharing these stories. No matter where your agency is in its growth, no matter how large or small, no matter your plans for 2025, if you have not started a safety committee, created safety protocols and operating procedures, and invested in GPS-enabled emergency response systems for your staff, do so NOW, so this story doesn’t become your story.

One More Story is One Too Many

The tragic death of Joyce Grayson made headlines across the country both immediately after her death and for months after with lawsuits and new regulations in her state. This week, another avoidable incident left a home health aide in Massachusetts bedridden and temporarily unable to walk.

The aide, who asked to remain anonymous said she thought she was going to die. “I was screaming Help! Help!,” while a man in his 70s, for whom she has provided care for more than two years, attacked her with a knife. The man repeatedly stabbed, slashed, and sliced her while she kept kicking at him and thrashing her body. Despite all her attempts to escape, the man would not let her get up.

“I was tired,” she recalled, after fending off her attacker, “I’m gonna die here, I think that, but in that moment I remembered my sons, my family and giving me power. I confronted him.”

As she fled the apartment, the man followed her with a piece of wood. She ran down the hallway, where a security guard intervened. The man lost his balance during the struggle and fell. The home health aide spend two days in the hospital, receiving blood transfusions and dozens of stitches. She has decided no to return to her job, which she has held for a decade.

“He’s not going to kill me. He’s not going to pull me down.”

Home Health Aide Attacked on the Job

Next Time, it Could be You

No care at home worker deserves to feel unsafe or to be attacked at work. No agency owner wants to be the headline of the next story about a home care worker who ended up in the hospital or the morgue. Don’t be the next agency that has to explain to a family how this happened to their mother, daughter, son, or uncle, or cousin. No child wants to find out that their parent isn’t coming home because they did not have the means to call for help.

Act Now, Before it's Too Late

You might be surprised, if you asked, how many of your caregivers have ever felt uneasy, unsafe, or uncomfortable during their shift. Whether is the client, a family member of the client, pets, firearms, the neighborhood, or something else, most lone workers will experience some degree of fear. While not entirely preventable, there are steps you can take to minimize the risk:

- Ask your employees for honest feedback
- Research the client, family members, and the neighborhood for safety issues
- Create a committee comprising management, administrators, and caregivers, to create a safety plan
- Invest in training for your staff to include deescalation techniques, situational awareness, self-defense, and any other classes your safety committee deams necessary
- INVEST IN GPS-ENABLED EMERGENCY RESPONSE SYSTEMS FOR EVERY EMPLOYEE, NOW!

Recommendations

As a company that engages in software adoption consulting, we don’t often make direct recommendations, prefering instead to tailor software selection to each agency and its unique needs. This is one area where I will make the exception and continue to make the exception until every lone worker in and out of the care at home industry is equipped with a safety device.

POM Safe

POM Safe is a personal safety solution that allows lone workers to get help when needed, but was designed to incorporate prevention and de-escalation. “The best 911 call is the one that never happens.”

The device includes features such as:

- Fake phone calls to allow the caregiver to step away from a situation
- Check on me to alert the agency if the caregiver has not checked in after an appointment
- Appointment Sync to give first responders precise locations in an emergency
- One-tap text sending a pre-written text with precise GPS location
- Incident Reports to prevent future incidents
- Two-way calling to a dispatcher when emergency help is needed
- Voice activation when your caregiver can’t get to the device
- Real-time crime data by neighborhood
- Sex offender registries
- 24/7 emergency dispatch
- Device or app-based

Katana Safety

The Katana safety device attaches directly to the caregiver’s phone. It has a quick-trigger activation to bypass the phone’s lock screen, and provides instant help 24/7.

This device includes features such as:

- Audible and inaudible alerts that launch GPS signals and connect worker to call center
- 24/7 highly trained PERS center
- Safety text and call after an alert with immediate dispatch if caregiver does not answer
- Walk with me feature to have a dispatcher stay in contact while the caregiver gets to safety
- Circle of safety to alert up to seven people in case of emergency
- Customizable safety commands that each clinician sets up with voice activation
- Beacon backup if bluetooth fails
- Text messaging with GPS location
- Employee check-in with voluntary location tracking and pin drop
- 2-year battery life
- Options to connect by app, fob, watch, or voice

Final Thoughts

Ensuring the safety of your employees before you send them out to care for your clients is not an optional benefit, a “nice to have,” or something you can do when you “get around to it.” Providing the training and safety devices needed to make sure each and every one of your caregivers makes it home every day should be your top priority. Whether you choose one of the devices above or go with a different option, start looking for one now. If you need help starting your safety committee or writing a survey to assess the safety risks in your agency, I will help you. With all of the technology available to us, there should no longer be any stories of caregivers who were attacked and did not have the means to call for help.

