Why Every Provider Must Establish and Maintain a Fraud and Abuse Compliance Program

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by | Jan 31, 2024 | Admin, Regulatory

by Elizabeth E Hogue, Esq.

Providers may have heard or read about the importance of Fraud and Abuse Compliance Plans in their organizations. Despite the wealth of available information about Compliance Plans, many providers continue to express uncertainty about their value. Here are some of the questions providers commonly ask about Compliance Plans:

Why should we have a Fraud and Abuse Compliance Plan?

First, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services has clearly stated that, consistent with the Affordable Care Act (ACA) as described below, all providers are now expected to have current Compliance Plans that are fully implemented.

As a practical matter, when providers establish and maintain Compliance Plans, it clearly discourages regulators from pursuing allegations of fraud and abuse violations.

Technically speaking, the Federal Sentencing Guidelines make it clear that establishment and implementation of Compliance Plans is considered to be a mitigating factor. That is, if accusations of criminal conduct are made, the consequences may be substantially less severe because of a properly implemented Compliance Plan.

In addition, providers with Compliance Plans are more likely to avoid fraud and abuse. This is because Plans routinely establish an obligation on the part of every employee to report possible instances of fraud and abuse, and Plans include training for all employees.

Compliance Plans may help to prevent qui tam or so-called “whistleblower” lawsuits by private individuals, rather than by government enforcers, who believe that they have identified instances of fraud and abuse. There are significant incentives to bring these legal actions since whistleblowers receive a share of monies recovered because of their efforts. Some whistleblowers have received millions of dollars. Compliance Plans make it clear that employees have an obligation to bring any potential fraud and abuse issues to the attention of their employers first. Compliance Plans provide a clear path to resolve fraud and abuse issues internally.

In addition, the federal Affordable Care Act (ACA) requires providers to have Compliance Plans. In short, it’s the law!

Finally, the Deficit Reduction Act (DRA) requires providers who receive more than $5 million in monies from state Medicaid Programs per year to implement policies and procedures, provide education to employees, and put information in their employee handbooks about fraud and abuse compliance.  These requirements can be met through implementation of Fraud and Abuse Compliance Plans.

We don’t receive reimbursement from the Medicare or Medicaid Programs. Do we still need a Compliance Plan?

Statutes and regulations governing fraud and abuse also apply to providers who receive payments from any federal and state healthcare programs, including Medicaid, Medicaid waiver and other federal and state health care programs, such as TriCare and the VA. Many private insurers have followed the federal government’s lead in terms of fraud and abuse enforcement. Therefore, providers that don’t receive reimbursement from the Medicare Program must have compliance plans, too.

We hear that the OIG of the U.S. Department for Health and Human Services has provided guidance for various segments of the healthcare industry regarding Compliance Plans.

  • Specifically, the OIG has already published guidance for clinical laboratories, hospitals, home health agencies, hospices, physicians’ practices, third-party billing companies, and home medical equipment companies. Should we just use the model guidance that is applicable to us?

The answer is, “No!” Guidance from the OIG is not a model Compliance Plan.   Guidance from the OIG consists of general guidelines and does not constitute valid Compliance Plans. In addition, the OIG has made it clear that Plans must be customized for each organization.

We have read that, before implementing Compliance Plans, providers must conduct expensive internal audits that can take many months to complete. Is this true?

While beginning the compliance process with an extensive internal audit is certainly one way to proceed, it is not the only viable way to work toward compliance. It is equally valid to begin with Compliance Plans that are customized for the organization and include training for all employees about fraud and abuse, and Compliance Plans. Then all staff members can subsequently participate in internal compliance activities, including audits, with a process in place to handle any issues that arise as a result of the audits.

We have all sorts of policies and procedures in our organization. Why do we need something else called a Compliance Plan?

Compliance Plans are specific types of documents that routinely address fraud and abuse issues that providers do not usually cover in internal policies and procedures. In addition, providers may not gain benefits under the Federal Sentencing Guidelines described in paragraph one (1) above if there is no formal document called a Compliance Plan.

We just spent a lot of money to become accredited or reaccredited. Doesn’t certification mean that we are in compliance?

On the contrary, Compliance Plans appropriately address potential fraud and abuse issues. They also include mechanisms for helping to ensure compliance, such as processes for identification and correction of potential problems that are not addressed during the certification process. In other words, organizations may be accredited, but fail to meet applicable compliance standards for fraud and abuse.

