2025 Caregiver Survey: An Interview with Stephen Vaccaro

by Kristin Rowan | Dec 18, 2025 | Caring for the Caregiver, Clinical, Vendor Watch

by Kristin Rowan, Editor

2025 Caregiver Survey

An Interview with Stephen Vaccaro

The end of the year seems like a good time to see where caregivers fall on questions about technology, training, management support, career motivations, and other relevant and pressing topics. Some of the results of the HHAeXchange caregiver survey are not surprising. Others, you may not expect.

The Rowan Report spoke with HHAeXchange President Stephen Vaccaro this week to discuss the survey.

Key Takeaways

Here are a few of the key takeaways from the 2025 Caregiver Survey:

Just over 65% of respondents said they are comfortable with technology, up from 55.65% just two years ago
Caregivers find technology supports them most with managing shifts and schedules
70% said they would spend an extra 3-5 minutes documenting client observations if it improves care
Higher pay is still the #1 complaint of caregivers
A desire for additional training and flexibility increased to 21.7% and 28.2%, respectively

Read theHHAeXchange survey press release.

In His Own Words

The Rowan Report:

Stephen, thank you for talking with me today. It’s good to see you again. It’s been quite a year or so of changes for HHAeXchange.

Stephen Vaccaro:

Thanks, Kristin. 2025 has been truly transformational for HHAeXchange. State Medicaid and Medicaid managed care plans have been very positive with the change. We’re now in a position to invest at scale.

RR:

It’s been fascinating watching. I can’t wait for what’s next. The answers you received in the 2025 Caregiver Survey had some significant changes to the answers this year. What can you tell me about this year’s survey?

HHAeXchange 2025 Caregiver Survey Vaccaro

Stephen:

We are connected to close to 3 million caregivers on the personal side. The past couple of years, we’ve done the caregiver survey. 2025 is the third year. It’s interesting to see the evolution of it. In the beginning there was a lot of fear around EVV technology. Now, the level of adoption is increasing and they’re starting to see that it’s a value add to their job. This year, 65% had positive feedback on technology in the home.

RR:

To what do you attribute this change in response?

Stephen:

It’s a very meaningful change. The first round of technology was different. There were promises, delays, and a lot of pepople who didn’t think it would ever happen. It has gone from “We’d like to see you use it” to “you have to use it.” There’s a certain level of expectation. And now, it’s pushing down to managed care plans. Providers are cooperating now because it’s not okay not to. Sometimes it’s the consumers that are convincing the caregiver to use the technology.

RR:

Do you think there’s any tie in to the average age of the caregiver?

Stephen:

I think that helps, certainly. I think when new caregivers come in, they are starting mobile first. It’s part of the orientation. It’s how the job is done. But it’s also the impact the technology makes.

More than 61% ranked the positive impact on the client as the most important thing that they do. Having the app is bringing them in to the care team. Nurses and NPs are collaborating with caregivers and seeing that the observations of the caregiver are important, even when they seem small.

So, as we start to look at different care needs, we have to design programs accordingly, and that also has impacted the the change. Caregivers want support to get the training they need to do their job the best they can. They want resources, tools, and information. Advanced training is important, but the technology to be able to see the patient records, notes, and observations is key and that necessitates the technology.

RR:

What are the top reasons a caregiver leaves an agency?

Stephen:

Well, salary of course is the number one challenge. But more training and more flexibility rank pretty high on the list.

2025 Caregiver Survey Vaccaro HHAexchange

RR:

What do you see coming in 2026 and beyond?

Stephen:

I think there will be a big focus on technology. It will be the year we truly step into mobile first as a standard.

I also think we will continue to see the evolution of the caregiver as part of the care team. We will start leveraging the caregiver as the untapped asset that they are. We will see increased continuity of care, especially for integrated dual eligible patients.

RR:

And, what’s next for HHAeXchange?

Stephen:

We will continue looking for ways to innovate and bring value to the industry and the ecosystem. In the home care economy, all the players are involved. The patient, the caregiver, the doctor, and the payor. But, also the training vendors, food suppliers, transportation providers, and so many more. We will be looking at ways to involve all of the players from a patient’s home ecosystem into the care plan.

RR:

Stephen, it’s always a pleasure talking with you. Thank you, again for sharing your 2025 Caregiver Survey with us and for your always valuable insights. Happy Holidays.

Stephen:

Thank you for having me. Happy Holidays

Final Thoughts

Caregivers are embracing technology not for themselves, but for their clients. The desire to help and make a positive impact on their clients’ health and well-being is the core drive for caregivers, so it’s not surprise that they want better access to information and training. Non-medical supportive care at home has more contact hours and indiidual time with clients and are an invaluable untapped resource for home health and hospice. With the technology finally catching up to the motivation, we can tune in to that resource and provide better care across the board.

# # #

Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news, and speaker on Artificial Intelligence and Lone Worker Safety and state and national conferences.

She also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

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

What can Providers Give to Patients, Part 7

Admin

by Elizabeth E. Hogue, Esq. | Dec 12, 2025 | Admin, Clinical, Legal

by Elizabeth E. Hogue, Esq.

What Providers can Give to Patients

Providers, including marketers, are tempted to give patients and potential patients free items and services. While providers usually have good intentions, they must comply with applicable requirements.

