by Rowan Report | Jun 21, 2024 | Partner News
June 18, 2024
Washington, D.C. and Alexandria, VA – On June 10, the Board Chairs and chief executive officers of the National Association for Home Care & Hospice (NAHC) and the National Hospice and Palliative Care Organization (NHPCO) met in Washington, D.C. to formally sign the affiliation agreement between the two leading organizations in the care at home community.
NAHC and NHPCO are the two largest organizations representing and advocating for providers of care in the home and the millions of disabled, elderly, and dying Americans who depend on that care. With more than 90 years of experience between them, NAHC and NHPCO provide world class education to help their members deliver the best possible care and tireless advocacy to expand access to home and community-based services.
“The NAHC-NHPCO Alliance will be the leading authority and unifying voice of the care at home community,” said NAHC Board Chair and Chair-Elect of the Alliance Kenneth Albert. “The leadership of both organizations have worked for 18 months to make this happen and the talented staff at NAHC and NHPCO are already hard at work integrating the two organizations. Together, we will make home the center of health care.”
“This alliance between NHPCO and NAHC will create the most powerful voice the care at home community has ever had,” said NHPCO Board Chair and Vice Chair-Elect of the Alliance Melinda Gruber. “For members, it means access to the best education and expert advice, as well as a strong advocate for sensible policies that help providers deliver the best possible care to the millions of Americans who need it the most.”
“The affiliation of NAHC and NHPCO is a historic event,” said NAHC President and CEO William A. Dombi. “Unifying the voice of health care at home has been a longstanding goal of NAHC, as it is the essence of the original formation of NAHC in 1982. Combining our two organizations will significantly strengthen that voice for the benefit of our members and the patients they serve.”
“The community of providers delivering care primarily in people’s homes is stronger when we work together,” said NHPCO Interim CEO, Ben Marcantonio. “We have demonstrated that strength in recent years with shared advocacy efforts and joint research that have helped change the conversation in Washington and beyond. Aligning NHPCO and NAHC into one new organization will mean we can better serve our members well into the future.”
The signing of the agreement takes NAHC and NHPCO into a new phase of an ongoing process. Beginning July 1, the organizations will begin integrating operations, a process that is expected to take the rest of the year. That process will take place under the name the NAHC-NHPCO Alliance while the future name of the organization is determined. Considerable progress on a new name has been made and is in process of trademarking approvals. Meanwhile, a robust search for a CEO for the new organization is under way, with dozens of qualified candidates being considered.
Press Contacts:
- Thomas Threlkeld, NAHC Director of Communications
- Elyssa Katz, NHPCO Marketing and Communications Manager
###
About National Association for Home Care & Hospice (NAHC)
The National Association for Home Care & Hospice (NAHC) is the voice of home care and hospice. NAHC represents the nation’s 33,000 home care and hospice providers, along with the more than two million nurses, therapists, and aides they employ. These caregivers provide vital services to Americans who are aged, disabled, and ill. Some 12 million patients depend on home care and hospice providers, who depend on NAHC for the best in advocacy, education, and information. NAHC is a nonprofit organization that helps its members maintain the highest standards of care. To learn more, visit http://www.nahc.org.
About NHPCO
The National Hospice and Palliative Care Organization (NHPCO) is the nation’s largest and oldest membership association for providers who care for people affected by serious and life-limiting illness. Our members deliver and expand access to high-quality, person-centered interdisciplinary care to millions of Americans. NHPCO provides education and resources to support that mission. Together with our advocacy partner, the Hospice Action Network (HAN), we serve as the leading voice advancing public policy to improve serious-illness and end-of-life care, while our CaringInfo program provides free resources to educate and empower patients and caregivers. nhpco.org.
by Rowan Report | Jun 13, 2024 | Artificial Intelligence, New Tech, Partner News
by Tom Herzog, COO of Netsmart
Navigating the Next Era of Tech-Enabled Healthcare
While the talk is about Artificial Intelligence, the immediate opportunity is Augmented Intelligence.
We are living through one of the most exhilarating times in healthcare, a journey made possible by significant milestones over recent decades. As healthcare technologists deeply committed to the cause + communities we serve, we’re excited by the promise of the upcoming era of technological empowerment. This phase is set to showcase and expand upon the extensive work done in digitizing healthcare, highlighting the relentless pursuit of innovation that has characterized our field. In conversations with colleagues and clients, we have recognized the need to explore these developments as we progress collectively. Matthew and I thought a series of reflections on these conversations would be helpful for all of us, providing insights into technology’s transformative impact on healthcare and the critical initiatives currently underway. We envision this dialogue as a series of posts throughout the year, sparking discussion and reflection as we navigate forward.