Will the fact that our organization has a Compliance Plan make any difference regarding the outcome of fraud and abuse investigations and the imposition of Corporate Integrity Agreements (CIA’s)?

Yes, it may make a considerable difference, based on statements from the OIG. If providers have Compliance Plans in place during investigations that are current and fully implemented, the OIG may be less aggressive in pursuing potential violations. Enforcers are likely to ask for information about Compliance Plans and related policies and procedures. Enforcers are now also likely to ask providers to show them how much money they have spent on fraud and abuse compliance activities!

When the OIG discovers problems with fraud and abuse in organizations, providers are usually asked to develop and implement a Corporate Integrity Agreement (CIA). The OIG often requires CIA’s to include a process for stringent monitoring by the OIG on a continuous basis. These monitoring activities can be extremely burdensome to providers in terms of both time and money. Providers with valid Compliance Plans may not be asked to develop and implement CIA’s.

Now is the time for all providers to recognize and act upon the need to establish and maintain Compliance Plans. “Working on it” is no longer good enough.

©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.

NAHC Fights for Home Health on Capitol Hill

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by | Jan 31, 2024 | Admin, CMS, Regulatory

By Kristin Rowan, Editor

The National Association for Home Care and Hospice joined other advocacy groups this month on Capitol Hill to fight against the looming pay cuts from CMS. Some members of Congress joined the fight for “common sense policies” to expand access to care in the home for Americans.

Rep. Adrian Smith (R-NE-3), who spoke at the event, decried moves against home health, saying “there are cuts looming that are not based on reality” and “we want to make sure reimbursement policies are reflective of the actual realities.” Smith is also the representative who introduce the “Homecare for Seniors Act,” H.R. 1795, which would allow the use of Health Savings Accounts (HSAs) to be used for home care.

Rep. Terri Sewell (D-AL-7) has a personal connection to home care and spoke about how her mother cared for her father through a series of strokes he suffered. She expressed strong opinions about payment reductions that could see home health lose as much as $20 billion dollars over the next ten years. Sewell called the idea “frightening” and said, “I am a big fan of making sure that my constituents have access to quality, affordable health care.”

The Medicare program has admitted that home health is not just a bringing of great care and not just a more cost effective way to provide care, but is a service that provides dynamic value. Care in the home has decreased overall costs by $3.2 billion dollars just in the small segment of value-based payment model test cases. Patients who receive care in the home are re-admitted to the hospital 37% less frequently than those who do not and are 43% less likely to die than patients who do not receive care at home. Still, CMS is looking at additional pay cuts which bring the total payment reduction down 13.72% since 2019. The costs of everything else have increased in that time. According to the U.S. Bureau of Labor and Statistics, the average cost of living has increased 22% since 2019. NAHC President Bill Dombi said, “Where we’re headed in 2024 is that half of all home health agencies will be operating in the red with the cuts facing them in the Medicare program. It’s not a recipe for continued access to care.”

Dombi, along with many others, is predicting that 50 percent of agencies will be operating in the red after the next round of payment reductions and that without a reversal of these pay cuts we could see the end of care at home altogether with a collapse of the home health payment system.

The advocacy event on Capitol Hill helped raise awareness of the plight of care at home among some policymakers, but more help and advocacy is needed. Please, take a few minutes to click the link below and tell your members of Congress to support the Preserving Access to Home Health Act of 2023.

# # #

Kristin Rowan

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.homecaretechreport.com One copy may be printed for personal use: further reproduction by permission only. editor@homecaretechreport.com

 Please GO HERE to tell your members of Congress to support the Preserving Access to Home Health Act of 2023

Most Americans Cannot Afford Long-Term Care

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by | Jan 17, 2024 | Admin, Clinical

by Kristin Rowan, Editor

with Bob Roth, Managing Partner at Cypress HomeCare Solutions

Saving for Long-term Care Starts in High School

What is the primary focus for an 18-year-old? Graduating high school, getting into the college or career training program of their choice, their first apartment, perhaps their first car, and their first adult job are things that come to mind. As the parent of a 20-year-old and a 16-year-old, I can attest to most of these and have encouraged both my kids to plan for them. Of course, the 18-year-olds might tell you they are focusing on spending time with friends, travelling, having fun, “finding” themselves, discovering their passion, and learning how to adult. These are all important as well. I’m sure there are other items you would add to these lists. But, how many of you would put long-term care on that list? How many of you were planning for private pay personal care services when you were 18? I’d guess not many of you. 