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Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news .She also has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2025 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Medicare Advantage Lowers Home Health Care Use

by Kristin Rowan | Feb 6, 2025 | Hospice, Medicare Advantage

by Kristin Rowan, Editor

End-of-Life Care in Medicare Advantage vs Traditional Medicare

Using research from CMS, researchers from Mt. Sinai in New York and Brown University in Rhode Island studied the data of adults aged 66 and older who passed away and had Medicare coverage in their final year of life. Included in the study were people potentially eligible for home health care and not in a nursing facility, hospital, or hospice care setting. Data from close to 1.8 million people was analyzed. The researchers identified whether the participants received home health care and how many days of end-of-life care they received.

Home Health Higher in Traditional Medicare

Of the nearly 1.8 million participants, the average age was 82. 51.5% were female and 36.5% were enrolled in Medicare Advantage. In the final year of life, home health care use was recorded at 37.5% for MA enrollees and 41.7% for traditional Medicare.

When the researchers looked at different demographic groups within the data sets, home health care usage was higher in traditional Medicare in most groups. However, among American Indian and Alaska Native groups, Medicare Advantage had a slightly higher rate of home health use at 37.9% compared with 37.1% in Traditional Medicare.

Conversely, in the Asian or Pacific Islander demographic, home health use rate was 32.6% in MA and 41.8% in TM. Similarly, the rate of use among the Hispanic group was 33% in MA and 44% in TM. Following a similar trend, in the non-Hispanic Black group home health usage in MA was 38.8% compared with 42.9% in TM. Likewise, among the non-Hispanic White group, home health use in MA was 37.9% versus 41.5% for TM. For those of unknown race, usage was 36.1% in MA compared with 40.1% in TM.

Days of Care Lower in Medicare Advantage

Home health users across all racial and ethnic demographic groups enrolled as Medicare Advantage beneficiaries had fewer days of care in home health than those enrolled in Traditional Medicare. The stand-out group in this part of the research was those of Hispanic descent, who averaged 81.9 days in home health care in Medicare Advantage compared with 111.9 days in Traditional Medicare.

Implications

The researchers indicated some limitations in the study, namely that data was pulled from pre-covid patients because of the changes in home health during covid. The study should be repeated with post-covid data. One of the researchers received personal fees while serving as a senior advisor to CMS. Another received personal fees as a section editor for UpToDate. A third researcher reported receiving personal fees from Abt and UpToDate.

Despite these limitations, the implications of the study show that end-of-life care is not the same between Medicare and Medicare Advantage patients. Medicare Advantage is largely operating on a Value-Based Purchasing Model. The fewer services the beneficiary receives, the more money the primary doctor, hospital, and payer keep. It is not surprising, therefore, that MA patients get fewer services for less time. Patients who switch from Traditional Medicare to Medicare Advantage, especially if they are your patients, should be informed that they are still eligible for home health care and hospice care, but they may have to ask for it.

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Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news .She also has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2025 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Bill Dombi to Continue the Care at Home Fight in D.C.

by Kristin Rowan | Feb 6, 2025 | Advocacy, Regulatory

by Kristin Rowan, Editor

Bill Dombi Key Supporter of Care at Home

The end of 2024 and the official merger of NAHC and NHPCO also brought to a close the extensive service to the care at home industry by former NAHC President Bill Dombi. Dombi served as vice president for law from 1987 to 2017. He was named interim presidnt in 2017 and president in 2018, where he served until 2024.

Bill has been instrumental in the advancement of care at home policies at the federal level, a champion for advocacy for care at home at local, state, and national conferences and organizations, and spearheaded lawsuits and challenges to CMS rulings for year. His retirement, though well-earned, was a great loss to the industry.

Back in Action

On February 4, 2025, Arnall Golden Gregory law firm, of Atlanta and Washington D.C. an Am Law 200 law firm with a client-service model of “business sensibility” announced the additional of Bill Dombi to the firm as senior counsel. With more than 40 years of experience with litigation and policy in the care at home industry, Bill will continue his fight to advance care at home in D.C.

“It’s not a stretch to say that Bill is the face of the home healthcare space and the standard-bearer for advocating on its behalf, whether in state or federal court or through his deep-rooted experience and relationships within Congress and various federal agencies. In addition to tackling major policy issues, Bill has fiercely defended providers and patients in litigation across the country. His broad perspective and exceptional legal acumen will be invaluable to our already outstanding Healthcare practice, particularly in the areas of home health, hospice, and post-acute and long-term care litigation, benefitting both our teams and the clients we serve.”

Jason E. Bring

Healthcare Litigation co-chair, Arnall Golden Gregory LLP

From AGG

Bill has been actively involved with significant litigation matters affecting home health policy since 1976. Notably, he served as lead counsel in the lawsuit that resulted in the expansion of Medicare home health coverage in 1980, and he was pivotal in the creation of the Medicare hospice benefit in 1983, the institution of the Medicare Prospective Payment System (PPS) for home health in 2000, and national healthcare reform legislation in 2010. In 2017, Bill was selected as NAHC’s president and served through 2024, ultimately concluding his tenure as president emeritus and counsel of the National Alliance for Care at Home, the combined organization of NAHC and the National Hospice and Palliative Care Organization.

“To call Bill a major addition to AGG’s Healthcare practice would be an understatement,” said Sean P. Fogarty, AGG’s managing partner. “Bill has been a pillar in the home health industry for years, and I know I speak on behalf of the entire firm when I say we we’re thrilled to have him join our team.”