Back to the Future
In 2015, we envisioned a future where the concept of navigation as we know it would be obsolete, advocating for a universal search that is nearly autonomous, informed by the known context specific to every role. By 2019, we were discussing workflow automation, using the example of Lane Departure Warning systems in automobiles as a metaphor for technology that enhances outcomes through precision responses. The pace at which these technologies are evolving is astounding, moving beyond mere speed of thought to how we can iterate at the speed of innovation itself. Before we achieve the aspirations of true Artificial Intelligence, we must start with Augmented Intelligence, which may very well be the most significant technological innovation in my lifetime.
The Gentle Guidance of Technology: Augmented Intelligence in Healthcare
Artificial Intelligence (AI) and Augmented Intelligence stand as beacon forces driving innovation forward in this fast-evolving technology landscape. Drawing an analogy to driver assistance systems in modern vehicles, we explore the nuanced differences between these concepts, simplifying their understanding and underscoring the distinct roles in enhancing human capabilities.
Artificial Intelligence: The Autonomous Navigator
Imagine AI as the driving force behind fully autonomous vehicles, adeptly navigating complex terrains without human intervention. This epitomizes the grand aspiration of AI: to emulate or even transcend human Intelligence in specific tasks, thus granting machines the ability to function independently. It’s a prospect that is as exhilarating as it is intimidating, reminiscent of scenarios depicted in futuristic films. Such advancements bring to light profound questions about the limits of technology and the ethical considerations it entails. While we marvel at the potential, apprehension about the unknown shadows our enthusiasm. As we venture into this era, it’s imperative that we tread thoughtfully, balancing our ambitions with caution, as we unlock new realms of possibilities. Together, we must navigate this journey towards outcomes that are not only innovative but also meaningful and ethically sound.
Augmented Intelligence: The Co-Pilot’s Nudge
Conversely, Augmented Intelligence mirrors the driver assistance systems in vehicles – providing “nudges” or guidance while ensuring the driver remains in control. These systems bolster safety and efficiency, complementing human Intelligence with technological support. This partnership epitomizes the collaborative synergy between technology and human skills for a safer and more efficient driving experience.
The American Medical Association (AMA) aligns with this vision, emphasizing Augmented Intelligence’s role in enhancing human Intelligence rather than replacing it. The AMA advocates for the use of AI in healthcare as a means to augment the capabilities of medical professionals, not to substitute their critical thinking or clinical judgment.
Augmented Intelligence in Healthcare: Enhancing the User’s Ability
Reflecting on the transition from conceptual frameworks to tangible applications, we’ve initiated the Augmented Intelligence family. These solutions are meticulously designed to support clinical, operational, and financial workflows across all healthcare roles. Aimed at simplifying user experiences, these tools provide the best available context and automate information for validation and use as needed. This initiative marks a significant step in harnessing the potential of augmented Intelligence, enabling transformative shifts in healthcare practices and outcomes.
Michelle Donelan MP, reflecting on the U.K.’s commitment to AI in healthcare, highlights the transformative impact of augmented Intelligence, “AI will revolutionize the way we live, including our healthcare system. That is why we’re backing the U.K.’s fantastic innovators to save lives by boosting the frontline of our NHS and tackling the major health challenges of our time”. Donelan’s statement emphasizes the government’s support for utilizing AI to enhance healthcare delivery and address pressing health issues.
Augmented Intelligence promises to extend the partnership between human capabilities and technological advancement to medical professionals. Vincent Liu, MD, from Kaiser Permanente, elucidates this synergy, stating,
“There is a stage at which regulations can stifle some of the innovation [that AI might advance] … There is a role for providing a safe harbor [from certain regulations] so that we can use our best data to improve our patients’ care.”
This perspective underscores the potential of augmented Intelligence to enrich patient care by integrating comprehensive data analysis within the regulatory framework.
From the inception of conversations at our annual user conferences in the early 2000s to the present, we’ve witnessed the evolving landscape of healthcare technology. The decades-long journey of healthcare digitization has set the stage for today’s advancements, where Artificial Intelligence and Augmented Intelligence solutions leverage data to significantly improve care and operational efficiency.
Navigating Ethical Considerations
The integration of Augmented Intelligence in healthcare navigates through a maze of ethical considerations. Upholding the sanctity of the caregiver-patient relationship, ensuring patient privacy, and addressing potential biases in AI algorithms are paramount. The objective is to leverage Augmented Intelligence in a manner that respects these ethical boundaries while enhancing patient benefits.
