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?

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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

# # #

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

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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

The Future of Care at Home

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by Kristin Rowan, Editor

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

Hospital at Home Popularity

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

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

Massachusetts Ambulatory Nurses Unionize

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

Hospital-at-Home Nurses at Mass General Unionize

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

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

Hospital-at-home nurses unionize at Mass Gen

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

Home Health Unionization

hospital-at-home changing home health unions

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

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

CMS Response to Union Backlash

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

Maximize VBPM with Technology

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

# # #

Kristin Rowan, Editor
Kristin Rowan, Editor

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

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

NAHC and NHPCO Sign Affiliation Agreement

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by Kristin Rowan, Editor

BREAKING NEWS

In a joint statement on June 18, 2024, NAHC and NHPCO announced that the Board Chairs and CEOs of each organization met in Washington. During this meeting, they formally signed the affiliation agreement. This is a union of the two largest advocate organizations for care at home providers. They hope to unify the voice of the care at home community. The combined resources of the organizations will provide education, expert advice, and increased advocacy for policies that help deliver the best care to those who need it most.

After 18 months of discussions, meetings, and challenges, the two organizations have agreed on terms for the combining of the two groups.

 

“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.”

Read the full press release from NAHC and NHPCO here.

# # #

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

Preventing Violence: More Action Items

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By Elizabeth E. Hogue, Esq.

Violence in Healthcare

According to a recent analysis of Bureau of Labor Statistics data, healthcare is one of the most dangerous places to work. Homecare field staff members who provide services on behalf of private duty agencies, hospices, Medicare-certified home health agencies, and home medical equipment (HME) companies may be especially vulnerable. Contributing to their vulnerability is the fact that they work alone on territory that may be unfamiliar and over which they have little control. Staff members certainly need as much protection as possible.

 

Preventing Violence Bureau of Statistics Graph

Must-Haves

First, regardless of practice setting, management should develop a written policy of zero tolerance for all incidents of violence, regardless of source. The policy should include animals. The policy must require employees and contractors to report and document all incidents of threatened or actual violence, no matter how minor. Emphasis should be placed on both reporting and documenting. Employees must provide as much detail as possible. The policy should also include zero tolerance for visible weapons. Caregivers must be required to report the presence of visible weapons.

Below are some additional important actions for healthcare organizations to take that are based on UCHealth’s SAFE Program:

  • Encourage staff members to STOP if they feel unsafe for any reason.
  • Workers should pause to generally ASSESS their environments. Staff members should think about what has happened and observe what is currently occurring. Is there, for example, mounting frustration or anger?
  • Staff should then FAMILIARIZE themselves with the room. Who is the patient? Where is the patient? Are there any factors that might escalate behaviors? Staff members should also consider putting themselves in positions where they have a route to escape, if necessary.
  • Practitioners should also ENLIST help. Getting help may, for example, include pushing panic buttons on mobile devices.

Here is what Chris Powell, Chief of Security at UCHealth said in Becker’s Hospital Review on June 4, 2024:

“You can’t just talk about the shrimp and give you a good picture. We have to talk about the roux and the rice and everything else that goes into this for a good picture to be painted so people have an understanding. We want to solve this with an electronic learning or a 15-minute huddle, but we can’t. This is continuous and a persistent pursuit toward educating, communicating, recognizing, responding to, reporting and recovering from workplace violence.”

Every caregiver matters. The healthcare industry has lost caregivers to violence on the job in the past. Let’s not repeat these terrible events.

©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.

When Social Media Goes Too Far

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by Kristin Rowan, Editor

Access to Information: Pro & Con

The advent of social media has allowed millions upon millions of users worldwide to connect with distant friends and family, meet new people, and share information among followers. From Six Degrees in 1997 to BlueSky in 2023, social media has evolved over time. Some say social media has brought us closer together and created more opportunities for small business marketing and branding. Others argue it has replaced human interaction and created overuse of mobile devices, addictions to “likes”, and a host of fake news and propaganda. Whatever your particular outlook on social media, it’s probably here to stay.

Social Media

Having a profile on a social media platform (or several as most people have), allows friends, family, and colleagues to connect quickly and easily. This easy access to user information can be great for social networking and branding. Recently, however, the social media platforms have started gathering the information from your profile to enhance the paid marketing campaigns you see in “Sponsored” posts. If you’ve never noticed it before, pay attention to how often a sponsored post appears on your social media feed that happens to match a recent browser search, email, or, scarily enough, conversation, you are part of.