Read Parts 1-6

OIG Advisory Opinion

This article provides an example from OIG Advisory Opinion No. 09-11 that shows how the OIG applies exceptions described in this series of articles.

A Case Example

The request for this Advisory Opinion was submitted by a hospital that provides free blood pressure checks to anyone who requests the service during certain hours. The hospital said that it does not advertise free blood pressure checks, which are provided by a member of the nursing staff who follows specific guidelines and procedural checklists.

The hospital also said that free blood pressure checks are not conditioned on use of any other goods or services from the hospital or any other particular provider. No discounts are offered for follow-up services. Recipients of blood pressure checks are advised to see their own practitioners when results are abnormal. The hospital does not bill any payor, including the Medicare and Medicaid Programs, for this service.

OIG Analysis

In its analysis, the OIG first referenced the exception for preventive services described in Part 5 of this series.

The OIG then pointed out that the fair market value of this service, especially if recipients use the service more than once, may exceed the limits of $15 per service or $75 per year described in Part 2 of this series. Therefore, said the OIG, the services may constitute a kickback.

According to the OIG, blood pressure checks are preventive services. The key question, however, is whether the free care promotes the provision of other, non-preventive care reimbursed by the Medicare and/or Medicaid Programs.

Is It Promotional?

In this case, the OIG said that it is unlikely that free blood pressure checks will result in the provision of other services. The factual basis for this conclusion in the Advisory Opinion was that the hospital did not:

Make appointments with its practitioners for individuals with abnormal results
Offer individuals discounts for additional covered services
Otherwise promote its particular programs

Crafted with Care

“In sum,” said the OIG, “the Arrangement is appropriately crafted so as to avoid improper ties to the provision of other services…For these same reasons, we conclude that we would not impose administrative sanctions arising in connection with either the anti-kickback statute or the CMP on the Hospital in connection with the Arrangement.”

Final Thoughts

The 7 parts of this series describe and summarize the laws and exceptions to providing incentives, gifts, and help to patients in accordance with the Anti-Kickback Statute and the Civil Monetary Penalties Law. As long as you are following these regulations, providers should certainly use all of the exceptions available to them to provide better quality of care for patients.

# # #

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.

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

MedPAC Proposes Drastic Cut

Clinical

by Kristin Rowan | Dec 12, 2025 | Clinical

by Kristin Rowan, Editor

MedPAC Proposes Drastic Cuts

Five Year Decrease Not Enough

The onset of PDGM and the recalculations of payments in 2020 have led to an overall decrease in Medicare reimbursement rates for home health by approximately 12%. CMS continues to calculate budget neutrality with flawed formulas. The Alliance, along with several other advocacy groups as well as agencies and individuals, continues to fight against the formula and the pay cuts, estimating that nearly half of all home health agencies will be losing money in order to stay open.

Industry Report

Despite the continual decrease in payment rates, MedPAC recommends additional steep cuts. Highlights from the MedPAC report include:

97% of beneficiaries have access to 2 or more HHAs
The total number of HHAs declined 1% in 2024 (excluding CA)
Only 7.9% of beneficiaries used HH in 2024
Number of 30-day periods per beneficiary increased 2.6%
The overall profit margin for Traditional Medicare is 21.2%
The overall profit margin for all payers is 5%
Anticipated profit margin for 2026 is 19% for Traditional Medicare (3% overall)

Less than 0

The Traditional Medicare profit margin in 2026 is projected at 19%. This is offset by the negative profit margin from Medicare Advantage and private insurance plans. It may not be realistic or fair for the taxpayer to offset poor policies in Medicare Advantage and private insurance plans, but that has been the reality for years. Medicare Advantage plans yield high profits for insurance payors, and negative margins for HHAs. With an overall profit margin of 3%, lowering the Medicare reimbursement rate by more than 3% will put all HHAs in the red.

The Math Isn't Mathing

The numbers are there. HHAs earn 5% now, 3% next year. MedPAC recommends that CMS reduce the 2026 rate by an additional 7%.

NET PROFIT MARGIN -4%

Conclusion from MedPAC: This will not impact care; providers will still be willing to treat Traditional Medicare beneficiaries.

That statement may be true. However, in order for HHAs to survive, they will have to drop all MA plans. More than 50% of Medicare beneficiaries are on MA plans. 40% of MA patients use HH care after hospitalization. Medicare Advantage will survive through hospitals and physicians, but the Home Health benefit won’t have any providers.

Hospice Tie-In

CMS is currently weighing the option of the hospice carve-in to Medicare Advantage plans. The pilot plan failed miserably and yet rolling this out across all plans is an option, somehow. CMS and MedPAC must not be able to see what has happened to Home Health under MA plans. Hospice will suffer the same fate through the carve-in. It is irresponsible and destructive to add Hospice to MA. For that matter, it is irresponsible and destructive NOT to remove Home Health from MA. Move it all back to Traditional Medicare where at least the profit margin is above 0.

May Cooler Heads Prevail

From the proposed rule in July to the final rule in November, CMS lessened the permanent rate cut by about 5%, finally hearing the concerns of advocates who told them HHAs would go out of business. We certainly hope CMS will keep that in mind when considering the MedPAC recommendation.

# # #

Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news, and speaker on Artificial Intelligence and Lone Worker Safety and state and national conferences.