A Future of Collaborative Care
Looking ahead, the promise of healthcare augmented by Intelligence offers a landscape where clinicians are equipped with unprecedented tools and information. This era does not diminish the essence of human judgment or the significance of the human touch in medicine but serves as a potent ally to these irreplaceable elements of care.
A Journey of Human-Machine Collaboration
Augmented Intelligence in healthcare symbolizes the collaboration between human Intelligence and artificial capabilities. This collaboration is not about relinquishing control but about enriching human expertise to tackle modern healthcare challenges. As we continue to integrate this technology, it heralds a future where healthcare is more personalized, predictive, and precise. The path forward, illuminated by the gentle guidance of Augmented Intelligence, promises a realm of endless potential for improved health outcomes for all.
Our immediate focus is three-fold 1) providing the communities we serve with the benefits of Augmented Intelligence, 2) ensuring we achieve Meaningful AI for every role, and 3) doing so through incremental progress so that AI now is a reality.
Final Thoughts
If you are reading this, you are likely one of the pioneers helping forge the path we are on today. If it were not for the initial efforts to digitize the ecosystem, we would not be talking about this today. Thank you for making this happen, for your perseverance and tenacity to find a way. Now we are at the transition from AI as a futuristic concept to its current role in shaping healthcare practices marks a remarkable chapter in the ongoing story of innovation in healthcare. It reaffirms the importance of digitization as the foundation upon which AI and other emerging technologies are built, enabling a future where healthcare is more informed, more empowered, and, ultimately, more human.
# # #
Tom Herzog is responsible for leading solution and technology strategies focused on person-centric design to optimize workflow, efficiencies and outcomes. His teams work in collaboration with both clients and partners to deliver comprehensive solutions for the human services and post-acute care communities.
Tom oversees multiple business units, including Netsmart consulting organization, solutions, development, engineering, technology, innovation, product development, IT, support, human resources, legal and operational functions.
Tom’s additional experience includes leading teams to automate systems and integrate financial, document management and information systems. He has been recognized for his ability to create innovative approaches and strategies that deliver results through vision and building strong teams.
Tom earned a bachelor’s degree in business management and human relations from Mid-America Nazarene University. He serves on the boards of the Overland Park Chamber of Commerce and the United Community Services of Johnson County.
by Rowan Report | Jun 13, 2024 | Partner News
ROAD TO THE TELEHEALTH “SUPER BOWL”: ATA ACTION CAPITOL HILL DRIVE
WASHINGTON, DC, JUNE 12, 2024 – ATA Action, the American Telemedicine Association’s affiliated trade association focused on advocacy, hosted its 2nd annual Hill Day, bringing nearly two dozen ATA Action members to Capitol Hill for meetings with Congressional leaders to discuss top federal telehealth policy priorities. ATA Action members underscored the ATA and ATA Action playbook for comprehensive, permanent telehealth reform, including passage of the CONNECT for Health Act (H.R. 4189, S. 2016), the Telehealth Modernization Act (HR 7623, S.3967) and the Advancing Access to Telehealth Act (HR 7711).
“This well-timed Hill Day accomplished our goal, to keep telehealth access front-and-center in the minds of our Congressional champions and underscore the urgent need for Congress to act now to give patients and providers certainty about the continued availability of telehealth services,” said Kyle Zebley, senior vice president, public policy, the ATA and executive director, ATA Action. “We continue to hammer home the fact that access to telehealth is essential for delivering safe, effective, quality care to all individuals, including those in rural and underserved communities, as part of a modernized healthcare system.
“As we continue to seek permanent access to virtual care services, we remain grateful to the unwavering bipartisan, bicameral support for appropriate and necessary policies to ensure citizens have access to often life-saving telehealth services, when and where they need it. But the clock is ticking. We need Congress to act now, so that appropriate telehealth policies are implemented in a timely manner without arbitrary and unnecessary barriers to care such as in-person, brick-and-mortar, or geographic requirements,” Zebley added. “We are also eager to see our Senate champions act on these important telehealth policies.”
ATA Action members participating in Hill Day included a diverse range of organizations advocating for telehealth. Members of ATA Action’s Patient Voices for Telehealth Coalition also joined Hill Day meetings.
About ATA Action
ATA Action recognizes that telehealth and virtual care have the potential to transform the healthcare delivery system by improving patient outcomes, enhancing the safety and effectiveness of care, addressing health disparities, and reducing costs. ATA Action is a registered 501c6 entity and an affiliated trade organization of the American Telemedicine Association (ATA).
