What are You Hiding?

Admin

by Elizabeth E. Hogue, Esq.

Bring on the Fraud Enforcers

We Have Nothing to Hide!

Oh, but you do! Statements like this from providers are cringe-worthy. If you have said it before, please don’t ever say it again.

Here’s why:

Fraud Enforcement

First, many providers think that when fraud enforcers are required to show intent they must show that providers sat down at their desks on a Friday afternoon, for example, and decided to engage in fraud. On the contrary, enforcers can demonstrate intent by showing that there was fraudulent conduct that providers knew about or should have known about. This is a game changer! It’s not hard to imagine fraudulent conduct that providers should have known about, but have not identified and corrected.

In addition, George Will points out in his Washington Post column, “Have you committed a felony yet? Probably so.” that the volume of legal requirements has skyrocketed. Here is what Mr. Will says:

“Less than a century ago, …a single volume contained all federal statutes. By 2018, they filled 54 volumes – about 60,000 pages. In the past 10 years, Congress has enacted about 2 million to 3 million words of law each year. The average length of a bill is nine times what it was in the 1950s. Agencies publish their proposals and final rules in the Federal Register, which began at 16 pages in 1936, and now expands by an average of more than 70,000 pages annually. By 2021, the Code of Federal Regulations filled about 200 volumes. And in a recent 10-year span, federal agencies churned out approximately 13,000 guidance documents.”

Mr. Will goes on to point out that ignorance of the law is, therefore, inevitable. Congress has added an average of 56 new federal crimes each year so that there are not more than 5,000 federal statutory crimes. In addition, at least 300,000 regulations of federal agencies include criminal sanctions.

 Here are some common examples:

Fraud Enforcement George Will
    • If you are a discharge planner/case manager in a hospital or skilled nursing facility you may not know about guidance from the Office of Inspector General of the U.S. Department of Health and Human Services that says you can’t accept gift cards from post-acute providers that want referrals.
    • If you are a home care/private duty provider and accept payments from the Medicaid Program, you may have repeatedly violated technical requirements, such as recording the time caregivers arrive and leave patients’ homes.
    • If you provide home health services and use the services of consulting physicians as Medical Directors, chances are very good that fraud enforcers will demonstrate that you violated at least one of a multitude of requirements that govern these relationships.
    • Finally, hospice providers know all too well that enforcers are going to claim that their patients are not terminally ill.

Mr. Will says in his column that James Madison predicted our current situation in which laws are “so voluminous that they cannot be read, or so incoherent that they cannot be understood” and “undergo such incessant changes that no man, who knows what the law is today, can guess what it will be tomorrow.” 

So, don’t even think that you have nothing to hide, much less say it!

 

# # #

Elizabeth E. Hogue, Esq.
Elizabeth E. Hogue, Esq.

Elizabeth Hogue is an attorney in private practice with extensive experience in health care. She represents clients across the U.S., including professional associations, managed care providers, hospitals, long-term care facilities, home health agencies, durable medical equipment companies, and hospices.

©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

©2024 Elizabeth E. Hogue, Esq. All rights reserved.

No portion of this material may be reproduced in any form without the advance written permission of the author.

NonCompete Agreements and What to do About Them

Admin

by Elizabeth E. Hogue, Esq.

What to do About Noncompete Agreements

The Federal Trade Commission (FTC) published a final rule earlier this year that banned noncompete agreements. The final rule was effective on September 4, 2024.

 Requirements of the rule included:

    • A ban on new concompete agreements with all workers, including senior executives
    • Existing noncompete agreements could remain in force for senior executives if
      • they make more than $151,164 per year including salary, commissions, and performance bonuses but not including benefits, board and lodging; and
      • senior executives have authority to make policy decisions for the entire company
    • Existing noncompete agreements with workers other than senior executives are unenforceable after the rule is effective

There are a number of exceptions to the rule.

In the meanwhile, litigation

On July 23, 2024, a federal court in Pennsylvania refused to issue a preliminary injunction to prevent implementation of the final FTC rule. The U.S. District Court for the Eastern District of Pennsylvania said that the statutory authority of the FTC to prevent unfair methods of competition under Section 5 of the FTC Act is not limited to procedural rules for adjudications and extends to substantive rulemaking [See ATS Tree Servs. v. Fed. Trade Comm’n, No. 24-1743 (E.D. Pa. July 23, 2024)].

Noncompete Agreements

But...

In early July, a federal court in Texas granted a preliminary injunction that delayed the effective date of the final rule. The Court declined to issue a nationwide injunction [See Ryan LLC v. Federal Trade Comm’n, No. 3:24-CV-00986-E (N.D. Tex. July 3, 2024)]. 

Then, on August 20, 2024, the Judge issued an order in the Ryan case that included a nationwide prohibition on implementation of the FTC rule. The basis of this decision is that the FTC does not have authority to order a ban, and that the rule was arbitrary and capricious. Based on this ruling, employers may continue to enter into and enforce non-compete agreements with workers.

 

Another but...

A number of state legislatures have enacted restrictions on use of noncompete agreements. As of August 21, 2024, four states ban the use of noncompete agreements and thirty-three states plus the District of Columbia restrict the use of these agreements. 

Providers must comply with applicable requirements in the states in which they conduct business. Providers who fail to do so risk enforcement action.  

Comfort Keepers, for example, agreed to pay $500,000 to resolve claims that it unfairly restricted workers’ mobility according to the California Department of Justice. Comfort Keepers’ Client Care Agreement that clients were required to sign before receiving care prevented clients from using, hiring, or soliciting current and former Comfort Keepers’ caregivers for up to one year after the termination of services. Violations required payment of $12,500.

So...

The current bottom line is that the FTC rule banning noncompete agreements is not in effect, but providers must comply with applicable state requirements or risk enforcement action.

Stay tuned for more!

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Elizabeth E. Hogue, Esq.
Elizabeth E. Hogue, Esq.

Elizabeth Hogue is an attorney in private practice with extensive experience in health care. She represents clients across the U.S., including professional associations, managed care providers, hospitals, long-term care facilities, home health agencies, durable medical equipment companies, and hospices.

©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

©2024 Elizabeth E. Hogue, Esq. All rights reserved.

No portion of this material may be reproduced in any form without the advance written permission of the author.

