Medicaid Cuts Still Looming

Clinical

by Tim Rowan | Jun 20, 2025 | Clinical, Medicaid, Regulatory

by Tim Rowan, Editor Emeritus

Medicaid Cuts Looming

Terminal Prognosis

Let me tell you about my brother. In his early 30’s, Tom was diagnosed with a rare disorder, one of the 25 versions of Ataxia. A disorder that is sometimes genetic, sometimes of unknown cause. It damages the part of the brain stem that controls balance, eye-hand coordination, and speech. He was supposed to be confined to a wheelchair by age 45 and not make it to 60.

Medicaid to the Rescue

Tom will celebrate his 71st birthday next week. Some years back, an experimental drug appeared that happened to be effective with his variation of Ataxia. That medication, administered intravenously in his home, is ridiculously expensive. If not for Medicare and Medicaid, those early prognoses would have come true. With the treatments, the disorder does still progress, though much more slowly. During my visits to his home — yes, he still manages on his own for now — he and I talk about the Assisted Living or Skilled Nursing Facility that looms in his future. Always with his head low and a sigh, he says he knows that day will come.

One in 71 Million

The 20 percent of American citizens who qualify for Medicaid are as nervous as Tom is about a bill making its way through Congress. As of May 22, 2025, H.R. 1 passed the House of Representatives by one vote. Today, it is still under debate in the Senate, where several amendments are being considered.

Medicaid Pays More than Medicare

In a February report, the Kaiser Family Foundation explained it this way:

Four in ten adults incorrectly believe that Medicare is the primary source of coverage for low-income people. For those who need nursing or home care, Medicaid is the primary payer. Medicaid covered two-thirds of all home care spending in the United States in 2022. With House Republicans considering $2.3 trillion in Medicaid cuts over 10 years, the availability of home care could be affected in future years. Home care cannot afford the loss of almost one-third of the entire Medicaid budget.

Medicaid Cuts Impact

The February report indicates that H.R 1 could fundamentally change how Medicaid financing works. This would consequently impact enrollees’ access to care. The authors assert that “cuts of this magnitude would put states at financial risk, forcing them to raise new revenues or reduce Medicaid spending by eliminating coverage for some people, covering fewer services, and/or cutting rates paid to home care workers and other providers.”

“Such difficult choices would have implications for home care because over half of Medicaid spending finances care for people ages 65 and older and those with disabilities, the enrollees most likely to use home care and related services.”

Mohamed, A.; Burns, A.; O'Malley Watts, M.

Authors, What is Medicaid Home Care (HCBS)?

Medicaid Cuts Proposals

The Center on Budget and Policy Priorities has been listening to Senate debates and reading proposed amendments. In a news release this week, CBPP offered a dismal assessment.

“The health provisions in the Senate Republican leaders’ plan are, alarmingly, even harsher and more damaging than the health provisions in [H.R. 1]. Under both plans, tens of millions of people would face substantially higher health care costs and millions would lose access to life-saving treatments, routine care, and medications they need.”

Higher Costs, Less Access

Home Care and the Work Requirement

There is much talk in Congress and in social media about able-bodied Medicaid beneficiaries who sit at home and play video games all day. Not only does this indicate a confusion between healthcare and welfare (you can’t eat or sleep in Medicaid), but it also tends to exaggerate the scope of this fraud/waste/abuse target.

As KFF points out, most Medicaid adults under age 65 are already working but are paid low enough that they still qualify. Many who are not working (12%) serve as caregivers for a family members. If they are removed from the home to go to a job, someone else would have to take over caregiving duties, probably a home care agency. Thus, there would be a net loss to the system.

Net Loss

The Congressional Budget Office found when examining the House version that work requirements would decrease federal spending by reducing the number of uninsured. However, in the same report, the CBO notes that there would be no increase in employment numbers.

On top of the uncertain benefit of the work requirement, the bill as it stands today would greatly increase reporting requirements. In place of “once qualified, always qualified,” Medicaid eligibility will require regular reporting to prove employment and annual re-qualification paperwork. The new red tape burdens will be especially difficult on seasonal workers or those who frequently change jobs.