# # #
CONTACT:
Gina Cella
gcella@americantelemed.org
t: 781-799-3137
by Rowan Report | Jun 13, 2024 | Partner News
AMERICAN TELEMEDICINE ASSOCIATION JOINS WEST HEALTH INSTITUTE’S COLLABORATIVE FOR TELEHEALTH AND AGING
WASHINGTON, DC, JUNE 11, 2024 – The American Telemedicine Association (ATA) today announced it has joined the Collaborative for Telehealth and Aging (C4TA), an initiative led by the West Health Institute (WHI). The ATA will serve as an Advisor to the C4TA, which is committed to accelerating the adoption of telehealth to meet the needs of seniors. WHI is a non-profit medical research organization dedicated to lowering healthcare costs and engaged in applied medical research and improving healthcare delivery for older Americans.
“The ATA has long been a proponent of using telehealth and virtual care technologies to better care for our aging population, not just to live longer, but to live better, to support our caregivers and improve our healthcare system to benefit all stages of life,” said Ann Mond Johnson, CEO, the ATA. “We are pleased to join the C4TA to accelerate the adoption of telehealth to meet the needs of seniors and enable individuals to remain vital, engaged and independent through their later years, and create a better health system for everyone.”
C4TA was established in 2021 by West Health, the University of Virginia, and the Mid-Atlantic Telehealth Resource Center to gather experts from health systems, academic institutions, member organizations, and non-profit foundations focused on aging to develop and provide guidelines implementation tools for using telehealth with older adults.
“We are proud to welcome the American Telemedicine Association among the more than 35 national organizations joining our mission to enhance telehealth services for older adults,” says Dr. Zia Agha, Chief Medical Officer of West Health Institute. “Together, alongside experts in geriatrics, telehealth, and patient advocacy, collaborative members have established vital principles and guidelines to ensure equitable, accessible, and integrated remote care options. This collaboration underscores our shared commitment to improving the well-being of older adults across the nation.”
The ATA’s Healthy Aging Collaborative is a member forum focused on identifying and pursuing opportunities to make an impact on the daily life of our aging population through policy guidance and the use of technologies to ease the burden of communications, social isolation, and whole person care management. The ATA Healthy Aging Collaborative hosts quarterly webinars, providing insights and education for the broader community. The group recently published a report, Leveraging Telehealth to Support Caregivers and Those They Care For.
About the ATA
As the only organization completely focused on advancing telehealth, the American Telemedicine Association is committed to ensuring that everyone has access to safe, affordable, and appropriate care when and where they need it, enabling the system to do more good for more people. The ATA represents a broad and inclusive member network of leading healthcare delivery systems, academic institutions, technology solution providers and payers, as well as partner organizations and alliances, working to advance industry adoption of telehealth, promote responsible policy, advocate for government and market normalization, and provide education and resources to help integrate virtual care into emerging value-based delivery models.
# # #
by Rowan Report | May 10, 2024 | Partner News, Telehealth
FOR IMMEDIATE RELEASE
ATA ACTION APPLAUDS HOUSE WAYS AND MEANS COMMITTEE FOR UNANIMOUSLY ADVANCING A TWO-YEAR EXTENSION OF MANY CRITICAL TELEHEALTH FLEXIBILITIES
WASHINGTON, DC, MAY 8, 2024 – ATA Action, an affiliated trade organization of the American Telemedicine Association (ATA), applauds the House Ways and Means Committee for their proactive approach in unanimously advancing a two-year telehealth extension. This extension will maintain many of the current Medicare telehealth flexibilities through the end of calendar year 2026, demonstrating the Committee’s commitment to telehealth.
“While we prefer Medicare telehealth flexibilities be made permanent, we understand the dynamics and applaud the Committee for a two-year extension of many of the critical flexibilities without arbitrary and unnecessary guardrails such as in-person requirements,” said Kyle Zebley, Senior Vice President, Public Policy, the ATA and Executive Director, ATA Action. “This is a clear sign that our bipartisan telehealth supporters are at work, determined not to leave the American people without access to safe, effective, quality healthcare where and when they need it. But this is not over yet. There will be additional markups and other committees need to weigh in, as we continue to push for telehealth permanency.”