Hospice Fraud Oversight

Admin

by Kristin Rowan, Editor

CMS Oversight in Fraud-Ridden States

In 2023, The Centers for Medicare and Medicaid Services (CMS) cited research suggesting that hospices profit from fraud far too often. CMS has identified cases of hospices certifying benficiaries who are not terminally ill, providing little to no services, and still billing CMS. Four states have had rapid growth in fraudulent hospices: Arizona, California, Nevada, and Texas.

Churn-and-Burn

Some of the registered hospices had non-operational addresses. This information led to an investigation that resulted in evidence of the fraud dubbed “Churn and Burn.” This scheme involves registering a new hospice and billing for services until there is an audit or the agency maxes out on yearly payments. Then, the hospice closes, keeps the money, registers for a new Medicare billing number, and starts all over again.

Program Integrity Strategy

As a result of  the findings of this research, CMS put more effort behing the hospice program integrity strategy to find and address fraudulent activity. Part of the strategy was unannounced visits to hospices nationwide. Hospices not active at listed addresses were deactivated and Medicare billing privileges were revoked. Of the more than 7,000 hospices visited, 400 had potential administrative action pending.

Enhanced Oversight

In the four states identified as having higher instances of fraud, CMS implemented a provisional period of enhanced oversight. During the provisional period, CMS conducted a medical review prior to payment for hospices in these states that have identified problems.

Nationwide Pilot Project

In addition to the provisional period for the four identified states, CMS started a pilot project to review hospice claims after a patient’s intitial 90 days of hospice care. This pilot project was not limited to the four states, but was implemented nationwide. CMS launched the program to help inform medical reviews in determining whether hospices are submitting claims for eligible patients.

Regulatory Changes

CMS also proposed some regulatory changes to combat hospice fraud. Some of these regulatory changes were initially suggested by hospice providers. The proposals include:

Hospice Fraud
    • Prohibiting the transfer of Medicare billing privileges of a new hospice for 36 months
    • Clarifying the definition of “Managing Employee” to include the administrator and medical director of a hospice
    • Implementing a Special Focus Program to increase oversight on poor-performing hospices that have ongoing health and safety deficiencies
    • Adding criminal background checks for owners when they initially enroll for Medicare billing privileges.

Prepayment Review Expanded

CMS has just announced that they will expand the prepayment review process in the four states beginning in September, 2024. Information from CMS is limited and states that prepayment review volume will start low to protect compliant hospices, but will increase if a hospice is found to be non-compliant. Consequences for non-compliance includes delays in payment, extended review, or additional administrative actions.

According to preliminary information we received from a hospice consultant, the expanded program puts all new hospices or hospices with ownership changes into prepayment review even if they have not had identified problems. 

We have reached out to both CMS and some of our expert hospice consultants to get more information and will update this story as information becomes available.

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Kristin Rowan, Editor
Kristin Rowan, Editor

Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Meet Dr. Steve Landers, MD

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Get to know the new NAHC-NHPCO Alliance CEO

Steven Landers, MD, MPH

Dr. Steve Landers

Dr. Landers named CEO for joint NAHC NHPCO. A recognized leader and innovator in home health, primary care and aging services, Dr. Steven “Steve” Landers brings almost two decades of experience as a physician, executive leader and public health policy advocate to lead The Alliance as its first Chief Executive Officer.

Physician

As a board-certified physician in family medicine, geriatric medicine, and hospice and palliative medicine, Dr. Landers has dedicated his career to seeking home- and community-based solutions for ill and aging Americans. He is a champion of the impactful role home care and hospice play in the health and lives of communities, acknowledging that as an aging nation, providing compassionate, dignified and cost-effective systems of care to patients is critical.

Education

Dr. Landers graduated from Case Western Reserve University School of Medicine, where his training included a family medicine residency at Case Western and a geriatric medicine fellowship at the Cleveland Clinic. He also attended the Johns Hopkins Bloomberg School of Public Health, where he focused on health policy and management. He received a bachelor of arts in political science from Indiana University in Bloomington.

Early Career

Early in his career, Dr. Landers based his clinical practice on providing health care through house calls and has made thousands of home visits, primarily to low-mobility patients. While in this setting, he saw the need to better connect home care and hospice to the broader health care system and medical community. He understood that to improve patient care, he would need to understand and play a leading role at the intersection of clinical work, health policy and systems of care. He pursued a master’s degree in public health, which contributed to his passion for influencing federal and state policy to improve health care delivery to vulnerable patients.

On The Board

Dr. Landers has served on numerous boards and committees in the home-based care policy space, including past appointments to the boards of directors of the National Association for Home Care and Hospice, American Academy of Home Care Medicine, the Partnership for Quality Home Health, and the Alliance for Home Health Quality and Innovation (now Research Institute for Home Care). He has represented these organizations by engaging policymakers, including meeting with members of Congress; providing committee testimonies for Congress and state legislatures; and discussing home care policies and regulations with the U.S. Secretary of Health and Human Services, the administrator of the Centers for Medicare & Medicaid Services, Medicare Payment Advisory Commission officials, and federal agency staff.

Home Care

Prior to joining The Alliance, Dr. Landers served in several executive leadership roles. He was the director of home care at the Cleveland Clinic, and for more than 11 years was the president and CEO of the Visiting Nurse Association Health Group, Inc. — one of the oldest, largest and highly respected home health, hospice and community health organizations in the country.

As a renowned author and thought leader in the care at home sector, his work has been published in the New England Journal of Medicine, the Journal of the American Medical Association and the Huffington Post. The work of Dr. Landers and his team to prioritize at-home vaccines for homebound seniors during the COVID-19 pandemic also has been featured by major news outlets such as ABC’S Good Morning America and CBS Mornings with Gayle King.

Personal Life

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

This bio originally appeared on the NAHC-NHPCO Alliance web site. It is reproduced in The Rowan Report by permission. It may be freely reproduced.

It’s Official! NAHC NHPCO Alliance Name New CEO

Admin

WASHINGTON D.C. Steven Landers, MD, MPH, has been named the inaugural Chief Executive Officer of the newly merged NAHC-NHPCO Alliance (The Alliance). A recognized national leader and innovator in home health, primary care and aging services, Dr. Landers brings almost two decades of experience as a physician, executive leader and health policy advocate to The Alliance, which represents care at home and community providers across the country. (Read more about Dr. Landers at our accompanying article in this week’s issue.)