She also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

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

Appeals Court Filing

Advocacy

by Kristin Rowan | Dec 4, 2025 | Advocacy, Clinical, CMS, Hospice, Legal

by Kristin Rowan, Editor

Appeals Court Filing

Hospice ALJ

A hospice claim may fall under review either before or after the claim has been paid. A hospice agency with a denied claim must file appeals until the claim is approved or the appeals are exhausted. First, they file a written request to reconsider. Then, they file an appeal to a Qualified Independent Contractor (QIC) who employs medical professionals to assess the case. Next, they file an appeal to an Administrative Law Judge (ALJ).

The ALJ is meant to review the documentation to determine whether it satisfies Medicare requirements. That’s all. There are two sets of criteria: the Medicare requirements and the patient record. If they match, the claim is paid. However, a recent ALJ decision and subsequent challenge suggests that the ALJ ignored expert testimony and decided independently that the patient did not qualify for hospice care.

Request to File

The hospice agency in this case filed suit against the ALJ, arguing that physician expertise should be shown deference in these cases. The National Alliance for Care at Home (the Alliance), joined by the American Academy of Hospice and Palliative Medicine (AAHPM), represented by William A. Dombi of Arnall Golden Gregory (AGG), has requested the right to file an amicus brief. An amicus brief provides extra information in a court case from an individual or group that is not part of the lawsuit, but has a vested interest in the outcome.

The Dispute

The Alliance puts at the heart of the case several issues, including:

Predicting death is inherently difficult
Physicians are the experts and their opinion should carry more weight
Oversight from non-qualified third parties add confusion, increase costs, and limit care

The Argument

The wording in multiple parts of the hospice benefit recognizes the expertise and importance of the physician. It is the physician who determines terminal illness. Physicians must have a face-to-face for continued eligibility. And it is the physician’s clinical judgment makes these determinations based on a patient’s individual circumstances, not an arbitrary set of standards.

If an ALJ, or any non-medical person, can overrule the treating physician’s assessment of a patient, they are effectively usurping the role of the doctor in providing a treatment plan. Medical care is subjective, which is why CMS has repeatedly considered and rejected defined criteria that would overrule a physician.

Broader Implications

The brief argues that medical professionals are better able to make care determinations. Further, the brief includes the complexity of health care prognosis, particularly in terminal illnesses. Previous court decisions have noted that “clinical judgments must be tethered to a patient’s valid medical records….” which already eliminates the need for this oversight. The Alliance stated a high probability that the decision in this case will carry substantial weight and influence both in the Sixth Circuit and in courts nationwide.

In fact, the implications may be farther reaching than that. Payors in and out of hospice deny claims deemed “unnecessary” regularly. Claims denials range from about 19% in the ACA Marketplace to as much as 49% from private payers. Even though about 80% of appeals are later accepted, only about 1% of denied claims are appealed.

Not only could this case help more patients get the hospice care they need, it could also lay the groundwork to require insurance companies to rely more heavily on the treating physician’s recommendation. We could see lower denials from prior authorization requests, unconventional treatment plans, VA benefits, and more.

Final Thoughts

The Rowan Report supports the Alliance’s efforts in this case and wholeheartedly agrees that a physician knows better the care his patient needs than a judge ever could. We are hopeful that Bill Dombi and his team at AGG will be successful in this case and that hospice providers can get back to the business of patient care. Read the statement from the Alliance here.

# # #

Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news, and speaker on Artificial Intelligence and Lone Worker Safety and state and national conferences.

She also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

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

What Can Providers Give to Patients, Part 5

Admin

by Elizabeth E. Hogue, Esq. | Nov 25, 2025 | Admin, Clinical, Legal

by Elizabeth E. Hogue, Esq.

What Can Providers Give...

Recap

Providers, including marketers, are tempted to give patients and potential patients free items and services. While providers usually have good intentions, they must comply with applicable requirements.

Part 1

As Part 1 of this series indicates, there are two applicable federal statutes: the Anti-Kickback Statute (AKS) and the Civil Monetary Penalties Law (CMPL). Part 1 also makes it clear that there are a number of exceptions. If providers meet the requirements of applicable exceptions, they can give patients and potential patients free items and services that would otherwise violate applicable requirements.

Part 2

Part 2 describes an exception for items and services of nominal value with a retail value of no more than $15 per item or $75 in the aggregate per patient on an annual basis that may be given by providers to beneficiaries. Providers may not, however, give cash or cash equivalents.

Part 3

Part 3 describes the circumstances under which providers may give free items and services to patients with demonstrated financial need.

Part 4

Part 4 summarizes recent guidance from the Office of Inspector General (OIG) about giving incentives to promote vaccination against COVID-19.

Care & Services

According to the OIG, providers may also give patients free preventive care items or services. The definition of remuneration under the CMPL regulations excludes incentives given to patients/potential patients to promote the delivery of preventive care services so long as the delivery of such services is not directly or indirectly related to the provision of other services reimbursed in whole or in part by the Medicare Program or other state and federal healthcare programs. Preventive services include:

Prenatal services or postnatal well-baby visits, or specific clinical services described in the current U.S. Preventive Services Task Force’s Guide to Clinical Preventive Services
Services that are reimbursable in whole or in part by the Medicare Program, or other federal and state care programs

Incentives

However, incentives related to preventive services may not include:

Cash or instruments convertible to cash
Incentives of value that are disproportionally large in relationship to the value of the preventive care services in terms of either the value of the services or the future health care costs reasonably expected to be avoided as a result of preventive care

Preventive

Any tie between provision of exempt covered preventive care services and covered services that are not preventive may, therefore, violate the CMPL and the AKS.