Bill is renowned for his commitment to advancing care at home through legal, legislative, and regulatory advocacy. His background spans all key advocacy forums, including Congress, regulatory bodies, and the courts, where he has engineered laws and regulations that directly impact home health and hospice providers. This breadth of experience empowers his private practice to offer clients with a practical framework for compliance standards and operational excellence.

“As I look to the next chapter of my career after almost 40 years at NAHC, it’s exciting to join such an impressive firm and group of professionals with a well-established and supportive culture. AGG is so unique in its earnest focus on collegiality and collaboration, and I look forward to continuing my hard work with my new colleagues on behalf of the dedicated home health providers we serve.”

Bill Dombi

Senior Counsel, AGG

A hall of famer among several home care and hospice organizations, Bill has also served as executive director for the Center of Health Care Law and Home Care and Hospice Financial Managers Association at NAHC. He continues to serve the industry as a member of the board of directors of the Research Institute for Home Care and the Hospice and Home Care Foundation of North Carolina. With Medicaid expenditures now exceeding $130 billion annually and Medicare home health services growing from $300 million to over $25 billion, Bill’s work has seen the evolution of home care from a cottage industry to a cornerstone of long-term care in the U.S.

Bill attended the University of Connecticut, where he earned his law degree, as well as a B.A. in political science.

About Arnall Golden Gregory LLP

Arnall Golden Gregory (AGG) is an Am Law 200 law firm with offices in Atlanta and Washington, D.C. Our client-service model is rooted in taking a “business sensibility” approach of fully understanding how our clients’ legal matters fit into their overall business objectives. Our transaction, litigation, regulatory, and privacy counselors serve clients in healthcare, real estate, retail, technology, fintech/payment systems, global commerce/global mobility, life sciences, logistics and transportation, government investigations, and government contracts. With our rich experience and know-how, we don’t ask “if,” we figure out “how.” Visit us at www.agg.com.

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Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news .She also has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2025 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Medicare Advantage Increase for Payers, not Providers

by Kristin Rowan | Jan 23, 2025 | Artificial Intelligence, Breaking News, CMS, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

CMS Announces Medicare Advantage Pay Hike

On January 13, 2025, CMS announced its plans to increase payments to Medicare Advantage plans by 4.33%. Policy changes for Medicare Advantage and Part D include changes in how the agency calculates payments to health plans. A spokesperson from CMS said that the policy change provides access to affordable, high-quality care. The changes, however, don’t increase payments to the people actually providing the care, only to the payers.

Opposition

While major health plans across the U.S. were thrilled with the announcement and saw substantial stock price hikes immediately after, not everyone is on board. The American Medical Association (AMA) outlined how physicians who treat Medicare patients are getting pay cuts from CMS for the fifth year in a row. Meanwhile, HHS OIG released a report finding that MA insurers profited $7.5 billion from risk-adjusted payments in 2023.

“It’s unbelievable they’re giving insurance companies that had record profits an increase while at the same time cutting payment to physician practices that are struggling to survive. This contrast highlights the urgent need for Congress to prioritize linking payment to physician practices to the cost of providing care.”

Bruce Scott, M.D.

President, American Medical Association

Out-of-Pocket Cost Increase

In addition to the higher payments, the advance proposal includes an increase in the Part D deductible from $590 to $615. With this proposal, the out-of-pocket maximum will increase from $2,000 to $2,100 as well. Cost sharing after the deductible is reached but before the out-of-pocket max is reached will also increase. There is no increase for beneficiaries whose income is less than 100% of the Federal Poverty Level.

Coverage Increase

The CMS advance proposal calls for coverage and policy changes. Medicare and Medicaid programs will now cover anti-obesity medications. The plan imposes stricter rules on MA policies to prevent denial of reasonable and necessary services that would be covered under Medicare Part A and B. Finally, imposed guardrails on the use of AI. The guardrails will ensure AI systems are unbiased in patient care decisions. Additionally, the guardrails will ensure they do not perpetuate existing inequity in access to and receipt of medical services. The American Hospital Association appplauded this last change.

“The AHA commends CMS for taking important steps to increase oversight of 2026 Medicare Advantage plans to help ensure enrollees have equal access to medically necessary health care services. The AHA has previously raised concerns about the negative effects of certain Medicare Advantage practices and policies…that are more restrictive than Traditional Medicare and can compromise enrollee access to Medicare-covered services.”

Ashley Thompson

Senior Vice President, American Hospital Association

Changes are not Definite

Even though CMS has announced these changes to start in January, 2026, they are not set in stone. As of January 20, 2025, we are operating under anew administration and the changes under Trump have already started. CMS intends to continue it’s three-year plan to update the MA risk adjustment model and the implementation of the Inflation Reduction Act. However, it seems likely that the Inflation Reduction Act will be replaced with a different plan for inflation.