Dr. Landers has dedicated his career to seeking home- and community-based health care solutions for people of all ages. As a board-certified physician in family medicine, geriatric medicine, and hospice and palliative medicine, he is a champion of the impactful role health care at home plays in the health and wellbeing of communities, acknowledging that as an aging nation, providing compassionate, dignified and cost-effective systems of care to patients is critical.

“The Alliance members provide a wide range of high-quality home- and community-based services that promote comfort, dignity and independence. I’m so proud to become a part of this organization, and am eager to serve,” said Dr. Landers. “I’ve had the opportunity in my career to see the health care industry from many vantage points, and in this new role with The Alliance, I will use all that I have learned to make a difference for our members as we continue to expand to meet the growing public needs for our care.”

Prior to joining The Alliance, Dr. Landers served in several executive leadership roles. He was the director of home care at the Cleveland Clinic, and for more than 11 years was the president and CEO of the Visiting Nurse Association Health Group, Inc. — one of the oldest, largest and highly respected home health, hospice and community health organizations in the country. During his most recent tenure as the president and CEO of Hebrew SeniorLife, he led an organization known for superior senior living, geriatric health care, research and teaching.

Dr. Landers has served on numerous boards and committees in the care at home space and has represented organizations by engaging policymakers, including meeting with members of Congress; providing committee testimonies for Congress and state legislatures; and discussing home care policies and regulations with the U.S. Secretary of Health and Human Services, the administrator of the Centers for Medicare & Medicaid Services, Medicare Payment Advisory Commission officials, and federal agency staff.

“Providing leadership around policy and advocacy efforts is critical to our mission at The Alliance,” said Transition Board Chair Ken Albert. “Throughout his career, Dr. Landers served the field as an effective policy advocate, shaping policy at both the state and federal levels. We are thrilled to welcome him as our inaugural CEO, and I know he will build an extraordinary team to offer value for our members.”

Steve Landers NAHC NHPCO Alliance CEO

Early in his career, Dr. Landers based his clinical practice on providing health care through house calls and thousands of home visits, primarily to low-mobility patients. While in this setting, he saw the need to connect home care and hospice to the broader health care system and medical community. He understood that to improve patient care, health care providers need to explore and thrive at the intersection of clinical work, health policy and systems of care. He pursued a master’s degree in public health, which contributed to his passion for influencing federal and state legislation to improve health care delivery to home-based patients.

“Dr. Landers’ rich and diversified experience makes him the ideal candidate to lead our membership as our organization evolves,” said Alliance Transition Board Vice Chair Melinda Gruber. “Working alongside community health workers and within our patients’ homes, he understands what we need as frontline caregivers and advocates.”

Dr. Landers is a graduate of Case Western Reserve University School of Medicine, where his training included a family medicine residency at Case Western and a geriatric medicine fellowship at the Cleveland Clinic. He also attended the Johns Hopkins Bloomberg School of Public Health, where he focused on health policy and management. Additionally, he received a bachelor of arts in political science from Indiana University in Bloomington.

# # #

About the NAHC-NHPCO Alliance 

The NAHC-NHPCO Alliance brings together the National Association for Home Care & Hospice (NAHC) and the National Hospice and Palliative Care Organization (NHPCO), two organizations with more than 90 years of combined experience serving providers of quality care in the home to form one new association. This historic alliance creates a national organization representing providers of home care, home health, hospice, and palliative care, forming the most powerful voice and resource the care-at-home community has seen. The integration process underway is expected to continue through the beginning of 2025. While leadership explores a permanent name, the new organization is operating under the interim name the NAHC-NHPCO Alliance.

Keep track of updated news on the NAHC and NHPCO websites.

This news release originally appeared in The Rowan Report. by permission of the National Association for Home Health and Hospice. It may be freely reprinted.

HHVBP Model Payments Begin January 1, 2025

Admin

by Kristin Rowan, Editor

Background on the HHVBP Model

The Home Health Value Based Purchasing (HHVBP) Model, implemented by CMS in 2016, began in nine states. The goal is “to provide incentives for better quality care, to study new quality and efficiency measures, and to enhance the reporting process.” It may also provide new avenues for payment models.

According to the CMS website, the original HHVBP Model, launched in nine states, improved an average of 4.6 percent HHA performance scores and saved Medicare $141 million. Additionally, the model lowered unplanned hospitalizations for acute care and reduced skilled nursing facility (SNF) stays.

HHVBP Model Expansion

From the initial study, CMS surmised that expanding the model would increase performance, increase savings, and further reduce hospitalizations and SNF stays. Early in 2021, CMS announced the nationwide expansion of the HHVBP Model.

The expanded model started on January 1, 2022. In its first expansion year, CMS provided training and allowed HHAs time to adjust practices based on HHVBP expectations and requirements. During the transition year, HHA performance did not risk future payment rates.

HHVBP Model Performance Year

January 1, 2023 marked the beginning of the performance year, in which all HHA results would impact future payments. CMS will adjust fee-for-service payments based on performance relative to other HHAs. CMS groups HHAs into cohorts determined by beneficiary count the previous year. Cohorts include large- and small-volume for agencies above and below 60 unique HHCAHPS eligible beneficiaries, respectively.

Using data already reported by HHAs through the Home Health Quality Reporting Program (HH QRP) and HHCAHPS surveys, CMS compares an HHAs data to similar agencies. Based on this comparison, CMS adjusts future payments between -5% and 5% for fee-for-service payments.

Interim Performance Report

The Interim Performance Report (IPR) is a quarterly report with performance data for all HHAs participating in the HHVBP Model. Active HHAs that were Medicare certified before January 1, 2022, are eligible for payment adjustment, and meet the minimum threshold of data for at least one quality measure receive the reports. Reports are available at iQIES. Registration on the portal is required.

CMS publishes new reports every quarter and eligible HHAs should receive an email when a new report is available. 

Points System

Payment adjustments for the next calendar year are based on an HHAs performance in the last report. For CY 2025, payment adjustments will use the Final Annual Performance Report, published 30 days prior to each payment year.

The process to determine your HHAs ranking in relations to the other HHAs in your cohort can be confusing and has many steps. Payment adjustments are based on “Care Points”, which are calculated on a weighted scale, using the higher of the agency’s earned achievement points or improvement points. An HHA must have at least 20 quality stays for claims-based measures and at least 40 surveys for the HHCAHPS survey-based measure.