Social Media Access to Outside Information

Cookies

We’ve all seen the warning pop-ups on websites that read “This site uses cookies.” Cookies store your browser information and history, page visits, keyword searches, and other information. This information is accessible to other websites. This is why Amazon sends you an email for sale items you recently searched for, even if you didn’t search on Amazon. Most of us know we have the option to allow only necessary cookies and to opt out of everything else. However, most people rarely take this extra step. Rather than selecting from a list of allowable cookies, the default action is to “allow all.” We are just one click away from continuing our browsing, reading, or shopping.

PHI Information Accessed by Social Media

We accept that when we allow cookies, our information will be shared. However, when you share personal information with your doctor, you assume that information is not subject to the cookie preferences, even if the information is uploaded digitally. The federal Health Insurance Portability and Accountability Act (HIPAA), in fact, requires that this information not be shared. Ron Prosky that the Palm Beach Health Network, the largest health care network in Palm Beach County, Florida, did just that. Palm Beach Health Network allegedly used Meta’s pixel code in their website, allowing Facebook to target patients with personalized ads based on their medical condition and other sensitive information.

Similar lawsuits alleged the same action against Atrium Health in North Carolina and against Kaiser Permanente, both in April of 2024. Kaiser Permanente claimed an “accidental breach” after knowingly using website trackers from Microsoft, Meta, and Google. Kaiser alleged they were unaware that the website trackers would send private information. Website trackers gather information that includes the user’s name and IP address. This information does not necessarily violate HIPAA laws. However, because the “cookies” attach to the IP address, they follow the user around the web. This makes it fairly easy for the data to infer a diagnosis or illness and use that to market to patients.

A Word of Caution for Agencies Using Tracking Data

If your website is set up to track users through partner codes from Google Analytics, Facebook Pixel, or any other tech provider, you may be inadvertently sharing protected patient data with any of these companies.

If you are tracking landing page and link clicks through Google Analytics, you may be sharing sensitive data. Here is an easy to follow article to prevent sharing Personally Identifiable Information (PII).

Social Media No Data<br />

A Word of Caution for all Social Media and Internet Users

Social Media No Cookies<br />

The digital world is one in which we all live. Whether you are engaging with social media content, shopping in an app, or browsing online, protect your personal information. 

Opt out of cookies whenever possible. If it’s not possible, limit access to only necessary cookies and don’t allow your information to be sold. Only use websites that are secure. Delete your browser history or use incognito mode as often as possible.

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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

Curantis Solutions Partners with Amazon HealthLake

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by Kristin Rowan, Editor

Having a lot of data can help grow your business, streamline processes, improve efficiencies, and make your agency more profitable. But, if you don’t know how to use the data, or simply don’t have the time and man-power to analyze the data, then those hidden treasures waiting in all that data remain hidden. Understanding the value of that data, Curantis Solutions partners with Amazon HealthLake to help you harness it.

Curantis Solutions is a Texas based company delivering value to hospice and palliative care agencies. Their cloud-based management solutions help you increase operational and financial efficiencies while still offering well-coordinated and high quality patient care. The platform works to address two common pain points in our industry: siloed data and software systems that operate separate from each other. Curantis Solutions re-imagines workflows to reduce hours spent on tasks outside of direct patient care.

The Impetus for Change

New CMS regulations and the HL7 Fast Healthcare Interoperability Resources (FHIR) create standards that providers and health care plans must meet. This could help home health and hospice agencies with clinical data issues. FHIR imagines a unified EMR system for greater interoperability. Facing FHIR compliance, Curantis Solutions turned to AWS to help centralize their data. Using Amazon HealthLake, a fully managed FHIR service, Curantis was able to make their client data interoperable.

The Solution for Curantis Solutions

Using Amazon’s Working Backwards process, Curantis found a customer-centric solution. AWS helped Curantis work through:

  • Business objectives
  • A free, introductory program, “Gain Insights”
  • Cloud set-up and solution design

Curantis also implemented Amazon Kinesis to help collect, process, and analyze real-time data. All of Curantis’s data is now easily accessible, opening the door for AI, analytics, and business intelligence.