The OIG has stated that some free or discounted services may fit within the preventive care exception described above. These services may include free blood sugar screenings and cholesterol tests.

Anti-Kickback Exceptions

The AKS does not include an exception similar to the provisions of the CMPL described above. In commentary to Supplemental Compliance Guidance for Hospitals, however, the OIG said:

From an anti-kickback perspective, the chief concern is whether an arrangement to induce patients to obtain preventive care services is intended to induce other business payable by a Federal health program. Relevant factors in making this evaluation would include, but not be limited to: the nature and scope of the preventive care services; whether the preventive care services are tied direct or indirectly to the provision of other items or services and, if so, the nature and scope of the other services; the basis on which patients are selected to receive the free or discounted services; and whether the patient is able to afford the services.

Final Thoughts

Based upon the above, the OIG is unlikely to challenge the provision of free preventive services given to patients and potential patients, under either the CMPL or the AKS, so long as the above requirements are met.

# # #

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.

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

OASIS, OASIS Everywhere!

Artificial Intelligence

by Tim Rowan | Nov 13, 2025 | Artificial Intelligence, Clinical, New Tech

by Tim Rowan, Editor Emeritus

OASIS, OASIS, Everywhere

At this year’s annual meeting of The National Alliance for Care at Home, one could not attend a general or breakout session or walk an aisle in the exhibit hall without hearing about artificial intelligence. After 27 years covering Home Health, Home Care, and Hospice technology, I have seen buzzwords come and go. Declared game-changers have evolved from Windows to the iPad, to smartphones, to telehealth, to Big Data, to the Internet itself.

Interestingly enough, the “game” never changed. Patients/clients, nurses/CNAs, claims, payroll, and A/R have always, and will always, keep owners, administrators, and managers sprinting. AI will bring massive changes, but not to these constants.

AI is a Supplement, not a Replacement

There is much concern, and a plethora of articles, about how easily AI can be abused, even with the most noble intentions. We have detected serious concern about a movement to allow AI to make clinical decisions. We concur that this is inappropriate. Advising clinical decisions, providing background on previous patients with similar symptoms, or quickly accumulating data on the history of a chronic condition, can benefit our patients and clients in ways no other technology has been able to do. Making clinical decisions is different in both kind and degree.

This is why we were impressed with the focus on supplementing over replacing that we witnessed in New Orleans.

Ambient Listening for OASIS

When WellSky acquired Kinnser, everyone wondered whether the Home Health EMR would improve or merely be maintained for its customer base. Longtime friend of The Rowan Report, and WellSky and former Fazzi consultant Cindy Campbell, RN, convinced us with her uncharacteristic effusiveness to take another look at the latest WellSky feature.

How it works

During the OASIS visit, the nurse in the home logs into an app and places it between him/her and the patient. As the normal OASIS conversation takes place, the AI-enabled app not only hears but interprets every nuance of the chat. By the time the OASIS visit is over, the agency’s EMR has been fully populated. Every OASIS question has been answered, and every numerical rating field has been accurately completed.

Human touch

Wisely, WellSky allows no AI OASIS assessment to be saved or signed without review by a human. This is going to become standard practice as AI evolves, or at least it should be, the WellSky rep told us. Machine assistance is far removed from machine perfection. Nevertheless, she asserted, few changes are required by the reviewer, usually a QA nurse.

Beyond OASIS

In addition to streamlining the OASIS assessment visit, the new app gives voice reminders to each nurse of their daily and weekly schedule, and background information about each patient’s visit history, current condition, and goals.

But Wait, There's More

Our AI tour did not end at the WellSky booth. We lost count of the number of smaller companies that were demonstrating the exact same AI-assisted OASIS assessment. It was as though some unknown force ordered, “OK, everyone. It’s 2025. Roll out your Home Health AI functions.”

One of many

Roger is the name of one of the more evolved such apps, from the aptly named Roger Healthcare. We had interviewed co-founder Yunus Ansari several months ago and were impressed by the product’s progress since then. Like WellSky and the others, Roger claims 15-minute OASIS visits, 5-minutes routine visit notes, 2-minutes EMR syncing, and larger per-nurse patient caseloads without additional work time.

Where Do We Go From Here?

Clearly, AI is not a fad. It has already permeated Amazon, Facebook, and most gas and electric vehicles. In Home Health, Home Care, and Hospice, it promises to accelerate research, education, paperwork, and revenue cycle management. Here is the red line in the sand. When used to enhance the efficiency and working knowledge of a nurse, CNA, or non-medical caregiver, it will go a long way toward helping in-home care to keep up with budget cuts, reimbursement reductions, inflation, and nurse/caregiver shortages.

When used to replace the clinical expertise of physicians, nurses, CNAs, and even personal care assistants, it smacks of HAL, the renegade computer of 2001: A Space Odyssey. What we need to do as AI infiltrates more and more aspects of our lives, is constantly remind ourselves that it is only a tool, not a master.