Achievement Points

Achievement points are earned by scoring above the median performance on each quality measure (better than half of the agencies in your cohort) and dividing that by the difference between your score and the top 10 percent in your cohort.

HHVBP Model Calculate Achievement Points
Improvement Points

Improvement points are calculated using an HHAs prior year performance measure, current measure and the mean score of the top 10 percent of agencies in your cohort.

HHVBP Model Calculate Improvement Points
Care Points

Care points are the higher of Achievement Points or Improvement Points for each quality measure. Each quality measure is weighted differently in each category of OASIS-based Measures, Claims-based Measures, and Survey-based Measures.

The higher of each agency’s achievement and improvement scores is multiplied by its assigned weight to calculate the weighted score within each measure. Each measure then has its own weight. OASIS- and Claims-based measures each count for 35% of the total score while Survey-based measures make up 30% of the final score.

The HHA score is measured against all HHAs in the cohort to determine your rank. Where your weighted points fall in comparison with the rest of your cohort determines whether your next payment cycle will go up or down by as much as 5 percent. 

HHVBP Model Weighted Scores

Public Reporting

Your scores will not only be used to determine your payment increase or decrease. These reports will be made public as well. CMS will publicly report each quality measure’s benchmark and achievement threshold. For every HHA that qualifies for a payment adjustment, CMS will also publish:

      • Measure results and improvement thresholds
      • Total Performance Score and Percentile Ranking
      • Payment adjustment percentage

Scoring well on the Achievement and Improvement markers for each measure may offer an HHA an opportunity to gain more referrals, recruit talented clinicians, and gain a reputation for quality care.

On the other hand, scoring low may hurt an agency irreparably. HHAs who think there is an error in the initial reporting can submit a recalculation request within 15 days of the publishing of a preview report. Based on CMS’s decision, HHAs have 15 days to submit a reconsideration request if they submitted a recalculation request and are not happy with the decision. If the HHA is still not in agreement with the decision of the reconsideration request, they have seven days to submit a request for administrative review.

Next Steps

According to the information we can find on CMS, these reports will be published quarterly. Logically, then, the recalculation requests can also be submitted quarterly along with reconsideration and administrative review requests. We will continue to follow this and provide updated deadlines to submit requests as we find them.

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Kristin Rowan, Editor
Kristin Rowan, Editor

Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Cat on a Hot Tin…Keyboard?

Admin

by Elizabeth E. Hogue, Esq.

HIPAA Violation

HIPAA violation: Trent James Russell was convicted in federal Court on charges of obtaining another person’s health care information in violation of the Health Insurance Portability and Accountability Act (HIPAA). Russell was employed by an organ transplant organization. As a transplant coordinator, he had access to electronic medical records at George Washington University Hospital in Washington, DC.

Justice Ginberg

In January of 2019, Russell accessed the medical records of U.S. Supreme Court Justice Ruth Bader Ginsburg even though Justice Ginsburg had not been referred as a possible organ donor. He took a screenshot of the records and then posted them on a message board called “4chan.” Ginsberg’s records quickly appeared on Twitter and YouTube, including her name and the exact dates and times when she received radiology, oncology, and surgical treatments at the Hospital between 2014 and 2018.

Hospital officials traced the search of Ginsburg’s records to one of Russell’s home computers. As soon as Russell was identified as a suspect, his access was denied by the Hospital. His request to have access restored was also denied. 

Tall Tales RBG

The Cat Made me Violate HIPAA Laws

Russell initially told federal agents that his “cats had run across his keyboard.” He later characterized this statement as a “nervous joke.” Russell said that he had no idea how his computer searched terms that produced the Justice’s records and that “everyone makes typos.”

Online users who viewed Ginsberg’s records promoted various antisemitic conspiracy theories. One theory was that Ginsburg had died in late 2018 and that democrats were hiding her death in order to deny President Trump an opportunity to appoint her replacement. A search of Russell’s computer also revealed a search for the term “dirty jew.”

An FBI agent said that she found an image on Russell’s hard drive that mimicked a poster for the film “Weekend at Bernie’s.” The caption said “Weekend at Ginsburg’s” and showed leaders of the U.S. House of Representatives propping Ginsburg up from both sides in a morbid play on how the movie characters covered up Bernie’s death so that they could use his beach house.

Ignorance of HIPAA Law is not a Defense

But, he didn’t even have that. The Chief Executive Officer of the transplant organization at the time the access occurred testified that coordinators like Russell had “no business being inside the chart” of patients who had not been referred to the organization. The CEO said that Russell was certainly aware of this prohibition because of numerous agreements he signed with his employer and the extensive training he received.

Lessons Learned

There are several important takeaways from this case. First, it is important to note that Russell had extensive training about the requirements of the HIPAA Privacy Rule. He also agreed to comply with these requirements. The temptation is great, but employees must be reminded not to succumb. In addition, practitioners should take note of the fact that Russell was criminally prosecuted. Since he was convicted, he faces up to twenty-two years in prison and fines in the tens of thousands of dollars. Serious business!

# # #

Elizabeth E. Hogue, Esq.
Elizabeth E. Hogue, Esq.

Elizabeth Hogue is an attorney in private practice with extensive experience in health care. She represents clients across the U.S., including professional associations, managed care providers, hospitals, long-term care facilities, home health agencies, durable medical equipment companies, and hospices.

©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

©2024 Elizabeth E. Hogue, Esq. All rights reserved.

No portion of this material may be reproduced in any form without the advance written permission of the author.

Startup Offers $3 Caregiver Recruiting Service

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by Tim Rowan, Editor Emeritus

Costly Caregiver Recruiting

Out of desperation, the nationwide caregiver shortage has driven many Home Care agency owners to resort to expensive recruiting tools. How much, for example, do you spend on services such as Indeed, ZipRecruiter, or Monster, each of which charges per-click?

A Needle in a Stack of Needles

You know how job seekers use these services, correct? They complete one resumè and send it to dozens, if not hundreds, of companies every day. When you respond to their inquiry, thinking they have a keen interest in applying for your caregiver position, they typically respond, “Now, which one are you?”

Caregiver Recruiting GoInstaCare

Caregiver Recruiting Database Emerges

In the process of building a web site and app for families to find in-home caregiver services, former Home Care agency owner Amit Shrivastava suddenly found himself with more job seekers than he could place in homes, and this after launching in only five states. His solution was to open his collection of resumés to other agencies. After we tested his idea, we believe it will one day give Indeed and the others a run for their money.