Curantis Solutions and Amazon HealthLake Data Processing and Analytics

Curantis Solutions Amazon HealthLake

Using Amazon, Curantis Solutions can build visual dashboards and reports. The visual reports help agency administrators understand and apply the data at a glance without spending hours analyzing the data points. The integration allows data analysis in almost real time. The Amazon suite of services aids Curantis in growth and enhanced data processing for their clients. It also allows Curantis to highlight powerful industry and patient data trends. These key indicators will help with critical decision making for continued high quality patient care.

    This new platform adds expanded abilities to meet customer needs:

    • Enhanced partner integrations
    • Diverse way to prensent a patient-focused view
    • The power to make predictions about a patient’s decline based upon chart data
    • The ability for customers and internal stakeholders to easily explore data

     

    About Curantis Solutions

    Curantis Solutions was born from a desire to put hospice and palliative care first. With a genuine culture of caring, our team is dedicated to creating a refreshingly simple software experience that utilizes emerging technology, smart design and a cloud-native/serverless architecture to create an experience that is congruent with the technology you utilize in your everyday life. It’s time for hospice and palliative care software to make life easier vs creating arduous workarounds and added frustration. It’s time you experience Curantis Solutions!

    About Amazon HealthLake

    AWS HealthLake is a HIPAA-eligible service offering healthcare companies a complete view of individual and patient population health data using FHIR (Fast Healthcare Interoperable Resources) API based transactions to securely store and transform their data into a queryable format at petabyte scale, and further analyze this data using machine learning (ML) models. Using the HealthLake FHIR-based APIs, healthcare organizations can easily import large volumes of health data, including medical reports or patient notes, from on-premises systems to a secure, compliant, and pay-as-you-go service in the cloud. HealthLake offers built-in natural language processing (NLP) models to help customers understand and extract meaningful medical information from a single copy of raw health data, such as medications, procedures, and diagnoses.

    Curantis Solutions Amazon HealthLake

    # # #

    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

    NLRB Targets Non-Compete Agreements

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    by Elizabeth E. Hogue, Esq.

    The National Labor Relations Board (NLRB) has now joined the Federal Trade Commission (FTC) and some state legislatures to target non-compete agreements. The general counsel for the NLRB argued in a recent memo that non-compete agreements violate the National Labor Relations Act because they interfere with employees’ right to engage in protected concerted activity. Two recent actions by the Board provide more information about efforts of the NLRB to limit use of non-compete agreements.

    Juvly Aesthetics Non-Compete Agreement Settlement

    In February of 2024, the regional office of the Board in Cincinnati approved a settlement agreement between Juvly Aesthetics and three former employees. The Board claimed that Juvly, an operator of medical clinics, violated the rights of employees through the use of confidentiality, non-disparagement, non-competition, non-solicitation and requirements to repay training expenses under certain conditions. 

    According to the NLRB, Juvly prohibited employees from discussing their rates of pay. The Company also required some employees to sign a non-compete agreement that was in effect for a period of twenty-four months for any competing medical practice within twenty miles of any location of the Company.

    Juvly agreed to a settlement agreement that required:

    • Payment of back pay to some employees
    • Termination of unlawful policies and procedures
    • Release of employees from unlawful agreements
    • Posting of all of requirements of the settlement agreements for review by employees
    Non-compete agreements juvly aesthetics<br />

    NLRB Division of Advice

    non-compete agreements

    In December, the NLRB Division of Advice issued guidance that evaluated the legality of these issues:

    • Customer non-solicitation provisions do not violate the Act because they only prevent employees from soliciting existing customers for one year so that employees are likely not barred from other employment opportunities for more than one year.
    • Confidentiality agreements do not violate the Act because they prohibit only disclosure of trade secrets, marketing plans, customer lists, and other proprietary information, as opposed to information that could involve employee activity regulated by the Act, such as wage information. 
    • Provisions requiring the return of company property do not violate the Act.

    Providers are now clearly operating in an environment that prohibits employers from restricting employee activities that were fair game in the past. The specifics of efforts to limit the actions of employers remain unclear, but will likely be “fleshed out” in enforcement actions.

    ©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.