Jeff Davis, director of health policy at McDermott+ believes it is likely that Trump’s team will throw out the updates to MA and Part D as well as Biden’s proposed staffing mandate for SNFs. In the first 24 hours of his Presidency, Trump revoked both Biden’s “Strengthening Medicaid and the Affordable Care Act” and “Continuing to Strengthen Americans’ Access to Affordable, Quality Health Coverage” executive orders. He also rescinded the Drug Pricing Model executive order that covered obesity drugs, lowered the price of some drugs, and accelerated FDA approval for drugs that address unmet medical needs.

As Yet Unknown

As was to be expected, many of Trump’s initial 78 executive orders are already facing lawsuits from various entities. There are as of yet no definitive answers to changes in Medicare, Medicare Advantage, or other policies that impact healthcare and care at home. The Rowan Report will continue to follow these stories as they unfold.

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Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She also has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2025 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Product Review: Plan-of-Care Documentation

by Kristin Rowan | Jan 23, 2025 | Admin, Clinical, Product Review

by Kristin Rowan, Editor

OASIS Assessment is a Time Suck

Regulatory requirements for home health quality assurance are designed to monitor and improve quality of care. QA focuses on ensuring that patients get safe, effective, compassionate care that meets their individual needs. QA also improves patient outcomes and reduces adverse events like ER visits and rehospitalizations. OASIS includes 79 standardized medical, nursing, and rehab data elements for a comprehensive assessment. Typical OASIS assessments take 1-2 hours to complete, depending on the patient’s complexity and the assessment type.

Artificial Intelligence in OASIS coding

The Rowan Report recently came across a tool that addresses the complexities of OASIS coding. We sat down with Zach Newman (CEO) and Dan Conger (Founder) at Enzo Health to learn more about their AI powered QA tool with customizable workflows.

Co-pilot for Your Agency

Enzo Health is a documentation tool that automates workflows, acting as a co-pilot for your agency. Some of the workflows that Enzo Health supports include intake, OASIS, and QA reviews. Automating these processes can reduce errors and clawbacks, save your clinicians hours of paperwork, and offer cost savings to your agency.

QA Process

With the Enzo health QA tool, users upload all documents related to an episode. This will include the referral, initial visit notes, patient information, medical history, and form 485. Enzo calls out any issues it finds in the documentation.

In Face-to-Face encounters, Enzo looks for dates, signatures from qualifying clinicians, a valid primary diagnosis, and other qualifying information.

For ICD-10 Coding, Enzo assesses primary and secondary diagnoses, and adds notes with links to where the information can be found in the uploaded documentation.

Enzo then provides functional limitations and improvements that can be made. Using a team of clinicians that are trained as home health coders, Enzo provides a proxy for internal teams. These coders review charts and finalize diagnosis coding and OASIS answers.

Episode of Care

Qualification for an episode of care is required before anything else happens with a referral. Enzo’s intake automation tool reviews the referral package in advance of the initial F2F. Mirroring the agency’s internal intake process, Enzo determines whether the patient will be admitted to care, whether their insurance will cover the episode, and whether the patient’s psych history may impact the plan of care.

Clinical Assistance

The Rowan Report has often stated, and will continue to stand by this fact, that there is no substitute for face-to-face care and the expertise of the nurses and clinicians in the home. We have also seen the advancement of artificial intelligence that provides assistance and guidance at the point-of-care that can be useful. Enzo health includes a chat tool that pulls evidence-based information to provide guidance, coding instructions, and other help to nurses.

QA Tool Integration with Scribe Tool

Enzo Health has developed a talk-to-text scribe tool that integrates directly with the QA tool. The use of both products together would likely save more time as well as reduce errors. The Rowan Report will provide a thorough product review of the scribe tool at a later date. Enzo Health charges a flat fee determined by volume and offers bundle pricing for using both the QA and Scribe tools.

Final Thoughts

Costs are increasing, the workforce shortage is ongoing, nurses are suffering from burnout, and employees are stretched about as thin as they can go. Any tool that alleviates paperwork, stress, unpaid work at home to finish documentation, and the need for additional back-office staff is worth looking into. Enzo differentiates its tool from other QA software with their team of clinicians trained in home health coding to review the documentation. This end-to-end tool boasts a 95% accuracy rate and do date has no clawbacks or ADRs.

In my conversation with Zach and Dan, their coding expertise and knowledge of the home health industry were evident. They are excited about the tools they are creating and passionate about helping agencies to provide patient care, a task they referred to as “very noble.” They continue to improve upon their software and conceive of innovative additions. If they continue as they started, Enzo Health will be one to watch.

GUIDE Model Expanding

by Kristin Rowan | Jan 16, 2025 | Clinical

by Kristin Rowan, Editor

GUIDE Launched with 390 Participants

On July 1, 204, CMS launched the GUIDE Model and announced that 390 organizations had signed on to participate. The Guiding an Improved Dementia Experience (GUIDE) Model is a voluntary model test amied at supporting people with dementia and their unpaid caregivers (family members).

Overview

The GUIDE Model focuses on comprehensive, coordinated dementia care to improve the quality of life for people with dementia. It also hopes to reduce the strain on family caregivers and keep patients in their homes and communities longer. Medicare payments cover the package of care coordination, care management, caregiver education and support, and respite care.