Simple Process with Customized Results

After a $200 set-up fee, GoInstaCare users can look at the names, certificates, personality types, and work preferences of 10,000 caregivers, a list that continues to grow. An easy filtering system allows the user to narrow the list by certification, gender, zip code, and experience. Each entry displays whether the caregiver has a driver’s license, his or her own car, languages spoken, and ratings from past employers and clients.

GoInstaCare performs background checks so the hiring agency knows that the caregiver has a higher degree of passing their own checks. By selecting filters, a hiring agency can focus its search to the qualifications it requires. Once the 10,000 names are filtered down to a manageable half dozen or so, the hiring agency pays $3 each to download their contact information. At that point, GoInstaCare steps back and leaves the rest of the onboarding process to their participating agency.

"Uberized" Employer

For Caregivers

Like its counterparts in ride shares, delivery services, virtual assistants, and other gig economy positions, GoInstaCare allows caregivers to set their own schedules, provide flexible rates, get paid daily, and accept or decline a job at will. Caregivers are reviewed by clients and their families directly on the GoInstaCare platform.

For Agencies

The gig job nature of the platform gives agencies the option to cover a gap in scheduling or temporarily raise employee numbers without the hiring, onboarding, training, and retention of a full-time or part-time employee. Agencies can also save a caregiver profile to share with a team, or for future reference.

Where to Find GoInstaCare

As this is written, GoInstaCare has spread to five states, Texas, Illinois, Michigan, New York, and Florida. Mr. Shrivastava told The Rowan Report there are plans to continue to expand.

There are two ways to get in touch with Amit Shrivastava. Click on this link to schedule a product demo: calendly.com/goinstacare-sales/meeting. Or sign up to use the service here: Goinstacare.com/partner-with-us

Caregiver Recruiting GoInstaCare

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Tim Rowan, Editor Emeritus

Tim Rowan is a 30-year home care technology consultant who co-founded and served as Editor and principal writer of this publication for 25 years. He continues to occasionally contribute news and analysis articles under The Rowan Report’s new ownership. He also continues to work part-time as a Home Care recruiting and retention consultant. More information: RowanResources.com
Tim@RowanResources.com

©2024 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

Creating a Culture that Retains Employees

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This article is part two of a two-part series. You can read part one here.

by Todd Austin and Sasha Erickson

3 Steps Towards Creating a Culture of Love that Retains Employees

In a study done on the “Culture of Companionate Love and Employee and Client Outcomes in a Long-Term Care Setting,” researchers found displaying warmth, affection, and connection had a tangible impact on employee turnover, resident outcomes, and family satisfaction.

Employees who felt they worked in a loving, caring work environment reported higher levels of satisfaction, increased teamwork, and showed up to work more regularly. But the effects of a companionate culture aren’t just felt by your employees.

Research shows that employees who work in a culture of love companionate culture directly related to client outcomes such as improved patient mood, quality of life, satisfaction, and fewer trips to the ER.

A culture like this is only made possible through a conscious effort from leadership to make their employees feel cared for and appreciated. To see similar results in your own business, start creating a culture of love.

Be an advocate for your employees' mental health

Contrary to popular opinion, an employee doesn’t leave their emotions at the door when they come into work. Especially if they work in a service-based industry like long-term and post-acute care.

The emotions an employee feels while caring on the job affects performance, customer and employee satisfaction, and care outcomes.

For example, if an employee is feeling stressed, frustrated, or disgruntled, they will either appear so as they’re caring for their residents and patients or be forced to put up a positive front on the outside while bottling up negative emotions on the inside. Whether these types of negative emotions are revealed in the open or held within, either outcome leads to low satisfaction and high employee turnover.

Instead, be an advocate for your employees’ wellbeing and mental health. Provide resources for mental health support and regularly check-in with your staff at important milestones. Offering competitive benefits, flexible hours, and paid time off encourages employees to tend to their own needs as well as others.

Broaden your company’s definition of culture

Culture is more than a staff break room with a foosball table. Your company’s culture will create itself, whether you’re in control of it or not.

Creating a healthy company culture requires deliberate and consistent actions from your leadership team. It is your goal to ensure that when your employees think about work on a Sunday night, they feel positive about coming to work every Monday morning. At Activated Insights, our approach centers on understanding and enhancing the employee experience through several key strategies:

    • Culture and Engagement Assessments
      • We regularly administer assessments to identify strengths and areas needing improvement to help us stay attuned to the evolving needs and perceptions of our employees.
    • Employee Focus Groups and Culture Audits
      • We have started administering focus groups and culture audits to gain real insights and solutions directly from our employees. These sessions create open lines of communication where employees can express their thoughts and ideas.
    • Prioritizing Employee Wellness
      • We offer unlimited PTO with mandatory minimums, including one mental health day off each quarter and a minimum of two weeks off per year with at least one period of five consecutive days off. This policy underscores our commitment to employee well-being, ensuring that they can balance work with personal life effectively.
    • Effective Communication and Leadership
      • Continuously communicating, modeling, and reinforcing the company’s vision, values, mission, and guiding principles is crucial. Leaders play a significant role in setting the tone and maintaining a positive culture by leading with transparency, empathy, and consistency.
    • Team Building and Collaboration
      • At Activated Insights our teams are often comprised of both in-office and remote employees. We encourage teams to get together at least annually. It’s imperative that companies are deliberate in providing opportunities for their teams to collaborate, build trust, and break down silos. We find that this improves overall job satisfaction and productivity.
    • Building Trust and Accountability
      • Trusting employees and treating them like adults to manage their work and personal demands is essential. By creating an environment of trust and accountability, we encourage employees to take ownership of their roles and contribute meaningfully to the organization’s success.

By focusing on these strategies, we ensure that our employees look forward to coming to work, feel valued and supported, and are motivated to contribute to a positive company culture.

Learn to speak your employees’ professional “love language”

If you don’t speak two languages, you won’t connect with your employees to make them want to stay.

While everyone communicates in their own way, if you don’t know the language your caregivers will listen to, your recognition efforts are going to waste.

But this isn’t the type of language Duolingo can teach you. Rather, every provider in the long-term and post-acute care industry should become fluent in appreciating their employees.