Specifically, ATA Action is supportive of the bill extending the following telehealth provisions:
- Geographic and originating-site waivers
- Ability for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to continue to furnish telehealth services
- Expanded list of eligible Medicare providers, allowing Physical Therapists, Occupational Therapists, Speech Language Pathologies, and Audiologists to render telehealth services
- Ability to offer audio-only services
- Repeal of telemental health in-person requirement
- Preservation of the Acute Hospital Care at Home Program through CY2029
“We hope this action by the Ways and Means Committee will push Congress to enact this legislation soon to provide certainty for patients and providers across the country and allow U.S. healthcare systems enough time to implement appropriate virtual tools, technologies, programs, and processes moving forward,” Zebley added. “We support additional telehealth priorities that have not yet been acted upon, including the remote prescribing of controlled substances, which were not included in the legislative proposal. We believe, if left omitted, this would lead to a tremendous gap in care.”
“ATA Action is available as a resource and looks forward to continuing to work with Congress to ensure that the appropriate telehealth policies are implemented in a timely manner without arbitrary and unnecessary barriers to care such as in-person, brick and mortar, or geographic requirements,” Zebley said.
About ATA Action
ATA Action recognizes that telehealth and virtual care have the potential to transform the healthcare delivery system by improving patient outcomes, enhancing the safety and effectiveness of care, addressing health disparities, and reducing costs. ATA Action is a registered 501c6 entity and an affiliated trade organization of the American Telemedicine Association (ATA).
# # #
CONTACT:
Gina Cella
gcella@americantelemed.org
t: 781-799-3137
© The Rowan Report. For information on publishing this or any other press release, please contact editor@therowanreport.com
by Rowan Report | May 10, 2024 | M&A
Bon Secours Mercy Health to Outsource Home Health and Hospice to Compassus
Bon Secours Mercy Health (BSMH), the fifth-largest Catholic health system in the U.S., and Compassus, a leading national provider of home-based health care services, announced on May 2 that they have signed an agreement to form a 50/50 joint venture partnership for BSMH home care and hospice. Under the agreement, Bon Secours will outsource to Compassus, who will manage operations for 10 home health agencies and 11 hospice operations spanning five states.
Under the agreement, BSMH will maintain ownership of its existing hospice house real estate assets in specific locations while Compassus will manage the operations. BSMH will work closely with Compassus to support the home health and hospice associates transferring to employment with Compassus. Under the joint venture, the team will continue to provide spiritually grounded care and will operate in accordance with Ethical and Religious Directives.
The agreement is subject to state and federal regulatory review and final diligence; however, the agreement formalizes the intent of both parties to move forward with the transition and integration.
About Compassus
Compassus provides home-based services including home health, infusion therapy, palliative and hospice care. The company’s more than 6,000 team members serve more than 100,000 patients annually across more than 250 locations in 29 states. This is not the company’s first joint venture. In 2020, Compassus became managing partner of Ascension at Home, a joint venture between Ascension and Compassus.
About Bon Secours Mercy Health
Bon Secours Mercy Health (BSMH) is one of the 20 largest health systems in the United States and the fifth-largest Catholic health system in the country. The ministry’s quality
, compassionate care is provided by more than 60,000 associates serving communities in Florida, Kentucky, Maryland, New York, Ohio, South Carolina and Virginia, as well as throughout Ireland.
Bon Secours Mercy Health provides care for patients more than 11 million times annually through its network of more than 1,200 care sites, which includes 48 hospitals. In 2022, BSMH provided more than $600 million dollars in community investments across five states, ensuring that cost is not a barrier to health care for patients in need.
In addition to charity care, BSMH invests in programs that address chronic illness, affordable housing, access to healthy food, education and wellness programs, transportation, workforce development and other social determinants of health. The Mission of Bon Secours Mercy Health is to extend the compassionate ministry of Jesus by improving the health and well-being of its communities and bring good help to those in need, especially people who are poor, dying and underserved. https://bsmhealth.org/
©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
by Rowan Report | Apr 26, 2024 | Admin, Clinical, CMS, Regulatory
by Johnathan Eaves, Senior Director of Communications, Axxess
Treating Medicare patients comes with a level of nuance that is important to understand to ensure that organizations remain compliant and patients receive appropriate care. Standards for quality care and payment can sometimes be dictated by Medicare’s payment policies and at other times be decided by the Conditions of Participation. There is an important difference between these two governing principles that providers should understand to ensure compliance.
Care at home industry veteran and Axxess Senior Vice President of Clinical Services Arlene Maxim RN, HCS-C, offered insights into the differences between Medicare’s policy and its Conditions of Participation during a recent webinar.
Explaining the Difference
Maxim pointed out that the differences between policy and the conditional requirements comes down to what can be billed and what are the quality standards for the services provided.
“The Conditions of Participation are dealing primarily with quality, whereas Medicare policy is related to payment,” said Maxim. And while there is a difference, that doesn’t mean both aren’t important and must always be followed.