Poor-Quality Dementia Care

The GUIDE Model aims to address the key drivers of poor-quality dementia care in five ways:

- Defining a standardized approach to dementia care delivery for model participants – this includes staffing considerations, services for people with dementia and their unpaid caregivers, and quality standards.
- Providing an alternative payment methodology to model participants – CMS provides a monthly per-beneficiary payment to support a team-based collaborative care approach.
- Addressing unpaid caregiver needs – the model aims to address the burden experienced by unpaid caregivers by requiring model participants to provide caregiver training and support services, including 24/7 access to a support line, as well as connections to community-based providers.
- Respite services – CMS pays model participants for respite services, which are temporary services provided to a beneficiary in their home, at an adult day center, or at a facility that can provide 24-hour care for the purpose of giving the unpaid caregiver temporary breaks from their caregiving responsibilities.
- Screening for Health-Related Social Needs – model participants are required to screen beneficiaries for psychosocial needs and health-related social needs (HRSNs) and help navigate them to local, community-based organizations to address these needs.

Health Equity

Aspects of GUIDE designed to improve health equity include:

- Requiring participating providers to implement HRSN screenings and referrals.
- Offering financial and technical support for development of new dementia care programs targeted to underserved areas with less access to specialty dementia care.
- Annual reporting by participants on progress towards health equity objectives, strategies, and targets.
- Using data from the model to identify disparities and target improvement activities.
- A health equity adjustment to the model’s monthly care management payment to provide additional resources to care for underserved beneficiaries.

Exclusive Inside Scoop

PocketRN gives patients, families, and caregivers a “nurse for life,” closing the gap between healthcare and care at home. This whole-person support allows patients and their caregivers to have access to medical care through their virtual nurse, who establishes a relationship with the patients and families.

On January 13, 2025, PocketRN announced a Strategic Partnership with Nevvon to pilot the GUIDE Model.

Nevvon is a global home and health care training tech company that certifies caregivers for continuing education. The app-based learning allows caregivers to go at their own pace, simplifying compliance, and empowering agencies to deliver exceptional care.

On January 15, 2025, PocketRN announced a Strategic Partnership with Right at Home to provide support to eligible Medicare beneficiaries with dementia.

Right at Home is a nationwide provider of in-home care and will provide care and safety assessments for eligible beneficiaries to evaluate the safety of the home environment, the ability of the patient to manage and function at home, and report back to PocketRN any other factors that might impact the patient and their family caregiver.

Later today, PocketRN will announce a National Strategic Partnership with with Assisting Hands® Home Care to test the care model.

Assisting Hands provides in-home care to seniors, individuals with disabilities, and people recovering from illness or injury. The agency has a significant portion of their client base with a dementia diagnosis. Their franchise system has locations across the United States.

“We couldn’t be more thrilled to bring our revolutionary nurse-led care model to the millions of dementia patients and families who need it most. With PocketRN, patients and families get unwavering support from a ‘virtual nurse for life’ as they navigate the complexities of managing dementia at NO cost to them. Nurses are hands-down the best clinicians to be the ‘glue’ for patients and their families throughout their dementia journey–they’ve been doing so forever, and it’s high-time their work is valued by our system.”

Jenna Morgenstern-Gaines

CEO, PocketRN

In Their Own Words

The Rowan Report spoke with Nancy Gillette, Chief Growth Officer at PocketRN for this exclusive scoop. Nancy explained that with this program, PocketRN will be able to provide a nurse to dementia patients, provide a clinical overlay to care at home, work with care at home partners for respite benefits, and become a referral source when a home care agency has an eligible patient.

Existing models and studies using PocketRN have shown up to a 30% reduction in urgent care visits, ER visits, and hospitalizations. The company is focusing on finding new strategic partners for a greater understanding of patient engagement from a home care agency standpoint.

Nancy gave us this inside information:

The three recent announcements are just the beginning. Expect more announcements in the next 30-60 days and then continuing throughout the year.

PocketRN will eventually be applying the GUIDE Model in agencies, patients already using PocketRN, and direct referrals across all 50 states.

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Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news .She also has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2025 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

AI and Communication in Healthcare

by Kristin Rowan | Jan 16, 2025 | Admin, Artificial Intelligence, Caring for the Caregiver

An exerpt of “How AI is Enhancing Healthcare Communication” by Sandeep Shah, Founder and CEO, Skyscape

Edited by Kristin Rowan

How AI is Enhancing Communication

Artificial intelligence isn’t a new concept. In the healthcare industry alone, AI has been used to some degree since the 1970’s. It was first implemented to help identify blood infection treatments and showed promising results. This led to further curiosity about what it could do for healthcare professionals.

Today, AI is commonly used in several aspects of care, especially regarding radiology, screening tests, psychiatry, disease diagnosis, and predictive and preventative care. However, one lesser-known way AI tools are impacting our industry is through enhanced communication. AI is reshaping how care at home professionals interact with patients and care teams.