The Value of Communication

In 1992, Dr. Gary Chapman noticed a pattern of miscommunication after practicing couples’ counselling for years. He discovered that individuals often misunderstand one another’s needs by communicating how they would personally like to receive recognition, without taking the others’ needs into consideration. He concluded that how we respond to appreciation boils down to one of the following categories.

Learn how to speak your caregivers’ language of appreciation to increase caregiver retention, refine your leadership skills, and foster a culture of recognition:

Professional Love Languages

  • Words of Affirmation
    • Care employees ranked verbal recognition by a supervisor as their number one preferred form of recognition—and lack of communication from their employer as their top complaint. Actively seek out reasons you can praise your caregivers to boost company morale and foster a culture of gratitude:
      • Send handwritten thank you cards
      • Give your caregivers a shoutout in company newsletters or on social media
      • Recognize top performers using an employee of the month program to give everyone a chance to be in the spotlight
  • Receiving Gifts
    • While a raise may be outside of the company budget, 20.4% of caregivers mentioned smaller forms of monetary recognition as their chosen form of acknowledgement. Small bonuses for top performers, extra vacation time, or gift cards are simple forms of appreciation:
      • Give gift cards or free movie tickets
      • Give company branded clothing
      • Offer paid vacation time
  • Acts of Service
    • A care employee’s occupation is to literally provide service to those in need—but have you ever thought of ways to serve your care staff? Although it may seem counterintuitive to serve in a workplace where employees are paid, you can offer your staff the relief that they need by helping to shoulder some of their responsibilities:
      • Gather feedback and listen to how you can make their daily tasks or commute a little easier
      • Go the extra mile to make them smile by hosting random appreciation events where you can offer the company donuts, coffee, or even turkeys on Thanksgiving
  • Quality Time: Caregiving can be a very isolating job where they receive little social interaction with people other than their clients. Consciously create opportunities to spend quality time with your caregivers:
      • Hold group training events to create an environment where caregivers can ask questions and learn from fellow coworkers.
      • Schedule one-on-one meetings or lunches to build individual relationships with your caregivers and check in on how they are doing.
      • Support their learning and professional development by discussing your caregivers’ goals and needs

So, What Does Love Have to Do With It?

In short: everything.

Your ability to create a companionate culture of recognition for your care staff will be the difference that pulls you out of the revolving doors of recruitment and retention.

The quality of your leadership within your company directly impacts your quality of care for the long-term and post-acute care industry.

In 2024, spend more time consciously creating a companionate culture and start to see your employee retention and client satisfaction skyrocket.

# # #

Kristin Rowan, Editor
Kristin Rowan, Editor

As a highly accomplished executive, Todd Austin, COO & President of Activated Insights, is recognized as a leading voice in the rapidly-growing care industry. With over a decade of experience in executive leadership roles, Todd brings a wealth of knowledge and expertise to his current position as a key member of the Activated Insights team.

With a background in sales, marketing, management, operations, and finance, Todd is a true Renaissance executive with a rare combination of strategic and tactical skills. His expertise in developing and implementing growth strategies, optimizing operations, and driving profitability has made him a sought-after advisor to many organizations.

Sasha Erickson is the Director of Talent at Activated Insights, formerly HCP. With over 10 years of experience in human resources across a variety of industries, Sasha has worked with organizations ranging from small businesses to Fortune 500 companies. She graduated Summa Cum Laude from Utah State University with a degree in Business Administration and minors in Human Resource Management, Marketing, and Finance.

Sasha’s career history includes roles at Avant Guard Monitoring Centers, Goldman Sachs, Schreiber Foods, JBS and Pilgrim’s Pride Corporation, RR Donnelley, and Denver Public Schools. Her expertise spans talent acquisition, employee engagement, culture development, HCM software implementation, and strategic HR management.

©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

What’s Love Got to Do with It?

Admin

This article is part one of a two-part series from Activated Insights, formerly Home Care Pulse. Come back next week for the continuing story. Read more about Caring for the Caregiver here

by Todd Austin and Sasha Erickson

How to Create a Culture that Keeps Your Employees from Breaking Up with You

Healthcare employees admit that the 3 main factors contributing to the most stress at work are:

    • Concerns about being trainied for the required workload
    • Worries about job security
    • Finding the time to balance work and personal life

As a result, almost 60% of those working in the healthcare space reported their self-assessed level of burnout to be between moderate and very high—which can be attributed to the high-level emotional investment required for the job.

Post-Acute Turnover

While the long-term and post-acute care is one of the fastest growing industries in the nation, it also ranks in the top 5 workforces with the highest turnover.

Fortunately, the care employee burnout crisis is fixable.

The cure?

Treating our staff, and ourselves, with a little more conscious compassion.

It's Not You, It's Me

The Long-Term Effects of Unappreciation

For most other industries, employee turnover peaks at one year.

But for the long-term and post-acute care industry, 40% of turnover occurs within an employee’s first 100 days.

Which isn’t leaving much room for providers to retain their staff. According to the 2024 Activated Insights Benchmarking Report, annual care staff turnover increased by 14% within the last two years, averaging a total of 79.2%.

But there is hope in the data.

What if we told you that simply thanking your care staff more could get them to stay longer than 3 months?

According to the Benchmarking Report, recognition received the lowest satisfaction score from employees. Care staff are most dissatisfied with the appreciation they’re receiving after a job well done, followed by feeling inadequately prepared for the field.

Activated Insights Culture

Not only are feelings of unappreciation causing turnover rates to skyrocket, it’s also having a detrimental impact on the state of the industry.

As a result of not feeling appreciated or recognized for the work they do, your employees may be showing warning signs of impaired grief processing:  

    • Irritability or anger
      • oddly negative behaviors or attitudes that are uncharacteristic for the employee
    • Obsessive thoughts
      • rumination over certain patients or issues that is constantly brought up and seems to never be resolves
    • Hyper alertness or overreactive behaviors
      • intense, erratic behaviors or excessive attention to work that is unwarranted or outside of the normal response
    • Self-harming behaviors
      • gravitation to overworked, exhaustive behaviors e.g. refusing to take breaks, taking on added tasks unnecessarily
    • Apathy or numbness
      • lack of reaction to items that would normally cause a response, decrease in emotions, or refusal to address difficult emotions

Contrary to popular opinion, an employee doesn’t leave their emotions at the door when they come into work. Especially if they work in a service-based industry like long-term and post-acute care.