# # #

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

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

Interoperability and Gen X

Interoperability

by Kristin Rowan | Oct 30, 2025 | Interoperability

by Kristin Rowan, Editor

Interoperability and Gen X

Your Song

Part 1 of this series discussed the timeline and history of interoperability and the slow progress that has been made so far. Both in care at home and the broader health care system, interoperability seems to stall despite regulations and incentives for data sharing. Part 2 takes the discussion into the future when the next generation of care at home patients deals with data silos.

We Didn't Start the Fire

We (Gen Xers) have waited 15 years for HIEs to solve the free exchange of information between health systems. We have also watched and participated in the disparate system for our own healthcare and that of our parents and our children. We are in the unique predicament of needing care for three generations simultaneously. That in-between position gave us the nickname “The Sandwich Generation.” And we are ready to rock this boat!

For What It's Worth

More than 65% of us feel like there are barriers to accessing healthcare1
More than 70% are using or interested in using AI-assisted diagnosis
Almost 75% want Ai-powered care tools
45% believe healthcare will improve in the next 10 years
80% believe that improvement will come from AI-integration and better virtual access

Teach Your Children

Home care patients are still primarily baby boomers who did not grow up with technology embedded in everything they do. Their children, however, did. These are the adult children making decisions for their parents. They are the ones watching their parents sit through hours of Q&A to relay medical history that countless other doctors already have. They are the ones asking “why?”. They know there’s a better way and they expect you to find it.

But, Gen Xers are also independent, resourceful, and adaptable. We are tech-savvy and have a no-nonsense attitude toward authority. We are the generation that doesn’t wait for technology to get better; we create our own. And since our young employees (and our children) eat, sleep, and breathe technology, you can bet the solution will be innovative and quick.

It's Now or Never

The next generation of home health patients are approaching 60 and will be eligible for Medicare in 5 years. 2030 is your deadline for interoperability. When our doctors, insurance providers, and home health agencies tell them that information portability isn’t possible, they will not take that answer lying down. When the hospital asks them to drive across town to their imaging center, wait for the imaging center to transfer their results to a CD, and then deliver the physical copy to the hospital (yes, my hospital system made me do this), we will demand to know why.

I'm a Believer

The AI solutions that I’ve seen in the last few years have been innovative, creative, and fascinating. I believe in my fellow Gen Xers and the possibilities that lay before us. I believe that we all have the right to access our own health information, including visits, test results, imaging, notes, and recommendations. And I believe we have the building blocks to unify health records for every patient in real time. If I only I had the coding skills to build it. Maybe I should ask my kids.

# # #

Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news, and speaker on Artificial Intelligence and Lone Worker Safety and state and national conferences.

She also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

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

Interoperability: The Unreachable Dream

Interoperability

by Kristin Rowan | Oct 17, 2025 | Interoperability

by Kristin Rowan, Editor

Interoperability

The Unreachable Dream

Healthcare and care at home have been reaching for interoperability for decades. When I started working in the care at home industry, there was a learning curve for terminologies, abbreviations (oy! with the abbreviations already!), and the pain points experienced by agencies and vendors. Interoperability was at the top of that list. 2009, the first full year I worked in care at home, was the year Congress mandated EHRs and data exchange. The mandate did not accomplish much. Incompatible data structures limit post-acute care data to the most recent health event, not the patient’s full medical record.

Data Exchange

Following the EHR mandate, Congress continued to add regulations and rules to advance data exchange. Starting with HIPAA in 1996, interoperability advanced as follows:

Health Insurance Portability and Accountability Act ensures patient data stays private both within a healthcare system and during data exchange

Congress mandated the use of EHRs throughout healthcare

HITECH Act launched Health Information Exchanges (HIEs) that support secure exchange of information between health systems

Health Level 7 (HL7) designed a framework that establishes protocols for data exchange

Fast Healthcare Interoperability Resources (FHIR), an updated of HL7, enables processes in 84% of hospitals and 61% of clinician offices

21st Century Care Act allows patients to access their own medical information and requires developers to publish APIs and ensure all data in the patient health record is accessible through that API

Trusted Exchange Framework and Common Agreement (TEFCA) lists principles, terms, and conditions to standardize data

CMS Interoperability Framework pushes interoperability nationwide through improved data quality; advanced technology; data aggregation; and alignment of data, tools, and measures

Following the EHR mandate, Congress continued to add regulations and rules to advance data exchange. Starting with HIPAA in 1996, interoperability advanced as follows:

Health Insurance Portability and Accountability Act ensures patient data stays private both within a healthcare system and during data exchange
Congress mandated the use of EHRs throughout healthcare
HITECH Act launched Health Information Exchanges (HIEs) that support secure exchange of information between health systems
Health Level 7 (HL7) designed a framework that establishes protocols for data exchange
Fast Healthcare Interoperability Resources (FHIR), an updated of HL7, enables processes in 84% of hospitals and 61% of clinician offices
21st Century Care Act allows patients to access their own medical information and requires developers to publish APIs and ensure all data in the patient health record is accessible through that API
Trusted Exchange Framework and Common Agreement (TEFCA) lists principles, terms, and conditions to standardize data
CMS Interoperability Framework pushes interoperability nationwide through improved data quality; advanced technology; data aggregation; and alignment of data, tools, and measures

Thirty Years Later

Despite the laws, regulations, frameworks, and mandates, interoperability is not much better than it was in 1996. I had an experience this year that both enlightened and infuriated me. I switched health insurance plans for a variety of reasons. My new plan didn’t cover most of the doctors, hospitals, and health systems I had been using for many many years. So in February, I found a new PCP and had the standard start of care visit to establish my health history: current conditions, past conditions, past surgeries & procedures, current medications, etc. I requested referrals to new specialists and updates to prescriptions. My PCP performed a “complete physical” that was nothing more than a cursory overview. And then I waited.