Challenges in Medical Communication

Electronic Health records have reduced the incidence of medical errors by improving the accuracy and clarity of medical records. However, they do not address the communication challenges today’s healthcare organizations still face. Communication channels, especially in care at home, are often fragmented, leaving gaps in patient care, follow-up, and department collaboration. Moreover, patient engagement is increasingly tricky without good communication, resulting in disruptive care plans or gaps in their treatment.

Effective communication is paramount to enhancing patient outcomes, revenue growth, and operational efficiency. Thanks to advancements in technology, AI has the potential to bridge these gaps and create a better experience for both healthcare providers and the patients they care for.

AI Communication Improving Patient Care

Communication within a HH agency is becoming increasingly complex. With more patients and a shortage of nurses, your team may be overwhelmed with tasks, applications, and health information. Luckily, there are several ways that you and your team can leverage artificial intelligence to better communication with patients and care teams (physicians, nurses, surgeons, lab technicians, administrative staff, etc.)

Here are some AI applications that will have the most impact on your agency:

Scheduling and Follow-ups

AI can improve both scheduling and follow-up processes, where there are often delays and miscommunications. AI software can automate appointment reminders and confirmations as well as rescheduling appointments if needed. These automated systems increase patient engagment with your agency and in their treatment. Some AI platforms can analyze patient data to give you a better look at patients who may have additional needs, which could also increase your billings.

Real-Time Support

Care at home nurses and caregivers report burnout due to increased requirements and tasks, including patient communication. AI should not replace your caregivers, but it can be helpful for simple questions, appointment reminders, and other routine tasks.

Future uses may include assistance with medical questions and creating a plan of care. AI is becoming more powerful in learning predetermined information, including scientifically reviewed medical information. Having real-time access to evidence-based, clinical information can accelerate care decisions at the point-of-care.

Less Paperwork, Less Burnout

Care at home nurses and caregivers can spend hours per day on documentation and patient communication. AI cannot and should not completely replace human interaction and communication, but it can significantly reduce the administrative burden of your employees.

Documentation, care notes, intake, and patient emails consume a significant portion of the day. A study from the University of California San Diego School of Medicine found that AI-generated emails and replies significantly reduce the mental strain on medical professionals. The study focused on communication between doctors and patients, but suggests that is can ease the workload of nurses and other healthcare professionals.

Efficient Workflows

Streamlining workflows seems to be one of the most promising applications of AI. Generative AI can interpret the information it is given to create something new. For care at home, this means the eventual use of AI for OASIS coding, plan-of-care, NTUC documentation, and more.

Removing Language and Cultural Barriers

Language translation creates the possibility for any of your caregivers to care for any patient, regardless of the language they speak. AI translators bridge gaps in communication, especially when it comes to care plans and symptoms that are not generally part of the vocabulary taught when learning a language.

AI can also adjust communication for certain cultural backgrounds, improving patient trust and satisfaction, which can impact your star rating.

Care Collaboration

Using digital secure platforms, you can create communication channels with patients, family members, family caregivers, doctors, specialists, lab technicians, and anyone else involved in patient care. Instant updates to all the members of a patient’s care team relays critical information when it’s needed most.

Save Time and Money

Not only do these AI applications improve patient satisfaction and reduce the workload for your nurses, AI can save you money. By automating operations like scheduling, shift fulfillment, billing, and other routine, repetitive tasks, your agency can scale without adding additional administrative personnel. With minimal profit margins, automation can help ensure your agency can continuing putting effort where it matters most, into patient care.

The Platform Matters

AI sounds great, and the applications for improving efficiency, better patient satisfaction, better employee satisfaction, and lower costs are appealing to care at home agency owners. However, spending your time, effort, and money on the wrong AI platform can be worse than doing nothing at all.

AI platforms should enhance, not replace, any task it is designed to perform. If an AI platform promises to handle 100% of any task, run, don’t walk, in any direction.

With so many AI applications available, you could onboard dozens of platforms and still have room for more automation. Look for AI applications that perform multiple tasks and/or integrate with other AI software companies.

When you’re ready to let AI simplify your agency and make your staff and patients happier, it may be a good idea to find a consultant who is an expert in software and AI applications to recommend the right fit for your agency.

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About Buzz

Buzz is a HIPAA-secure platform that simplifies real-time on-the-go communications between all stakeholders in an organization’s healthcare ecosystem (administrators, operations, billing, payors, providers and patients). It supports commonly used communication modalities, including texts, dictation, private calls, audio, images, reports, and video sharing. By consolidating these features into a single platform, Buzz eliminates the need for multiple communication tools, reducing confusion and burnout and enabling healthcare teams to focus on delivering exceptional patient care.

Sandeep Shah is a pioneering technology entrepreneur, educator, and innovator, combining vision with strong technical expertise to transform healthcare delivery. Track record delivering innovative technologies to Harvard’s hospital network, and developing the first, truly usable mHealth application. Technical interests in telehealth, Clinical Communication and Collaboration (CC&C), and business leadership. Educational background in electrical engineering (B.Tech) and computer science (M.Tech), both from the Indian Institute of Technology, Bombay.