One Expert's Opinion

Bob Roth, Managing Partner at Cypress HomeCare Solutions knows all too well that so many families are ill-prepared for long-term care needs for themselves and their families. In his recent article, “The aging dilemma: Long-term care”, which originally appeared in Jewish News, Roth says we should start planning for long-term care when we graduate high school. Not knowing how to provide and, especially, afford this kind of care is something Bob has seen countless times in his more than 20 years in the industry.

Long-Term Care

Long-term care can be a critical part of the health care spectrum as we age and long-term care insurance alone in the United States is inadequate. According to Roth, this stark reality prompts a crucial conversation on the state of continuing care here and around the globe. The costs of long-term care are up, the need for quality care threatens economic fallout, and the current models are unsustainable.

According to a recent study from the Joint Center for Housing Studies of Harvard University, most older adults are unable to afford in-home or assisted living care. The number of older adults continues to rise, as does the number of cost-burdened older adults. Cost-burdened older adults pay 30 percent or more of their total household income for housing. When you add in the costs for food, transportation, medicine, etc., there is nothing left for in-home care.1

Paying for Long-Term Care

Unanswered Questions

Neither Bob nor I have answers or solutions to this problem. For many years, we’ve talked about the continuity of care across hospitals, doctors, home health, and home care. (Read our article this week on the patient data exchange network.) Perhaps a trusted exchange framework that includes personal care might one day lead to insurance coverage. In the meantime, we are looking for alternative solutions to the widening gap between people who need in-home care and people who can afford it.

# # #

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

Bob Roth is Managing Partner of Cypress HomeCare Solutions. Bob assisted in creating Cypress HomeCare Solutions with his family in 1994. With nearly 36 years of consumer products, health care and technology experience, Bob has successfully brought the depth and breadth of his experience to the home care trade and in doing so, Cypress HomeCare Solutions has been honored to receive a number of awards over the years.

He is a well-respected and knowledgeable member of our community.

Bob Roth Paying for Long Term Care
Bob Roth Paying for Long Term Care

1. Harvard (2023) Housing America’s Older Adults Key Facts chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.jchs.harvard.edu/sites/default/files/interactive-item/files/Harvard_JCHS_Housing_Americas_Older_Adults_2023_Key_Facts.pdf

What Home Health Agencies and Home Care Leaders Can Learn About Brands and Branding From the ‘Mayo Magic’

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by | Dec 6, 2023 | Admin, Marketing

By Mary E. Maloney

What can you learn about brands and branding from an iconic company like the Mayo Clinic?

We daresay a lot

In this blog, we are going to first explore the “Mayo magic”—some key ideas about why Mayo Clinic has been named, again in 2023 as it has been so many times before, “among the best of the best” hospitals by U.S. News and World Report and listed as one of the “most trusted healthcare brands” by Beckers Hospital Review.

Then we will discuss the benefits of having a solid corporate brand like Mayo’s.

Finally, we will relate the branding principles established by this iconic corporate brand to why it is worthwhile to have a solid personal brand.

Successful Brands Are Built on Trust

Perhaps the most important lesson to take away from Mayo Clinic is that the best brands are built on trust.

A February 2023 Business Insider article titled, Mayo Clinic CEO: Here’s Why We’ve Been The Leading Brand in Medicine for 100 Years, asks Mayo CEO Dr. John Noseworthy how the clinic built its reputation and manages to stay at the top.’

“I think it all comes down to our core value, which is that the needs of the patient come first,”; Noseworthy says in the piece, “I know that might sound kind of trite in today’s world, but our staff is extraordinarily committed. If you spent a day here, and you grab(bed) anybody at the Mayo Clinic and ask(ed) them, ‘what’s the purpose of your work?’; they would say, ‘to meet the needs of our patients.'”

In other words, patients come to Mayo because they can—and do—trust their needs will be served.

The Best Brands Are Consistent

Based on the Mayo example, the best brands are consistent. In the Business Insider article, Noseworthy explains how the Mayo brand is expressed the same way across the organization.

“In my role, what I hear every day from patients and family members is that the minute they step onto a Mayo campus, whether it’s in Rochester, Minnesota; Scottsdale, Arizona; Florida; or in our large integrated health system, they immediately sense that there’s something different,” he says. “They feel it right from the first person they speak with, and it’s the physicians, it’s the science, it’s the engineers and technologists. It’s that patient focus and a relentless focus on quality. This goes all the way from the heart surgeons down to the cleaning staff.