The emotions an employee feels while caring on the job affects performance, customer and employee satisfaction, and care outcomes.

For example, if an employee is feeling stressed, frustrated, or disgruntled, they will either appear as they’re caring for their residents and patients or be forced to put up a positive front on the outside while bottling up negative emotions on the inside. Whether these types of negative emotions are revealed in the open or held within, either outcome leads to low satisfaction and high employee turnover.

Instead, be an advocate for your employees’ wellbeing and mental health. Provide resources for mental health support and regularly check-in with your staff at important milestones. Offering competitive benefits, flexible hours, and paid time off encourages employees to tend to their own needs as well as others.

# # #

Todd Austin Culture

As a highly accomplished executive, Todd Austin, COO & President of Activated Insights, is recognized as a leading voice in the rapidly-growing care industry. With over a decade of experience in executive leadership roles, Todd brings a wealth of knowledge and expertise to his current position as a key member of the Activated Insights team.

With a background in sales, marketing, management, operations, and finance, Todd is a true Renaissance executive with a rare combination of strategic and tactical skills. His expertise in developing and implementing growth strategies, optimizing operations, and driving profitability has made him a sought-after advisor to many organizations.

Sasha Erickson is the Director of Talent at Activated Insights, formerly HCP. With over 10 years of experience in human resources across a variety of industries, Sasha has worked with organizations ranging from small businesses to Fortune 500 companies. She graduated Summa Cum Laude from Utah State University with a degree in Business Administration and minors in Human Resource Management, Marketing, and Finance.

Sasha’s career history includes roles at Avant Guard Monitoring Centers, Goldman Sachs, Schreiber Foods, JBS and Pilgrim’s Pride Corporation, RR Donnelley, and Denver Public Schools. Her expertise spans talent acquisition, employee engagement, culture development, HCM software implementation, and strategic HR management.

©2024 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

Sasha erickson Culture

Kickbacks for Referrals are Costly…and Illegal

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by Elizabeth E Hogue, Esq.

Kickback on Kickbacks

Three home health agencies and their parent company in Cincinnati, Ohio, must pay $4,496,330 to resolve alleged violations of the federal False Claims Act by providing kickbacks to assisted living facilities in exchange for referrals of Medicare patients. The settlement resolves allegations that, between 2013 and 2022, the companies provided lease payments and other valuable benefits; including wellness health services, sports tickets, and meals; to numerous ALFs and their residents. The companies then billed Medicare for the services provided to patients referred by the ALFs.

Referrals from ALFs

Getting more referrals from ALF’s and retirement communities seems to be a crucial piece of the puzzle for all types of providers. As the number of years in which they have been in business increases, ALF’s and retirement communities are more eager to assist their residents to “age in place.” This means that they often view availability of services from post-acute providers as essential to allow them to achieve this goal. 

While providers compete aggressively in the marketplace, they cannot, however, lose sight of the fact that the healthcare industry is highly regulated. With ever-increasing emphasis on fraud and abuse compliance, providers cannot afford to violate the law.

Kickbacks for Referrals

How can providers get more referrals from ALF’S and retirement communities? What are the potential legal pitfalls that providers must avoid? 

The most effective way to maximize referrals from these sources may be to take a multi-pronged approach that includes:

Assigning at least one coordinator/liaison to each referral source on at least a part-time basis

Use of coordinators/liaisons at ALF’s and retirement communities raises issues related to violation of the federal anti-kickback statute. This statute generally prohibits providers from either offering to give or actually giving anything to referral sources in order to induce referrals. Consequently, liaisons and coordinators must be scrupulous about avoiding the provision of free services to ALF’s and retirement communities and/or their residents. Possible violations include “staffing” an office with an RN who responds to requests from residents in their apartments or has “office hours” to address health conditions of residents.

Renting space for coordinators/liaisons to occupy so that providers have a frequent or continuous presence on the premises of referral sources to better serve patients

Renting space from referral sources also involves potential kickbacks, so providers must meet the requirements of the space rental exception or safe harbor. In order to do so, providers must enter into a written lease with the facility/community for a term of least one year. The lease must include the number of square feet providers are renting. Rent must be set in advance at fair market value and cannot take into account either the volume or value of referrals received. Finally, providers may rent only the amount of space that is commercially reasonable or that they actually need.  

The OIG has provided significant guidance about these requirements, which providers must master before they establish these types of relationships. Common pitfalls for providers is insistence by ALFs that providers must rent an entire apartment, whether or not they need it, and must pay an amount equal to the residents’ monthly rent, which includes food and other services. 

Entering into Preferred Provider Agreements

Preferred Provider Agreements may be verbal or in writing. There may be significant value in reducing these preferred provider relationships to writing. These types of relationships raise issues related to patients’ right to freedom of choice of providers. The common law or court decisions require providers of all types to honor patients’ right to freedom of choice. There are also federal statutes that guarantee this right to Medicare and Medicaid patients. In addition, states sometimes address these issues in applicable statutes and regulations. For this reason, providers should not attempt to use standard or “sample” Agreements, but must adhere to requirements in all of the states in which they use these types of Agreements.

Providing a full range of screenings and educational events for and about common chronic illnesses or community awareness activities

ALF’s and retirement communities often ask providers to conduct educational events and basic screenings for common chronic conditions. Generally, providers may do so if they walk a relatively fine line between engaging in community awareness activities and providing free skilled services to residents that exceed $15.00 in value at a time. At a minimum, such activities must be conducted consistent with a detailed policy and procedure that governs the provision of such services, so that providers do not violate the anti-kickback statute.

No kickbacks for referrals

Establishing relationships with ALF’s and retirement communities may result in numerous referrals to post-acute providers. Such relationships should be based on standard documents and comprehensive policies, as described above, in order to ensure compliance. Legal representation is essential for the development and implementation of these documents due to the complexity of the issues involved. 

Enforcement actions like those described above are avoidable.

Elizabeth E. Hogue, Esq.
Elizabeth E. Hogue, Esq.

Elizabeth Hogue is an attorney in private practice with extensive experience in health care. She represents clients across the U.S., including professional associations, managed care providers, hospitals, long-term care facilities, home health agencies, durable medical equipment companies, and hospices.

©2024 Elizabeth E. Hogue, Esq. All rights reserved.