“If Medicare policies are not followed, you are audited and if you do not have documentation to support those policies, you’re not going to get paid,” said Maxim “Oftentimes, with PDGM, staff members are not getting past that first 30 days. They’re not understanding what they need to do to keep that patient who continues to qualify for services on for longer.”
Maxim says that the problem is often that clinicians do not understand Medicare policy. “Every piece of documentation we submit to the Medicare program for review [needs to be] as pristine as we can possibly get it,” she said.
Assessment and Documentation
Proper assessment and documentation is something Maxim feels is critical in ensuring quality care, meeting Medicare requirements, and receiving payment for services.
“Complete and detailed documentation is going to be the key for agency payment by the Medicare program,” Maxim said.
Maxim pointed out certain services covered under Medicare policy may include observation and assessment, management and evaluation of a care plan, maintenance therapy, teaching and training activities, administration of medications, wound care, ostomy care, rehab nursing, venipuncture, skilled nursing visits, and more.
She also cautioned that agencies need to be prudent with the funds they receive from Medicare, viewing them as a potential “short-term, interest-free loan” until undergoing any audit. Until their documentation is reviewed and approved, there are no guarantees.
“Medicare is an insurance and it’s not free,” said Maxim. “Medicare policy provides us with a list of covered items. If experiencing an audit, and if the documentation is not there to cover the covered service, you’re not in compliance with that Medicare policy and you will not be paid for the services.”
Communicating With Physicians
Maxim further emphasized the importance of frequent contact with physicians, adherence to care plans, and ensuring that care plans are simple with individualized plans and goals that are achievable.
“You want to make sure that you have orders that physicians are actually going to read and to determine that they make sense and they’re going to sign off on them,” said Maxim.
“Keep your plan of care simple.”
# # #
Axxess Home Health, a cloud-based home health software, streamlines operations for every department while improving patient outcomes.
© 2024 Axxess. For reprint permission, please contact The Rowan Report: kristin@therowanreport.com
by Rowan Report | Apr 26, 2024 | CMS, Medicare Advantage, Regulatory
By Beth Noyce, RN, BSJMC, BCHH-C, COQS
CHAP-certified home health & hospice consultant
This is part 3 of the 3 in the series, outlining the discussions and implications in adopting new outcome and process measures for Hospice care. The final segment addresses future process and outcome measures that the board discussed, but did not yet implement. Read Part 1 on Outcome Measures and Part 2 on Process Measures.
The TEP discussed potential future process and outcome measure concepts that Abt Associates presented to the panel as well.
The process measures included:
- Education for Medication Management
- Wound Management Addressed in Plan of Care
- Transfer of Health Information to Subsequent Provider
- Transfer of Health Information to Patient/Family Caregiver
Hope-based outcome measures were:
- Patient Preferences Followed throughout Hospice Stay
- Hospitalization of Persons with Do-Not-Hospitalize Order
Developing education for medication management as a process measure was a popular concept, and the top priority of the recommended measures with the TEP as they “broadly agreed that CMS should develop this measure,” the report says, citing “a significant need for training in medication management for patients and their caregivers.” They recommended that the measure weigh more heavily when care is provided in a home setting than in a facility setting because hospices are unable to control facility training and hiring practices. One panelist commented that including the phrase “during today’s visit” in the measure is important.
Whether CMS should further develop the process measure addressing wound management in the plan of care was less straight-forward, as panelists provided varied feedback. They generally agreed that this measure is important, as having a record of wound management addressed in the plan of care can hold the staff accountable for treating the wounds. But some members recommended measuring wound management with outcome measures rather than process measures. One panelist cited potential problems from patients’ deterioration over time and another noted that the time frame of this measure is important, and encouraged recording the process of getting care in place once a wound is identified. The panel agreed CMS should carefully define the measure’s specifications.
Because standard practice for most agencies is, when a patient is discharged live, to transfer health information to the subsequent provider and to the patient and family or caregiver, TEP members expressed that the two measures were likely to “top out,” meaning they would almost always be marked “Yes,” making them of no value in differentiating between hospice providers. The group generally discouraged developing these process measures.
The group strongly rejected any merit in developing two outcome measures concerning Patient Preferences Followed Throughout Hospice Stay and Hospitalization of Persons with Do-Not-
Hospitalize Order. The report says “Multiple TEP members described situations in which patients who had preferred not to be hospitalized changed their minds when a crisis occurred. Patients’ preferences and unexpected crises are usually out of the hospice’s control. Although it is still important for hospices to ask patients about their preferences as part of patient-centered care, the TEP did not believe these two items would be practical measures of a hospice’s care quality.”