Iconic Brands Stand for Something Significant

A few years back, a woman I know took her young daughter to Mayo Clinic’s Rochester, Minnesota, location for treatment for epilepsy. Ask her what words came to mind when she thinks about Mayo today, and she’ll say: “research, specialists, world-renowned.”

Top brands know what they stand for—and then they deliver on it. For Mayo, this is serving people first, and especially people experiencing special health concerns.

“Founded more than a century ago by two brothers in the rural Midwest, the Mayo Clinic has built a world-renowned reputation as an exemplary network of clinics and hospitals that has become the preferred destination of patients with difficult-to-treat conditions,” reads the intro to a 2018 Q&A article published in Knowledge at Wharton, a business journal from the Wharton School of the University of Pennsylvania.

“As people live longer and have multiple different chronic diseases, the need for … advanced services will be ever greater,” says Larry Jameson, EVP of the University of Pennsylvania Health System, in the article.

The Benefits of a Strong Niche Brand

Being as famous and respected as Mayo would certainly be nice for any brand. But what are the deeper business benefits of having a strong brand in the home health/home care industry?

Qualtrics suggests that strong brands can capture greater market share, accelerate new patient acquisition through online rates and word-of-mouth marketing, and increase loyalty amongst a highly competitive set.

Here are some specific examples:

  • Having a strong brand can help an organization appeal to underserved or growing segments.
  • Having a strong brand that truly resonates with consumers can translate to patients promoting your organization through online reviews and social media mentions.
  • Having a strong brand can boost communication and help to create moments that matter with those the organization serves.
  • Having a strong brand creates “stickiness” and can mitigate employee turnover and improve retention rates. When employees feel like they are connected to an organization that is on-purpose, they are more likely to stay and to influence a healthy work culture.

Applying the Key Principles of Iconic Brands to Personal Branding

So how do these ideas we’ve garnered from an iconic brand translate into your personal brand?

As we have seen, consistently delivering on a brand promise helps people decide to do business with a brand. They trust that brand to deliver for them. At the end of the day, people do business with people if they have a choice.

Personal branding can help you excavate your very own brand manifesto and develop ways to tell others about it consistently and authentically. Being mindful of personal branding will help you answer mission-critical questions as: “What is my brand promise?” and “How consistently am I delivering on it?”‘

Personal branding can not only help you as a leader clarify what you stand for but also affirm it until you feel it with conviction. And it can help you to effectively deliver the same message about it in any situation—whether that’s the proverbial elevator, in an all-staff meeting, or in the field.

Imagine what your business would be like when everyone, whether it’s in the first 90 days or tenured staff, “owns” what they stand for and it aligns fully with your company core values.

You as a leader can

Knowing your “why” will also give you peace of mind to pursue your next act if you are in transition (on deck). Having a brand manifesto as your true north guide will enable you to more rapidly achieve your next career milestone and build your best exit strategy.

Once you get clarity, conviction and the ability to talk about your personal brand, maybe you’ll find yourself ranking on the Home Care Pulse 2023 Best of Home Care Awards or as part of the Modern Healthcare Hall of Fame.

Finally, a heartfelt thanks to all the healthcare leaders out there who are leading with purpose, no matter how tough it gets. It speaks volumes about your personal brand. You inspire us.

# # #

Brands and Branding Mary E MaloneyAn executive advisor, educator, speaker and author, Mary E. Maloney is the founder of Revealing Genius and the expert that accomplished leaders trust for positioning, messaging and brand strategy. A former CEO and CMO, Maloney guides healthcare C-suite leaders, founders and physicians to powerfully and strategically message their expertise and “why” so they lead with conviction and achieve their most coveted career goals. 

©2023 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@homecaretechreport.com

 

 

Big Win for Advocacy in Home Care

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by | Oct 25, 2023 | Admin, Regulatory

by Kristin Rowan, Editor

Marking a significant victory for the HCAOA Connecticut Chapter and the home care industry, in the legislative session that ended last week, lawmakers unanimously passed a bill to reverse the policy guidance issued by the Department of Consumer Protection in January that banned use of the word “care” by home care agencies. In response to the guidance that directly harmed the industry, the Chapter and its members engaged in a strong lobbying effort to reverse it.
The guidance had caused significant concern and confusion for agencies, caregivers, consumers and lawmakers. Indeed, the Department had recently begun enforcing the ban against HCAs, requiring them to remove the word “care” from websites and other advertising.