No portion of this material may be reproduced in any form without the advance written permission of the author.

Payer or Competitor?

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by Tim Rowan, Editor Emeritus

UnitedHealth Making Home Health Visits

Payer or Competitor…that is the question. According to a report in the Wall Street Journal, and questioned by the insurance industry’s lobbying arm, AHIP, UnitedHealth Group has increased its revenue from the Medicare Trust Fund by $50 billion by “finding” additional health issues during home visits to its MA customers.

In a July 16 investor call, CEO Andrew Witty said UnitedHealth clinicians made more than 2.5 million home health visits to UnitedHealthcare MA members in 2023. Following these visits to more than 500,000 seniors, UnitedHealth upgraded over 300,000 of them to higher payment levels by uncovering health conditions the individual seniors did not know they had.

The WSJ investigation found that between 2018 and 2021, insurers received $50 billion for diagnoses they added to members’ charts. Many of these diagnoses were “questionable,” according to that investigation.

Questionable Visits

Uncover versus Discover United Health

Though a UnitedHealth spokesperson called the analysis “inaccurate and biased,” former UnitedHealth employees told the Journal home visits are often used to add diagnoses. Clinicians say they use software during visits that offer suggestions as to what illnesses a patient might have.

CEO Witty maintained in the investor call that the practice is good for seniors. “UnitedHealth clinicians discovered more than 3 million gaps in care through home visits in 2023,” he reported, “and 75% of patients receive follow-up care in a clinic within 90 days of a home visit.” 

He added that the United home visit program “helps patients live healthier lives and saves taxpayers money,” concluding. “…Medicare Advantage makes programs and results like this possible.” 

The Journal concluded with the finding that few of these upgraded seniors are ever seen by a physician for their newly discovered health conditions. 

# # #

Tim Rowan, Editor Emeritus

Tim Rowan is a 30-year home care technology consultant who co-founded and served as Editor and principal writer of this publication for 25 years. He continues to occasionally contribute news and analysis articles under The Rowan Report’s new ownership. He also continues to work part-time as a Home Care recruiting and retention consultant. More information: RowanResources.com
Tim@RowanResources.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Recruitment, Retention, and Reward: Product Review

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by Kristin Rowan, Editor

Caregiver Recruitment, Retention, & Reward

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

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

How it Started

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

Home Care Immersion

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

Her Name was Ava

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

The Problem Statement

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

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

The Solution is Ava

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

Recognition and Rewards

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

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

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

Recruitment, retention, and reward AVA

Communication

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

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

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

Marketing

Recruitment, retention, and reward AVA

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

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

Customizable on Multiple Fronts

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

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

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

Track and Reward Your Top Employees

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

Badges

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

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

Training

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

Reporting

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

Limitations

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

Some current limitations we noticed in our intial demo:

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

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

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

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

The manual tracking of Google reviews is not scalable.

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

Final Thoughts

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

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

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

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

# # #

Kristin Rowan, Editor
Kristin Rowan, Editor

Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Department of Labor Changes Exemption and Overtime Thresholds

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by Tim Rowan, Editor Emeritus

Overtime and exemption thresholds impact employers trying to balance cost-effective policies with employee fairness. As such, they keep a close eye on rules they must follow that come down from the U.S. Department of Labor. When those rules change, remaining compliant requires a company HR leader to adapt those policies. One of those times is at hand.

 

Exemption and Overtime Thresholds for Hourly and Salaried Earners

Effective last week, July 1, the annual salary threshold for overtime exemption increased from $35,568 to $43,888. The DoL’s final rule does not stop there but sets another increase on January 1, 2025, to $58,656 per year or $1,128 per week. Salaries below those thresholds cannot be declared “exempt,” meaning they must be paid overtime rates for hours worked over eight per day and forty per week.

 

Executive Salaries also Affected

In addition to overtime and exemption thresholds, the new rule increases the highly compensated employee threshold twice as well. On July 1, the annual salary threshold increased from $107,432 to $132,964. That annual threshold will increase again on January 1 to $151,164.

Going forward, the DOL will increase all thresholds every three years starting July 1, 2027, relying on up-to-date wage data.

We learned these DoL rule details from Angelo Spinola, Executive Director and lead home care attorney with Polsinelli, a national law firm. 

Federal Overtime Rule

Angelo Spinola Comments

“Home care providers that have been making adjustments to comply with the July 1 deadline may have heard about a recent case out of Texas blocking the July 1 increases. While the Texas court did use a partial injunction blocking the July 1 increase, it only applies to Texas government employees. It does not affect any private employers.”

He recommended that all home health and home care employers continue to make changes as planned to comply with the July 1 increases. Spinola stated that his statements are for informational purposes only and are not intended to be legal advice. His comments quoted here should not be relied upon or used without consulting a lawyer to consider your specific circumstances, possible changes to applicable laws, rules and regulations and other legal issues.

Spinola Concludes

“There are still challenges pending that could affect the January 1, 2025 increases, however, those decisions are not expected for several months, and it is too soon to predict whether that deadline will be affected. We will continue to monitor these cases and provide any updates that may have an effect on the home care industry.”

Angelo Spinola can be reached via email at onlinesolutions@polsinelli.com

NAHC Comments on Exemption and Overtime Thresholds

“The long-awaited U.S. Department of Labor rule regulating minimum salaries levels to qualify for exemption to the Fair Labor Standards Act was issued today. We strongly advise the home care community to gain a comprehensive understanding of the rule and institute steps for timely compliance. While the changes may have limited impact on most home care companies, noncompliance comes with serious penalties.” – NAHC President Bill Dombi

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Tim Rowan, Editor Emeritus

Tim Rowan is a 30-year home care technology consultant who co-founded and served as Editor and principal writer of this publication for 25 years. He continues to occasionally contribute news and analysis articles under The Rowan Report’s new ownership. He also continues to work part-time as a Home Care recruiting and retention consultant. More information: RowanResources.com
Tim@RowanResources.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report.homecaretechreport.com One copy may be printed for personal use: further reproduction by permission only. editor@homecaretechreport.com

A New Path for Recruitment and Retention

Admin

by Kristin Rowan, Editor

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

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

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

About Wellsky

Recruitment and Retention Wellsky Ava

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

About Ava

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

Recruitement and Retention Ava Stats

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Kristin Rowan, Editor
Kristin Rowan, Editor

Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com