The Waiting Game

And waited…and waited…. I thought all these organizations and standards were supposed to make this easier. Still, I waited.

I waited for an “invitation” to my PCPs portal to see my visit notes and test results
I waited for my PCP to send referrals to new specialists
I waited for my health insurance provider to inevitably tell me the specialist wasn’t covered under my plan
I waited for a new referral from my PCP
I waited for appointments, results, and recommendations
I waited for access to new patient portals
I waited for the portal to figure out how to give me access to three different providers in the same app
- (spoiler alert: I have to log in to the same app three different ways to access three different providers; my providers can see all the information in one place, but I can’t)
I waited for test results to appear in each portal; some I had to call and request, some I’m still waiting for

Data Exchange "Advancements"

According to my research, 84% of hospitals and 61% of clinicians are currently using FHIR, designed to improve interoperability between different health systems using standard data formats and APIs.

Last month I had an appointment. Correction: I thought I had an appointment for an imaging scan. I thought this because the scheduling nurse called me to confirm the appointment day, time, and location. When I arrived, the check-in nurse couldn’t find me in their system.

It wasn’t just that she didn’t see my appointment. No, it was that she couldn’t find me at all. (We later discovered it was still pending because the imaging department never confirmed the appointment after the scheduling nurse added it.)

She could see no current or future appointments. She could see no past appointments because they were booked a different way. She couldn’t find any record of me at all. You see, my record started in the next building over.

Error 404: Not Found

Every one of these facilities is in the same healthcare system. (Think ACME hospital, ACME imaging, ACME specialist doctor, and ACME lab) Every office is part of the same healthcare system and none of them can see each other’s information. ACME hospital can’t see the schedule for ACME imaging and can’t schedule imaging appointments outside the hospital. For that, I have to call ACME imaging.

But wait! The doctor wrote my referral for ACME hospital, not ACME imaging. I need a new referral.
But wait! Neither the healthcare system nor the specialist can write a new referral. My payer will only accept a referral from my PCP.
But wait! My PCP has no idea what the referral is for, how it was written, or where it’s supposed to go because my PCP can’t access my records from the healthcare system.

This is advanced data exchange using FHIR, HIE, TEFCA, and QHIN. My health system uses our local HIE and CommonWell Health Alliance, an interoperability network designated as a federal QHIN. Apparently, this ensures the health system can share data with participating providers, but not with themselves.

Home Health is Even Further Behind the Curve

After so many years, so many advancements, and so many regulations, interoperability is no more “solved” than it was in 2009. Even the health systems that are using all the tools aren’t even internally interoperable.

Home Health has an even harder time attaining interoperability.

It is more difficult for HHAs to access patient information, which usually has to be manually imported into the home health EHR
Patient consent is required, but HHAs often deal with patients who don’t have the capacity to consent
Despite the requirement of APIs, most health information is spread out across multiple systems and the HHA only get information from the referring facility
Nearly 80% of HHAs use an EHR
Only 28% of HHAs are electronically exchanging information with outside facilities
Only 18% can integrate shared data into automated workflows
HHAs did not receive the financial incentives that larger healthcare systems got to push interoperability
TEFCA participation is not mandatory, slowing down the process of approving a data connection and exchange

Many legacy EHRs have met significant challenges moving into interoperability. Competitors in the space had no financial incentive to create standard languages and formatting designed to share information. HHAs are left with two choices:

The costly, time-consuming task of reviewing, selecting, and onboarding an entirely new EHR –or–

Piece together workarounds with multiple 3rd party or internal solutions haphazardly strung together to resemble interoperability

Time is Up

The call for interoperability started in 1996. With little advancement and not much hope on the horizon, we (your patients) are looking for other ways to get what we need. Next week, I’ll talk about my predictions for how interoperability will progress for the next generation.

# # #

Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news, and speaker on Artificial Intelligence and Lone Worker Safety and state and national conferences.

She also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

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

What Can Providers Give to Patients, Pt 2

Admin

by Elizabeth E. Hogue, Esq. | Oct 17, 2025 | Admin, Clinical, Legal

by Elizabeth E. Hogue, Esq.

Provider Kickbacks

Exceptions

Providers, including marketers, are tempted to give patients and potential patients free items and services. While providers usually have good intentions, they must comply with applicable requirements. As Part 1 of this series indicates, there are two applicable federal statutes: the anti-kickback statute and the civil monetary penalties law. Part 1 also makes it clear that there are a number of exceptions or “safe harbors. If providers can meet the requirements of an applicable safe harbor or exception, they can give patients and potential patients free items and services that would otherwise violate applicable requirements.

Limit Increase

The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services, the primary enforcer of fraud and abuse prohibitions, announced that; effective on December 7, 2016; the limits on free items and services given to beneficiaries increased. Specifically, according to the OIG, items and services of nominal value may be given to patients or potential patients that have a retail value of no more than $15 per item or $75 in the aggregate per patient on an annual basis. The previous limits were $10 per item or $50 in the aggregate per patient on an annual basis.