On June 2, the state Senate gave final legislative approval to House Bill 5781, which allows HCAs to use the word “care” in their business names and advertising and advertise having employees trained to provide services to individuals experiencing memory difficulties as long as the agency prominently advertises that it solely provides nonmedical care, and doesn’t use any words, such as those related to medical or health care licensure or services, to describe services beyond the scope of those a HCA is authorized to provide. Also, HCAs must give consumers written notice that the agency provides nonmedical care and obtain the consumer’s signature on the notice before providing services. The Governor is expected to sign Public Act 23-48 shortly.

Chapter leaders and many members testified in support of the legislation, contacted the Governor and met with lawmakers and other officials, engaged in grass roots support, and advocated for the change. “It was a significant effort by the Chapter but our strategy and the work of members paid off,” said Marlene Chickerella, Chapter Chair and owner of B&M Homemaking Services in West Haven. “We are very grateful to lawmakers for changing the policy and appreciate all the support and assistance of our member-home care agency owners. They stepped up and clearly made a difference.”

Additionally, House Bill 5781, which originally arose out of the Homemaker-Companion Task Force recommendations:
• Requires the Office of Policy and Management to develop a plan and proposed timeline to transfer oversight of HCAs from Consumer Protection to the Department of Public Health; the plan will include recommendations on training standards and appropriate use of the term “care” to describe home care services.
• Adds failure to give a consumer written notice that the agency provides nonmedical care to a list of violations for which DCP may revoke, suspend, or refuse to issue or renew a HCA’s registration; requires DCP to revoke a HCA’s registration if the agency is found to have violated any revokable provisions three times in a calendar year.
• Requires HCAs to develop in consultation with the consumer a service plan or contract that includes (1) a person-centered plan of care, (2) anticipated oversight by the agency of the caregiver assigned to the consumer, and (3) how often the person who oversees the agency’s caregiver and consumer will meet.
• Requires DCP to post on its website a guide detailing the process for consumers to file complaints against a HCA; and requires agencies to give consumers a printed copy of this guide with their contract or service plan.
• Requires HCAs to create a brochure and maintain a website detailing the services it provides.

###

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 at kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

Transformative Trends in Home Care: Strategies for Successful Business Sale

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by | Oct 4, 2023 | Admin, M&A

by Greg Schriber

In the dynamic landscapes of home health, home care, and hospice services, these industries are experiencing transformative trends, marked by evolving market changes and a surge in demand. Understanding these trends and strategically positioning one’s business for a lucrative sale is paramount. This article provides a detailed guide on understanding the current market landscape and optimizing business value for a successful sale.

Transformative Trends

The industry is witnessing a substantial increase in demand for home-based care services, primarily driven by an aging population and a growing preference for aging in place. This trend has been further propelled by the COVID-19 pandemic, as more families are opting for home care to mitigate the exposure risks associated with institutional settings. Additionally, the advent of technological advancements such as telehealth and health informatics is revolutionizing the way services are delivered, enhancing patient outcomes and operational efficiency. Embracing these innovative solutions is imperative to maintain competitiveness and address the changing needs of clients. The industry is also navigating through shifts in regulatory frameworks, emphasizing quality of care through value-based care models and patient satisfaction. Adherence to new regulations and standards is crucial to sustain the business and avoid penalties. Furthermore, the market is undergoing consolidation, with larger entities acquiring smaller providers to diversify their service offerings and extend their geographic reach. This trend poses both challenges and opportunities for business owners contemplating a sale.

Strategic Positioning for SaleTransformative Trends For Sale

To position a business attractively for sale, optimizing operational efficiency is crucial. Streamlining operations and minimizing overhead costs not only enhance profitability but also make the  business more appealing to potential buyers. Implementing industry best practices and leveraging technology can significantly elevate operational efficiency and service quality. Diversifying service offerings is another strategic move, as it can expand the customer base and open up new revenue streams. Providing a range of specialized and complementary services positions the business as a comprehensive solution, attracting acquirers. Building and maintaining a strong brand reputation through exemplary services, customer satisfaction, and community engagement is also vital. A reputable brand can draw in strategic buyers seeking market leadership. Investing in workforce development is equally important, as a skilled and stable workforce is a valuable asset that can influence business valuation positively. Maintaining financial health and accurate financial records is critical, as it demonstrates the business’s viability and can facilitate the due diligence process during the sale.