Dr. McNally expects that Abt. Associates will apply the HQEP TEP’s suggestions to the HOPE tool.
“Oh yeah, they did it,” he says. “Abt would come to a specific meeting with information, data, suggestions, and specific information about how these things would be measured. We’d give feedback. Then they’d come back to the next meeting having incorporated our suggestions,” he explains. “All of us felt very much heard and responded to. It didn’t feel in the least bit perfunctory.”
Whatever specific measures are eventually included in the HOPE tool, Lund Person sees value in its implementation. “Hospice providers have had a woeful lack of outcome measures for hospice patients, which has made the evaluation of quality hospice care based only on process measures and the family’s evaluation of hospice care in the CAHPS® Hospice Survey, she explains. “Implementing HOPE will begin to identify outcome measures that can be compared between providers.”
Lund Person warns of potential challenges as well. “The selection of risk adjustment and stratification must be carefully done to minimize bias and maximize effectiveness of measures,” she says. “In addition, hospice providers have been awaiting the release of the HOPE tool with significant anxiety about content and administrative burden.”
Dr. McNally is confident the HOPE tool will be a healthy change for hospices.
“A lot of my role as a medical director and hospice physician is supporting our nurses,” he says. “They do 95% of the work. I really would like to see this not be burdensome for our hospice nurses. I’m looking forward to seeing what the [HOPE tool] beta testing translates to in our own hospice world.” He added “What I would hope to see is that the tool feels user-friendly to the hospice team, the people who have to use it, and that it also provides useful information to patients and families.”
NAHC’s Wehri says that standardizing processes through the HOPE tool is the key foundational element for the hospice industry. “High quality care is driven by reducing variance through standardized processes, Wehri writes. “Also, CMS will have a better idea of how the type of population a hospice serves impacts some of the clinical care.” This small glimpse into hospice variances that CMS does not currently have could be very helpful in future policy and payment decisions, according to Wehri. “What CMS finds in terms of differences between hospices and their care for patients may be a bit of a surprise to CMS,” she says. “I hope they are pleasantly surprised with the overall quality of care that is revealed.”
# # #
Beth Noyce provides education, consulting, mentoring, compliance assessments and auditing services to home health and hospice agencies and their clinicians in several states. She also now provides patient and family guidance concerning hospice and home health services. Beth loves teaching and helping others succeed. She also makes available recordings of much of her education for her clients’ convenience.
©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
by Rowan Report | Apr 26, 2024 | Partner News
FOR IMMEDIATE RELEASE
Contact: Johnathan Eaves
(903) 445-6969
jeaves@axxess.com
Axxess’ AGILE 2024 Was a Massive Success
DALLAS, April 25, 2024 – Axxess’ AGILE 2024 conference was a resounding success, with an unprecedented number of industry leaders, innovators and professionals coming together to explore the latest trends, exchange ideas and foster collaboration.
More than 50 partners supported AGILE (Axxess Growth, Innovation and Leadership Experience) with sponsorships of the three-day event, which attracted several hundred industry leaders, including C-suite executives, clinical leaders, operational and financial managers, industry investors and strategic advisors.
“The AGILE conference exemplifies our commitment to fostering growth, driving innovation and empowering leaders as we revolutionize the healthcare industry and pave the way for a future where quality care thrives in the confines and comfort of our homes,” said John Olajide, founder and CEO of Axxess, the leader in technology supporting care at home providers. “The feedback we’ve received on this year’s conference is truly inspiring, and we are already hard at work to make next year’s event a transformative experience, introducing new dimensions of knowledge, collaboration and inspiration.”
The conference formally began with a keynote address from healthcare innovator and futurist Nick Webb, who spoke on megatrends impacting the care at home industry, from emerging technologies to patient experience and staffing.
“The experience always wins,” he told the audience. “Patients and their families want friction freedom, they want speed, they want transparency, they want genuine, authentic empathy, they want this to be painless.”
The event included a day-long Leadership Forum attended by industry leaders who participated in high-level conversations about business operations, advocacy and insights on the state of mergers and acquisitions with key leaders in care at home, finance and public policy.
The value of technology was emphasized in a later panel discussion on embracing risk to reimagine healthcare, featuring Kim King, CEO of Home Care Network.
“We’ve found arming our staff with technology that allows them to do a virtual visit allows an aide to work at the high end of what they’re able to do so that they can give real information back to a clinician,” King said. “If we need to take it to the next step and get a virtual visit with a physician [or] arrange transportation to get somewhere, that makes all the difference in the world.”
Annie Erstling, Chief Operating Officer at Forcura, urged attendees to rethink their relationship with technology companies.