Undue Influence

Under section 1128A(a)(5) of the Social Security Act, persons who offer or transfer to Medicare and/or Medicaid beneficiaries any remuneration that they know or should know is likely to influence beneficiaries’ selection of particular providers or suppliers of items or services payable by the Medicare or Medicaid Programs may be liable for thousands of dollars in civil money penalties for each wrongful act. “Remuneration” includes waivers of copayments and deductibles, and transfers of items or services for free or for other than fair market value.

In the Conference Committee report that accompanied the enactment of these requirements, Congress expressed a clear intent to permit inexpensive gifts of nominal value given by providers to beneficiaries. In 2000, the OIG initially interpreted “inexpensive” or “nominal value” to mean a retail value of no more than $10 per item or $50 in the aggregate per patient an annual basis.

Needed Items, not Cash

The OIG also expressed a willingness to periodically review these limits and adjust them based on inflation. Consequently, effective on December 7, 2016, the OIG increased the limits of items and services of nominal value that may be given by providers and suppliers to beneficiaries to a retail value of no more than $15 per item or $75 in the aggregate per patient on an annual basis.

Providers may not, however, give cash or cash equivalents.

These amounts may still seem paltry to many providers. According to the OIG, providers who see that patients need items worth more than these limits should establish relationships with charitable organizations that can provide items and/or services that are not subject to these limits. In other words, work together to meet the needs of patients!

Final Thoughts

With time and the emotional context inherent in home health and hospice, clinicians may want to offer gifts to their clients. Low reimbursement rates and workforce shortage may cause HHAs to consider gifts and incentives as a way to keep clients and get referrals to new ones. If you find yourself in this situation, make sure you’re staying under the legal threshold, and engage 3rd parties to fill larger needs.

This is part 2 of a 4-part series. Come back next week for the third installment.

# # #

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.

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

It’s More than Just Payroll

Admin

by Kristin Rowan | Oct 9, 2025 | Admin, Artificial Intelligence, Clinical, Product Review

by Kristin Rowan, Editor

Product Review: It's Payroll...and so Much More

Evolution into Health Care

I’m sure many of you remember the days before automated processes. Hand-written notes, paper forms, and paychecks that were filled in on a typewriter. Those days are behind us (mostly) in care at home with the alphabet soup of technology we have today: EMR, EVV, EHR, PECOS, API, EDI, UB-04, ADP

Technology evolves in unpredictable paths and patterns. And the best developers adjust to that evolution. That is the story of a software provider that we recently interviewed. What started as a general payroll and HR software evolved and steered the developers toward health care. Now, that payroll company is built for care at home and includes so much more than standard payroll. Introducing…Viventium

Home Health and Home Care Enhancements

When the Viventium team started their software, it was not industry specific. But some key clients put home care on their radar six years ago and the software development shifted to meet the unique needs of care at home agencies. Today, Viventium is a workforce management system that is built for care at home and includes features not found in general payroll software. Some of Viventium’s capabilities include:

Applicant tracking

Job board integration

Hiring data and talent recognition

Recruitment insights and analysis

Onboarding

Tax filing

Employee self-help section

Integration with Tapcheck

Time and Attendance approval

Time off requests

Scheduling and Open Shift management

Continuing education tracking

Benefits management

ACA compliance tracking and reporting

Automated blended rate payroll

Integrations and Automations

Viventium is already working with a handful of EMRs for direct integration. The system is also integrated with TapCheck for on-demand pay and with Nevvon for CEUs. For EMRs that are not fully integrated, they offer pre-built exports that can handle different export formats. Viventium can import information from virtually any patient record system.

Once the payroll system is set up for your agency, or agencies, many of the workflows are automated, relieving time and stress on your staff and saving you money on recruitment, retention, FTEs and missed visits. The staff responsible for new hires will experience such automations as pre-filling demographic information everywhere once it is entered once, customizable CEU requirement task assignment and reminders, tax preparation and filing, sharing job listings across multiple job boards, and payroll generation from EVV import.

Industry Differentiators

Standard payroll companies and software are perfectly capable of running weekly time cards and calculating state and federal taxes. Most of them automate direct deposit. Very few have the built-in capability to change hourly rates during a shift. Viventium allows agencies to customize visit types, names, and rates, allowing an employee to clock in at the start of a shift and adjust their job code as needed throughout the day. Even fewer calculate overtime, benefits eligibility, sick leave accrual, and daily overtime for per visit employees automatically. And Viventium is the first payroll software I’ve come across that is piece-rate compliant, calculating rest pay and non-productive time.

Customizations

HHAs are not “one size fits all” and neither is Viventium. The list of available customizations keeps growing. Agencies can apply custom parameters to:

CEU requirements based on license type, expertise, PiPs, etc.
Benefit information
Reminders for expirations and deadlines on performance reviews, licenses, certifications, and CEUs
Workflows for digital onboarding documents, progress tracking, and completion
Re-hire eligibility
Payroll and overtime calculations for one employee working across agency locations
Reporting, analytics, data, in addition to the static analytics dashboard

User Reviews

As a small business with very little need for robust HR systems, payroll software is not really on my “must have” list. Still, I’d be remiss if I didn’t consider using a system with this many “extras”. But, don’t take my word for it. Here is what Viventium customers have to say:

Hospital System with 11-50 Employees

“I enjoy the software and it beats most if not all payroll systems out there for attractiveness to use and navigate through. Very user friendly. When they update the product they always have a training associated with it. It easy to use for our employees as well.”