Managing the Sale Process

Seeking professional advice from industry experts, financial advisors, and legal counsel can offer invaluable insights and guidance throughout the sale process, aiding in accurate business valuation, negotiation of favorable terms, and navigation of legal intricacies. Negotiations require a strategic approach – understanding the buyer’s motivations, being transparent about expectations, and being willing to compromise can lead to a mutually beneficial agreement. Identifying a buyer whose vision aligns with that of the seller is essential to ensuring the continuity and growth of the business post-sale. Whether the buyer is a strategic entity looking to expand or a financial entity seeking investment opportunities, finding the right fit is crucial. Additionally, being well-prepared for the due diligence process can expedite the sale and reduce the risk of deal fallout. This includes organizing all necessary documents and addressing any potential issues beforehand. Developing a clear transition plan that involves open communication and support is essential to ensuring a successful handover and employee retention post-sale.

Positioning a healthcare business for sale is a multifaceted endeavor, involving operational optimization, brand enhancement, and meticulous strategic planning. By staying abreast of market trends, adopting best practices, and effectively navigating the sale process, business owners can maximize their business value and achieve a successful exit in this rapidly evolving industry. The journey extends beyond the sale; it’s about creating a legacy and ensuring the continued growth and service to the community under new ownership. By being proactive, strategic, and thoughtful, business owners can significantly impact the future of home-based care and improve countless lives.

Greg Schriber is the M&A Senior Advisor for American Healthcare Capital. To learn more about Transformative Trends, Greg can be reached at greg@ahcteam.com

©2023 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Home Care Technology: The Rowan Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com

No Nurse Shortage Here

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by | Aug 16, 2023 | Admin, Caring for the Caregiver, Clinical, Marketing, Recruitment & Retention

by Tim Rowan, Editor

When Joseph Furtado, RN, COS-C, moved from one Phoenix-area Home Health agency to another earlier this year, he faced a seemingly insurmountable problem. The new place had dropped to a 600 census during the pandemic and got stuck there. Marketers had nurtured strong relationships with referring physicians, but the agency was turning away most of them for lack of nursing staff.

Over a span of 70 days, Furtado hired 60 nurses. As of our conversation this week, none of them have left.

Furtado, the Administrator at MD Home Health told us about his hiring philosophy that helped grow the company’s census to 1,000 and boost it to second largest in the area. “People want to work here because of the way we treat them,” he said. His plan includes several strategies:

  1. Pay clinicians what they are worth:
    • Free up funds for salaries by eliminating marketing positions
    • Free up funds for salaries by reducing most training costs
    • Reduce training costs by hiring only experienced nurses from other agencies who need little or no training
  2. Treat clinicians like professionals:
    • Center orientation days around presentations about company culture, not nuts and bolts of the job
    • Include presentations by top employees
    • Include presentations by actual patients, who talk about what the company has done for them
    • Eliminate obligatory mass training sessions. Replace them with as-needed meetings with nurse supervisors, sometimes in a patient home, sometimes in a nearby coffee shop.
    • The invitation is never “you need to stop doing this wrong” but “may I take you to lunch?”
    • Adapt schedule and pay policy to accommodate the needs of the professional
    • Replace minimum productivity requirement with mission-driven expectation and rewards
  3. Replace marketers with a single visit from the administrator:
    • We are the best, we will keep your patients out of the hospital, we will not turn away your referral
  4. Constantly monitor Indeed and other online job sites:
    • respond to new job seekers within seconds
    • schedule same-day interviews when possible

Favorite Hiring Story

Furtado enjoys telling the story of his favorite hiring win. “I was a few minutes late to call a top-notch, experienced Home Health nurse who showed up on Indeed,” he began. “When I called her, she had just parked her car and was on her way into an interview appointment with another agency. Thinking fast, I said, ‘What do I have to say to stop you from walking in that door?’ She couldn’t believe I was asking her to do that; actually, I couldn’t believe I had said it either. I told her our agency was the best place to work in Arizona and she should get back in her car. I kept her on the phone and said, ‘Let me hear you start your car.’ Then ‘Let me hear you drive away.’ She drove straight to my office and I hired her.

Today, she is our Director of Nursing.

Productivity Without Mandate

He told us that he has heard criticism from peers at various conferences and other meetings for his lack of a visit-per-week requirement. “I use a point system,” he explained to us. “A one-hour visit is one point, an OASIS visit is two, and there are other points for driving distance and other factors. We ask for an average of five points per day, and we pay bonuses when they exceed that. We tell clinicians during an interview that we offer a generous base salary, but that he or she can earn 20 or 30 thousand more than that. By doing that, we achieve two things. We hire an enthusiastic clinician, and we have the luxury of not having to hang onto underperforming nurses out of desperation.