    ©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article appeared in Healthcare at Home: The Rowan Report. Reproduction by permission only.

    editor@therowanreport.com

    The Future of NAHC: An Interview with Bill Dombi

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    by Kristin Rowan, Editor

    NAHC President Bill Dombi announced at last week’s CAHSAH annual meeting and expo that he would end his tenure at NAHC and retire at the end of 2024. We reached had an interview with Dombi on Thursday, May 23rd. He said he was not prepared to speak yet about his upcoming retirement, but we should hear more about that soon.

    In the meantime, he provided additional details from his session at CAHSAH. We also discussed updates on the lawsuit against CMS and the status of the merger between NAHC and NHPCO. Tim’s article from last week talks about Dombi’s progress with Senator Wyland.

    Ongoing Litigation

    When we last spoke with Bill, he told us about the lawsuits filed against CMS. The suit claims that the budget-neutral calculations were based on faulty data and outdated software. These calculations determined the reimbursement rate reductions. Dombi explained the process for those lawsuits.

    “The first round of the battle is around whether the court has the power to hear the case either at all or at that point in time. The courts are littered with litigation that have been dismissed on jurisdictional grounds,” Dombi offered. The court dismissed the lawsuit and the case is now closed. The Department of Justice (DoJ) attacked jurisdiction to get the case dismissed. Most concerning, according to Dombi, was the DoJ’s question of whether the statute passed by Congress precluded any litigation. If the courts had found in their favor, they would have dismissed the lawsuit no further suits could be filed. Luckily, that argument didn’t hold. The second attack was whether NAHC had expedited administrative review, which is the argument that caused the dismissal. Now, they have to establish that it would be futile to get CMS to agree to expedited judicial review.

    Next Steps

    In light of the dismissal, NAHC had to decide whether to appeal the ruling, exhaust the expedited review step with CMS, or both. Ultimately, they decided not to appeal and is pursing the review with CMS. This process could take up to 6 months, according to Dombi. Although they are pursuing the review, CMS has already stated that their final position is that the budget neutrality has been calculated within the law. Dombi feels the review is futile because CMS is not going to change their position. Now, they just have to prove the futility.

    Two-Step Approach

    Advocacy from NAHC, NHPCO, and other individuals and organizations was always intended to be a two-pronged effort: Litigation and Congress. The two do not interfere with each other. Even though the court dismissed the litigation suit in favor of judicial review, the approach in Congress continues. Of Senator Wyland, Dombi said, “A year ago at this time, his view was that home health agencies needed no relief. Now, he’s indicated a willingness to find a way to help home health agencies and recognizes that the cuts have been harmful to home health agencies and others that provide care.” According to Dombi, it was the personal stories and individual provider information that was crucial in swaying Wyland. The organizations continue to meet with other members of Congress to persuade them in the same way.

    Dombi Provides Merger Update

    Last year, NAHC and NHPCO announced they would join forces and merge into a new, as yet to be named, organization. That merger is still moving forward, but there are a lot of odds and ends to tie up. Dombi told us, “Nothing is final, final, but I don’t see anything but tailwinds moving forward.” The two organizations are still hoping for a July 1, 2024 launch of the organization. There is an active, open search for a new CEO to actively run both organizations as one. According to Dombi, no one has been slated for that position yet, so they may end up launching before there is a CEO in place.

    The two organizations have already started integrating. They have lobbied together and they have worked on policy together. Additionally, they are integrating the association management system and building a website. “We feel confident enough that it’s going to reach the finish line that we’re investing time and money in these elements,” Dombi said. The two organizations can continue to operate together without a CEO, but there are a lot of decisions that need to be made that won’t be made until after there is a CEO.

    After the Merger

    Once the merger is complete and the two organizations operate under a new name with a new CEO, Dombi and his counterpart Bill Marcantonio of NHPCO will stay on for some time. Dombi will take the title President Emeritus and Council to the organization and Marcantonio will become the Chief Integration Officer. The new name of the organization has not been announced. Dombi says a lot of things are tied together, from an action standpoint, and it’s better to announce all of those details together along with the new name.

    Reflections From Bill Dombi

    When asked what was next for him after the merger is completed and he moves to retirement, Dombi reflected on his career:

     

    “I’m proud of what I’ve accomplished in my life, but I’m more proud of what the people I work with I have accomplished. It’s not the first time we’ve tried to merge the two organizations, but this time, we had all the right ingredients and I’m proud of that. I live with the confidence that my constituency is up to the challenge. Every time they get kicked back, they’re right back at it.