©2025 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Whistleblower Case Impedes Lawsuits

by Kristin Rowan | Jan 16, 2025 | CMS, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

Whistleblower Action

A United States District Court in Tampa, Florida ruled against a whistleblower action under the False Claims Act (FCA) against her former employer. In 2019, a family care physician filed a whistleblower, or qui tam, action against her employer for increasing the risk adjustment scores of Medicare Advantage patients in order to receive higher payments.

Whistleblower Protection

When an employee or person with information about a company’s wrongdoing, they can file a lawsuit against that company. Whistleblowers are protected under OSHA, EEOC, and several federal and state regulations against retaliation from their employer. A whistleblower, the person who brings evidence of wrongdoing to the court, is called a “relator.”

Before the Ruling

The False Claims Act is the first and one of the strongest whistleblower laws in the U.S. Under the FCA whistleblower rules, any private citizen can sue any individual, company, or other entity that is defrauding the government and recover damages and penalties on the government’s behalf. Whistleblowers also receive compensation when these suits are settled between 15% and 30% of the total proceeds. As the FCA has expanded since its passing in 1863, the law made it possible for anyone to serve as a whistleblower.

The Ruling

In the case noted above, the court ruled that FCA whistleblowers act as officers of the United States when they sue on behalf of the federal government. The decision reasoned that whistleblowers are appointing themselves as officers of the federal government by bringing these lawsuits.

Article II, Section 2, Clause 2 of the Constitution states that the President can appoint officers and officials to the government and that they require Senate approval for some of these. Cabinet appointments, judicial appointments, and other high ranking positions are often the subject of news stories during Senate hearings to confirm these appointments.

The court ruled that an FCA whistleblower becomes an officer of the federal government through self-appointment, violating the Appointment Clause of the Constitution. The court further ruled that the False Claims Act in itself is a violation of the Constitution, effectively nullifying the FCA, at least in Florida for now.

Widespread Implications

Any company who has lost a False Claims Act suit may now be able to challenge those rulings, using this case as precedent. However, there are some hoops they would need to jump in order to do so, depending on how this case is interpreted. Ironically, this case states that whistleblowers cannot be officers of the government without appointment, but if that’s true, then all False Claims Act decisions become easier to challenge.

If this decision stands and is adopted as precedent across the U.S., it could completely nullify the False Claims Act. It may even be considered for a Supreme Court ruling. In 2023, the U.S. government recouped $2.6 billion from FCA suits, nearly $2.3 billion of which were claims brought by whistleblowers.

Care at Home Implications

Medicare and Medicare Advantage are rife with fraudulent claims, “coding intensity“, upcoding, and predatory marketing. In 2024, CMS announced changes to the risk adjustment model in the Risk Adjustment Validation Final Rule after seeing higher-than-expected risk scores. The changes could help CMS recoup up to $4.7 billion in the next ten years.

MedPAC estimates that Medicare Advantage plans received as much at $88 billion in excess payments in 2024. The lowest share of overpayment reimbursement through the Fraudulent Claims Act would give whistleblowers a combined $13.2 billion. Eliminating the FCA may discourage employees and contractors from reporting fraudulent claims and overbilling through Medicare and Medicare Advantage.

Final Thoughts

A safeguard for people trying to do the right thing, a means to save the federal government billions of dollars that can be spent elsewhere, and ultimately better care for patients are all at risk if the FCA is struck down. A law that has been in place for more than 150 years should carry more weight than the ruling of one district court who applies a new definition to a long-standing term.

Whistleblowers and the federal government have generally been considered co-defendants in these suits. Two parties with separate interests in the same suit, acting independently, not a joint case like a class action suit would be. I anticipate an appeal on this decision and hopefully a panel of judges who better understand the necessity of the False Claims Act and the Whistleblower provisions.

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Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news .She also has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2025 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

VitalCaring Pulls Agreement

by Kristin Rowan | Jan 9, 2025 | Breaking News, Regulatory

by Kristin Rowan, Editor

Just as we were setting the article on UnitedHealth Group and Amedisys for publication, we received the following breaking news story:

VitalCaring Divestment Agreement Cancelled

VitalCaring entered into the agreement on June 28, 2024, just after the merger announcement and initial pushback from the Department of Justice. The DOJ approved the divestiture, despite some misgivings about the quality of care. VitalCaring said at the time that it believed the merger and the divestment were in the “best interest of patients and stakeholders.”

VitalCaring has been under its own scrutiny since 2022 when Encompass Health and its home health and hospice arm, Enhabit, Inc. accused VitalCaring CEO April Anthony of using unethical practices to establish the company. Anthony is the founder of Encompass Home Health & Hospice, the previous owner and CEO of Liberty Health Services, and founder and former CEO of Homecare Homebase.

She Who Shall Not be Named

Encompass Health filed an injunction against April Anthony, and her partners Vistria Group and Nautic Partners in 2021 for violation of the terms of her employment agreement, non-competition agreement, non-solicitation, and misappropriation of trade secrets.