Next Up

Now that MD Home Health has a full clinical staff, Furtado plans to implement a medical scribe system, based on the concept taught to him by his Medicare reimbursement consultant, Michael McGowan, a former CMS OASIS instructor and founding owner of OperaCare. During an OASIS visit, the field nurse consults live on a speaker phone with a QA nurse in the office. There is no computer between the nurse and the patient, and the OASIS is complete, quality checked, and ready to be submitted that day.

“We will make it optional,” Furtado said. “If it works as well as it has for Michael’s other clients, our hope is that more and more OASIS nurses will opt in once they see their co-workers going home at the end of the day with all their documentation already complete.”

©2023 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Home Care Technology: The Rowan Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com

Crackdown is Coming: Are You Paying Overtime?

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by | May 17, 2023 | Admin, Regulatory

by Tim Rowan, Editor

T

he Department of Labor, Wage and Hour Division, has selected several southeastern states as targets for its investigation into a practice that appears to be quite common, underpaying in-home caregivers. It appears, based on early DoL reports, that some Home Care agency owners in Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina and Tennessee either do not understand the law, or simply try to get away with it.

According to a mid-February, 2023 report:

“From 2020 to 2022, Wage and Hour Division investigators identified violations in nearly 89 percent of more than 1,200 home care and nursing care investigations. These reviews led the agency to recover more than $16.2 million in back wages and liquidated damages for more than 13,000 workers.

The department produced an instructional webinar on federal wage and hour regulations for home care, residential care and nursing care industry employers, workers and other stakeholders in the Southeast. “Caring For Those Who Care: Fair Labor Standards Act Requirements in the Care Industry,” is part of the DoL’s ongoing education and enforcement initiative to improve compliance in those states.

Home Health & Hospice

On October 13, 2022, the DoL published a Notice of Proposed Rulemaking to revise the Department’s guidance on how to determine who is an employee or independent contractor under the Fair Labor Standards Act. The NPRM proposes to rescind the rule, Independent Contractor Status Under the Fair Labor Standards Act (2021 IC Rule), that was published in the closing days of the previous administration, January 7, 2021, and replace it with an analysis for determining employee or independent contractor status that is more consistent with the FLSA as interpreted by longstanding judicial precedent. The Department believes that its proposed rule would reduce the risk that employees are misclassified as independent contractors, while providing added certainty for businesses that engage (or wish to engage) with individuals who are in business for themselves.

A DoL publication explained this targeted effort aligns with the agency’s initiative to protect essential workers in the Southeast. See an April 28 update on progress of the proposed rule here.

Writing for a Polsinelli Law firm bulletin, home care attorney Angelo Spinola stated, along with the caveat that this is not to be construed as legal advice, “The DOL is not required to give employers prior notice of an audit. In fact, WHD investigators often initiate unannounced investigations to observe normal business operations. As such, the best way to prepare for a DOL audit is to conduct regular and periodic internal audits of employment records and policies to ensure compliance with the FLSA. Internal audits typically include a review of exempt employee classifications, independent contractor classifications, payroll and time records, and FMLA and other leave law compliance. It is advisable to work with knowledgeable employment attorneys who can counsel employers on current wage and hour laws and best practices.”

Abuse Found to be Widespread

From 2020 to 2022, Wage and Hour Division investigators identified violations in nearly 89 percent of more than 1,200 home care and nursing care investigations. These reviews led the agency to recover more than $16.2 million in back wages and liquidated damages for more than 13,000 workers. In addition, the division assessed employers a total of $156,404 in civil money penalties. The February DoL report cited two recent North Carolina cases as examples of the practices it uncovered throughout the South:

Gentle Shepherd Care – which provides home healthcare services in the Charlotte area – failed to combine hours when employees worked at more than one of its locations during the same workweek. By doing so, the employer did not pay the affected workers their additional half-time premium rate for overtime for hours over 40 in a workweek. The Fair Labor Standards Act requires all hours worked in a workweek be combined when calculating wages, regardless of where employees performed the work. Back wages and liquidated damages recovered: $193,768 for 98 workers.

A separate investigation found Greenville”s At Home Personal Care paid employees straight-time rates for all hours worked, including hours over 40 in a workweek. By doing so, the employer did not pay the additional half-time premium rate for overtime as the FLSA requires. In addition, the employer failed to pay for travel time between the clients’ homes when the employees visited multiple clients during the same day. The agency also did not keep accurate records as required. Back wages and liquidated damages recovered: $187,148 for 28 workers.