    To see where we are today compared to the 70s, we are so many light years ahead of where we were then. I mean, we’re talking about a hospital level of care at home. That was part of the dream. The fore-runners of healthcare at home truly believed those things were possible. The problems that caused the workforce shortage are multi-faceted, so the solutions are multi-pronged.”

    Bill Dombi Spring Tour
    We will continue following the story of both the lawsuits and the merger and update you as soon as there is more information.
    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

    Bill Dombi Spring Tour has two Major Announcements

    Admin

    by Tim Rowan, Editor Emeritus

    Bill Dombi Spring Tour

    For the last time, NAHC President Bill Dombi is spending another Spring on airplanes. It is state association meeting season, and the Bill Dombi Spring Tour has been bringing his regular Capitol Hill update from coast to coast, this time adding the announcement that he will retire at the end of the year.

    After 40 years with NAHC, the lengthy standing ovation Californians gave him at the end of his Tuesday speech was well-deserved.

    Advocacy and Change

    Bill’s core message has not changed, though the details of his ongoing battle to force CMS to take HHAs and Hospices more seriously has its 2024-2025 nuances. “Letting Congress know that you are an important healthcare sector, and clearly the most popular sector, is not NAHC’s job alone. Every one of you has power. Use it. Make your voices heard.”

    Meetings with the Senate Finance Committee

    To illustrate the point, he related a story about his recent visit to Portland to meet with the Chair of the Senate Finance Committee, Ron Wyland (D-OR).

    “Senator Wyden has been one of the major roadblocks to Medicare agencies getting fair payment rates. I went to see him with a group of agency owners and workers to describe the hardships the current and planned pay rate cuts will impose, and to explain the exact problems with the dumb formula CMS is using to calculate those pay rates.

    “The Senator said, ‘But MedPAC says you make too much money and rates should be cut. Were they wrong? Or has something changed?’

    Reaching Agreement…Almost

    “Both, the group and I harmonized. One by one, each agency representative told him about the growing demand of an aging population, the difficulty hiring staff with the salaries our low pay rates allow them to pay, and a full litany of all the problems with Medicare Advantage.

    “By the end of our meeting, we hadn’t turned him 180 degrees, but I could see he was beginning to turn.”Later, Dombi added, he met with Senator Debbie Stabenow (D-MI), who is not only a member of the same Finance Committee but the fourth in line in the Senate pecking order. She offered to have a conversation with her colleague, and that turned Senator Wyden the rest of the way toward changing his position 180 degrees.

    You Can Make a Difference

    “If you think you as an individual owner have no power in Sacramento, Congress, or the White House,” Dombi concluded, “think again.”

    See sidebar for the complete list of Finance Committee members. Everyone has power, but if you are a voter in one of their states, you have an even more powerful voice.

    The Bill Dombi Spring Tour will continue throughout the year until his retirement. Join Dombi at the 2024 Financial Management Conference & Expo in Las Vegas, July 21-23 and at the 2024 Home Care and Hospice Conference and Expo in Tampa, October 20-22.

    Bill Dombi Senator Wyden

    Senator Ron Wyland (D-OR)

    SENATE FINANCE COMMITTEE MEMBERS

    Chair: Ron Wyland (D-OR)
    Ranking Member: Mike Crapo (R-ID)
    Debbie Stabenow (D-MI)
    Chuck Grassley (R-IA)
    Maria Cantwell (D-WA)
    John Cornyn (R-TX)
    Robert Menendez (D-NJ)
    John Thune (R-SD)
    Thomas Carper (D-DE)D-
    Tim Scott (R-SC)
    Benjamin Cardin (D-MD)
    Bill Cassidy (R-LA)
    Sherrod Brown (D-OH)
    James Lankford (R-OK)
    Michael Bennet (D-CO)
    Steve Daines (R-MT)
    Bob Casey (D-PA)
    Todd Young (R-IN)
    Mark Warner (D-VA)
    John Barrasso (R-WY)
    Sheldon Whitehouse (D-RI)
    Ron Johnson (R-WI)
    Maggie Hassan (D-NH)
    Thom Tillis (R-NC)
    Catherine Cortez Masto (D-NV)
    Marsha Blackburn (R-TN)
    Elizabeth Warren (D-MA)

    # # #

    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