Home Care Agency with 51-200 Employees

“Viventium has really helped my company by providing payroll services. As a new and small business owner, the “V” team has been patient, helpful and always a pleasure to work with. In our first 2 years, the service has been very helpful and timely. I am very happy I decided to go with the “V” team. Highly recommend for payroll services.”

∼ Carlos, SYNERGY HomeCare in Palm Bay.

Health and Wellness with 1,001-5,000 Employees

“It’s not just another payroll or HR tool, it feels thoughtfully built for real people, especially those of us in healthcare….

Plus, having everything from benefits administration to compliance tracking in one place has saved me countless hours. It’s helped our team stay organized and focused on what really matters: supporting our staff and growing our business.”

Review

In the care at home industry, Viventium is relatively new in comparison with other systems. Outside of care at home, Viventium is trusted by more than 3,000 companies and has the experience and expertise to support more than just payroll, but all workforce management.

The user interface is pleasant and visually pleasing enhancing its very user-friendly, easy to use platform. 3rd party tools are fully integrated, keeping every feature under a single sign-on. Also included is an Android and iOS app for your staff to track and view hours, pay rates, benefits, and education all in one place.

The automation and customization reduces payroll prep time, improves compliance and accuracy, strengthens retention and recruitment, eliminates physical paperwork for onboarding, and much more. This part is not my opinion, but is based on this efficiency study.

Final Thoughts

If you’re not using Viventium, it is worth exploring. The potential to eliminate multiple software systems and logins is real. The savings in time, retention, and reduced errors are measurable. Viventium is the best kept secret in care at home and based on my conversations with their team, we haven’t heard the last of Viventium’s innovation and industry-specific features.

# # #

Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news, and speaker on Artificial Intelligence and Lone Worker Safety and state and national conferences.

She also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

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

**Vendors never pay for product reviews nor does a vendor’s sponsor status influence the content of the review.

Imposter Clinicians

Clinical

by Elizabeth E. Hogue, Esq. | Aug 28, 2025 | Clinical, Legal

by Elizabeth E. Hogue, Esq.

Imposter Clinicians

Although it is relatively rare, there are individuals who impersonate clinicians! Imposters will inevitably slip through the cracks despite concerted efforts by providers.

The First Offense

For example, Thomasina Amponsah recently admitted to posing as a licensed registered nurse at more than forty facilities in Maryland. Beginning in about September 2019 through approximately August 2023 Amponsah used stolen nursing credentials and false educational and professional histories to secure employment at multiple facilities. She was employed primarily at rehab facilities and nursing homes. She earned at least $100,000 in wages with her false credentials.

Amponsah used a Maryland nursing license number issued to another individual, thus making this individual a victim of identity theft. She then presented a copy of the victim’s license to potential employers. Amponsah altered her name on applications to include the victim’s last name. She falsely claimed that she had been a supervisor and that she had a nursing degree from Florida State University.

Adding Injury to Insult

Amponsah also used a second stolen identify to obtain employment. In July 2021 she submitted an online job application to a staffing agency. She used a Florida nursing license that belonged to another victim. Amponsah provided a copy of this victim’s license to the staffing agency along with a fictitious resume. She then worked for at least twenty-one different skilled nursing facilities on behalf of the staffing agency.

Imposter Identity Uncovered

Although several employers learned her true identity and terminated her employment, Amponsah continued to gain employment as a nurse in other facilities. She faces a maximum sentence of five years in federal prison for false statements related to health care matters and a mandatory two-year sentence served consecutively to any other sentence for aggravated identify theft.

A Common Occurrence

Then there is the recent case of a Pennsylvania woman, Shannon Nicole Womack, who posed as a nurse in four different states. She used various false names and paperwork while employed at twenty nursing homes and rehab facilities as a licensed practical nurse, registered nurse, and even nurse supervisor. Womack was charged with endangering the welfare of care, unlawful use of a computer, identity theft, forgery, theft by unlawful taking, and several other crimes.

Inherent Risks of Imposter Clinicians

There are many implications for services provided by imposters. One is, of course, the possibility of injuries to patients. Another is that providers may wonder if they are liable under the False Claims Act for services provided by unlicensed individuals.

Southern Maryland Home Health Services, for example, hired Diane Cannon as a physical therapist (PT) who was unlicensed, even though she claimed to be a fully qualified PT. In order to gain employment, Cannon used the name of an actual licensed PT and provided false references from supposed former employers. In addition, the provider’s hiring agent who interviewed her said that Cannon was familiar with PT terminology and procedures. While Cannon was employed, the provider did not receive any complaints about her that would have put the provider on notice that she was an imposter.

Agency Liability

Consequently, the U.S. District Court for the District of Maryland concluded that providers are only liable for false claims for services provided by imposters if some degree of culpability is attributable to employers other than simply employing an imposter. In other words, providers will probably not have any liability for filing false claims for imposters’ services so long as providers comply with their internal policies and procedures and state and federal requirements, and nothing occurs that puts employers on notice that staff members are imposters.

Final Thoughts

It is quite scary to think about the provision of healthcare services by unlicensed personnel. The consequences could certainly be dire for both patients and providers. However, vigilance by providers usually, but not always, pays off.