North Carolina Wage and Hour Division District Director Richard Blaylock stated, “Workers who provide home healthcare services deserve to be paid every penny of their hard-earned wages as they care for our loved ones. When employers choose to ignore the law, they deny workers the wages they earned and need to support their families. Employers must use this investigation’s outcome as a reminder to review their pay practices to ensure they comply with the law.”

Employers can contact the Wage and Hour Division at its toll-free number, 1-866-4-US-WAGE. The division also offers online resources for employers, such as a fact sheet on Fair Labor Standards Act wage laws overtime requirements. Workers who feel they may not be getting the wages they earned may contact a Wage and Hour Division representative in their state through a list and interactive online map on the agency’s website. Workers and employers alike can help ensure hours worked and pay are accurate by downloading the department’s Android Timesheet App for free. Learn more about Wage and Hour Division.

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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

Medicare Advantage Is Neither Medicare Nor an Advantage

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by | Feb 1, 2023 | Admin

by Wendell Potter

Medicare Advantage is a money-making scam. I should know. I helped to sell it.

Right now, well-funded lobbyists from big health insurance companies are leading a campaign on Capitol Hill to get Members of Congress and Senators of both parties to sign on to a letter designed to put them on the record “expressing strong support” for the scam that is Medicare Advantage.

But here is the truth: Medicare Advantage is neither Medicare nor an advantage.

And I should know. I am a former health-care executive who helped develop PR and marketing schemes to sell these private insurance plans.

During my two decades in the industry, I was part of an annual collaborative effort to persuade lawmakers that Medicare Advantage was far superior to traditional Medicare — real Medicare. We knew that having Congressional support for Medicare Advantage was essential to ensuring ever-growing profits — at the expense of seniors and taxpayers. We even organized what we insiders derisively called “granny fly-ins.” We brought seniors enrolled in our Medicare replacement plans to Washington, equipped them with talking points, and had them fan out across Capitol Hill.

Instead of joining with the corporate lobbyists in extolling the benefits of Medicare Advantage while obscuring the program’s numerous problems… Congress should work to lower the cost of health care.

 

Apology and Accusation

I regret my participation in those efforts. Over the 20 years since Congress passed the Medicare Modernization Act, the Medicare Advantage program has become an enormous cash cow for insurers, in large part because of the way they have rigged the risk-scoring system to maximize profits. As Kaiser Health News reported last month, the Center for Medicare and Medicaid Services estimated “net overpayments to Medicare Advantage plans by unconfirmed medical diagnoses at $11.4 billion for 2022.” That was for just one year. Imagine what the cumulative historical total would be.

The Medicare and Medicaid programs have become so lucrative and profitable for insurers that UnitedHealth Group, the nation’s largest health insurer and the biggest in terms of Medicare Advantage enrollment, got 72 percent of its health plan revenues in 2021 from taxpayers and seniors. In fact, all of UnitedHealth’s enrollment growth since 2012 has been in government programs. Enrollment in the company’s employer and individual health plans shrank by 370,000 between September 30, 2012, and September 30, 2022. Much of the $81 billion UnitedHealth collected in revenues in the third quarter of last year was subsidized by American tax dollars.

Members of Congress on both sides of the political aisle – and both sides of the Capitol – are at long last calling for more scrutiny of the Medicare Advantage program. Sen. Chuck Grassley has called for aggressive oversight of Medicare Advantage plans to recoup overcharges and was quoted in the Kaiser Health News story. As was Sen. Sherrod Brown, who said that fixing Medicare Advantage is not a partisan issue. As Rep. Katie Porter commented, “When big insurance bills taxpayers for care it never intends to deliver, it is stealing our tax dollars.”

I know that Democrats and Republicans alike care about the financial stability of the Medicare program. Instead of joining with the corporate lobbyists in extolling the benefits of Medicare Advantage while obscuring the program’s numerous problems, and in the process helping Big Insurance make massive profits, Congress should work to lower the cost of health care.

Medicare Advantage is a money-making scam. I should know. I helped to sell it. And I am going to continue working alongside patients, caregivers, and elected officials to address the problems.

 

Wendell Potter is the former vice president for corporate communications at Cigna. He is now president of “Business for Medicare for All” and author of bestselling books Deadly Spin and Nation on the Take.

commondreams.org/author/wendell-potter

 

©2023 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Common Dreams.org. Reprinted by permission in Home Care Technology: The Rowan Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com