“You should lean on your technology partners,” Erstling said. “They should be real partners and they should keep you abreast of what’s the latest and greatest.”
Along with keynote speakers, panels and industry-specific education sessions offering continuing education credits, AGILE also included an Innovation Showcase featuring the latest developments to improve operations from Axxess partners, a GUIDE to dementia, which enabled participants to experience what those living with dementia go through each day, and a CPR training course where participants learned how to properly perform life-saving, hands-only CPR.
# # #
About Axxess
Axxess is the leading global technology innovator for healthcare at home, focused on solving the most complex industry challenges. Trusted by more than 9,000 organizations that serve more than 5 million patients worldwide, Axxess offers a complete suite of easy-to-use software solutions that empower home health, home care, hospice, and palliative providers to make healthcare in the home human again. Multiple independent certifications have confirmed that Axxess has the most secure and industry-compliant software available for providers. The company’s collaborative culture focused on innovation and excellence is recognized nationally as a “Best Place to Work.”
by Rowan Report | Apr 18, 2024 | Clinical, CMS, Regulatory
by Beth Noyce, RN, BSJMC, HCS-C, BCHH-C, COQS
CHAP-certified home health & hospice consultant
Process Measures
The outcome measures being considered look at effectiveness of hospice clinical efforts to decrease pain and other symptoms. The process measures paired with them focus on the hospice’s follow up with the patient after moderate or severe symptoms are found during assessment.
Exhibit 6 (below) shows the numerator and denominator for these.
TEP members determined that these two process measures have high face validity. This means the measure items clearly state, or “look like” they will measure what CMS intends them to measure. This allows consumers to see what hospices are assessing and treating. It can also help hospices track how well they are reducing or treating patients’ symptoms.
Katie Wehri, Director of Home Health & Hospice Regulatory Affairs for the National Association for Home Care & Hospice says the face validity of process items is the most important information the HQRP TEP provided to CMS. “Having HOPE items and subsequent measures that actually measure what is intended is key to success,” she says.
Exclusions from Process Measures Success
Exclusions from calculating a hospice’s process measures’ success need careful consideration. Here is the list of options of which patients to exclude:
- Patient desired tolerance level for symptoms
- Patient preferences for symptom management
- Neuropathic pain
- Actively Dying (death is imminent)
- Other conditions
The report says that reassessing a symptom within two days of identifying that symptom as moderate or severe is fundamental. This is true regardless of the beneficiary’s stated tolerance-level for symptoms. It also said that process measure calculations should include patients with no symptom-management preference. Further, exclusion criteria should be the same for pain and non-pain symptoms.
Neuropathic Pain
The TEP’s recommends including neuropathic pain in the HOPE tool’s pain-reassessment process measure. Including rather than excluding patients suffering neuropathic pain prompts nurses to reassess these patients for changes. The report references research that suggests 40% of hospice patients may experience neuropathic pain. Patients who experience neuropathic pain have more severe and more distressing pain symptoms. [Tofthagen, C., Visovsky, C., Dominic, S., & McMillan, S. (2019). Neuropathic symptoms, physical and emotional well-being, and quality of life at the end of life. Supportive Care in Cancer, 27(9), 3357-3364. doi:10.1007/s00520-018-4627-x]
The TEP agrees that patients with neuropathic pain should be part of the process measure. However, they recommend excluding the same patients from the outcome measure addressing the patient’s pain impact. The report cited TEP discussion that such pain is chronic and not likely to be resolved or decreased within two days when the reassessment captures outcome data.
The TEP broadly agreed that a nurse who assesses a patient who is actively dying (life expectancy of 3 days or fewer based on clinicians’ assessment) as suffering moderate or severe pain should attempt to reassess the patient. Such patientsshould not be excluded.
The panelists agreed that process measures should include patients of all ages. Several TEP members noted that all patients experience pain and non-pain symptoms, and therefore the measures should apply to adults and children alike.
Exclusion Due to Inability to Reassess
When a hospice is unable to reassess a patient for a valid reason process measures should exclude those patients.
Identified exclusion reason were:
- discharge, alive or dead
- visit refusal
- inability to access the patient due to an emergency department or hospitalization event
- the patient traveling outside of the hospice’s service area
- inability of the hospice to contact the patient or caregiver.
However, the report says, “…hospices should be penalized if reassessment is missing or delayed due to hospice staffing or scheduling issues.”
This article is the second in a series about implementation of HOPE. Next week, Beth Noyce shares details from the panel as it discussed potential future process and outcome measure concepts.
# # #
©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