Anthony and her partners purchased a small home health agency in Louisiana and started plan for its growth while Anthony was still CEO of Encompass. Additionally, Anthony recruited employees of Encompass to work at her new venture using a fake recruiter to cover her tracks. Anthony used fake names, spouses’ phones, and her personal laptop to remain undetected during this time. Anthony asked her partners and recruits to refer to her as Voldemort.

Judgment Day

In August of 2022, a judge called the actions of Anthony and her partners “willful misconduct” and agreed with almost all of Encompass’s allegations. The judge found that Anthony was in violation of her non-compete agreement and that she was actively running a direct competitor while still serving as CEO of Encompass. The judge stated, “These are not the actions of a person complying with her contractual obligations.” Although Encompass’s injunction asked to have the non-compete agreement extended, the judge only enforced the existing non-compete agreement, and found that that Anthony had violated the covenant.

Pay the Piper

The Delaware Court of Chancery, in December of 2024, agreed with the earlier findings of the court and found that Anthony, two former senior officers of Encompass, and the investment companies were complicit in their miconduct and that VitalCaring was a result of their deceit.

The court awarded an upfront payment for mitigation damages of $1.62 million dollars plus attorneys’ fees. The court also imposed a trust entitling Encompass Health and Enhabit to 43% of al of VitalCaring Group’s future profits, paid quarterly as well as 43% of proceeds if and when the company is sold.

Divorce Proceedings

Depending on the source, each of the companies involved in the divestiture agreement are claiming credit for filing for divorce.

An equity analyst for UnitedHealth Group said, “UNH has abandoned VitalCaring as a divestiture buyer after the Delaware Chancery decision against VitalCaring’s executives.”
An article from a hospice website stated, “Amedisys has halted the divestiture of some of its home health and hospice locations to Texas-based VitalCaring.
A stock market website reported “VitalCaring Group cancelled the acquisition of certain home health care centers from UnitedHealth Group, Inc.”

Regardless of who filed for divorce, UnitedHealth Group and Amedisys are courting new partners to acquire the home health centers that need to be divested before their marriage can be blessed by the DOJ.

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Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news .She also has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2025 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Congress Allows Medicare Advantage to Deny Coverage

by Kristin Rowan | Jan 9, 2025 | Advocacy, Editorial, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

Medicare Advantage Bill Dies in Congress

The 118th United States Congress, ran from January 3, 2023 to January 3, 2025. This Congress’s first law was passed on March 20, 2023, much later than most previous congressional sessions. In its first year, it passed only 34 bills. In the two years of this congressional run, the 118th passed 209 public laws, almost half the average since 1989. Among the many bills that died on the floor before time ran out was the Improving Seniors’ Timely Access to Care Act (H.R. 8702/S. 4532). Senate and House members introduced the bill on June 12, 2024.

Improving Seniors' Timely Access to Care

In June of 2024, senators and representatives introduced bipartisan legislation that would have curbed Medicare Advantage’s ability to deny claims. The bill included language that allowed CMS the authority to establish standard timeframes for electronic prior authorizations requests including expedited requests and real-time decisions for routinely approved services. The bill also included requirements for transparency and reporting, including:

- establishing an electronic prior authorization process
- establishing a process for real-time decisions for routine services
- providing more detailed reports on use of prior authorization including
  - rates of approvals
  - denials
  - average time for approvals
- pressing Medicare Advantage providers to incorporate input from health care providers on their authorization processes and decisions
- adopting prior authorization programs that adhere to evidence-based medical guidelines
- requiring Medicare Advantage providers to report on the percentage of denied claims that were later overturned

Overwhelming Support

At the time this bill was reintroduced to Congress in June, 135 House co-sponsors and 44 Senate co-sponsors signed on. By the end of July, the bill had been read, sent to the House Ways and Means Committee, and passed. Representative Mike Kelly (R-PA) noted that more than 500 organizations had endorsed the act.

Urgent Need for Change

In early 2024, an audit from the Office of the Inspector General (OIG) at the U.S. Department of Health and Human Services (HHS) revealed that Medicare Advantage plans eventually approve 75% of authorization requests for services that were initally denied. More recently, HHS OIG released a report showing that MA plans incorrectly denied services to beneficiaries even though they met the requirements for coverage. Following the report, HHS OIG made the following recommendations to CMS:

- issue new guidance on the use of MAO clinical criteria in medical necessity reviews
- update audit protocols for Medicare Advantage to address the issues of MAO use of clinical critera and examining service types
- direct MAOs to indentify and address the causes for manual review errors and system errors.

CMS agreed with all three recommendations.

Dead in the Field

Despite the bipartisan, bicameral support of this much needed overhaul of Medicare Advantage providers, the bill is currently in pile of unaddressed issues that the 118th Congress just didn’t get to. Despite having it in front of them for five months, and despite passing nearly half the legislation of the 17 most recent congressional sessions, the bill that would keep MA beneficiaries from waiting inordinate amounts of time for routine care will have to wait for the next session to resume. Let’s hope the 119th Congress is more productive.

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Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news .She also has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2025 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com