Medicaid Cuts and Rural Hospitals

No one is quite sure what the impact on home care will be when Medicaid cuts force rural hospitals to close, as the CBO predicts. Longer journeys to receive hospital care and doctor visits may push more beneficiaries to home care while home care will be struggling to find caregiving staff.

Before the bill becomes law, rural hospitals are already in trouble. The American Hospital Association says that 48 percent of rural hospitals operated at a loss in 2023 and 92 closed their doors over the past 10 years. There are 16.1 million Medicaid beneficiaries living in rural communities, including 65 percent of nursing home residents. Can home care cover the losses if a portion of the estimated $800 billion in Medicaid cuts over 10 years hit home care just as hard?

Medicaid Support in Congress

There are home care champions on the Republican side of the House and Senate. Some of them have already expressed their doubts about whether cutting home care would decrease or increase overall spending. In the “strange bedfellow” category, conservative icon Josh Hawley of Missouri swore he would “tank any bill that cuts Medicaid benefits.”

Senate Republicans can afford to lose only three votes to get this bill passed and sent back to the House. Today would be the time for all of them to hear from the care at home industry. Call your Senator. All phone numbers start with 202-224-

# # #

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

Workplace Violence in Home Health

Caregiver Safety

by Kristin Rowan | Jun 20, 2025 | Caregiver Safety, Caring for the Caregiver, Clinical, Home Health, Hospice

by Kristin Rowan, Editor

Workplace Violence and Policy Impact

Study of home health workers

A group of researchers from the University of Cincinnati, Ohio published a recent study¹ on the frequency and reporting procedures of workplace violence (WPV) in home healthcare. The study specifically addressed WPV in home healthcare, stating limited understanding of WPV in the home care setting. Most existing studies on WPV were hospital-based.

Frequency of Workplace Violence

Of the home health care workers (HHCW) surveyed, almost 37% responded that they experience both verbal and emotional violence in the workplace daily. More than 80% reported experiencing verbal aggression at some point. Physical violence is less prominent. 20% of respondants said they experience physical violence monthly. However, 56.6% said they have experienced physical violence at some point in their current agency. 76.6% of the time, the perpetrators of the violence are the patients of the HHCW.

Fig. 1 Frequency of occurrence of physical, verbal, emotional, and sexual abuse as a function of time: daily, weekly, monthly, <yearly, yearly, and never.

Reporting Workplace Violence

All of the study participants indicated they had knowledge of workplace violence reporting procedures in their agencies, but 26.7% were unsure if the policies are contained in the employee handbook. 46.7% were uncertain as to whether the agency offered WPV or de-escalation training and 66% said prevention and de-escalation training was not mandatory. Unfortunately, 40% said their management did not encourage reporting and 33% said they were not comfortable approaching management about WPV. Despite the frequency of WPV among the respondents, none of the participants reported these incidents to management.

Thoughts

According to this, and other research studies on workplace violence in home healthcare, the problem is prevalent and persistent. Most HHCWs have experienced some sort of aggression, violence, or abuse in the course of performing their jobs. Of those who have, most do not report the incidents to management. Most HHCWs have not been trained in prevention or de-escalation. Even with training, HHCWs need a way to get immediate help. Unfortunately, most do not have an emergency alert system on their person during home visits.

Solution

Care at Home agencies, including non-medical supportive care, home health, hospice, and any other lone workers who are visiting patients in their homes, need safety policies and procedures. Agencies must include the same in the employee handbook, explain during orientation, and make available to HHCWs digitally.

Policies and procedures should include:

A safety committee comprised of management, back office staff, and field workers
A clearly written policy regarding physical, emotional, verbal, and sexual abuse
- Against a patient or their family/friends by a HHCW
- Against a HHCW by a patient or their family/friends
- Against a HHCW by a colleague or manager
- Against a HHCW by the environment in which they work (i.e. aggressive pets, weapons, cigarette smoking indoors, etc.)
A digital reporting system that employees can use without having to approach management individually
A clearly written policy on the management response to violence reporting
A clearly written policy forbidding any retaliation or discrimination against a reporting employee
Required research about new patients including
- Background/History of violence and/or mental instability
- Neighborhood safety rating
- Family members likely to be in the home and their history of violence and/or mental instability

Additional Tools for HHCWs

Workplace violence against HHCWs is not “if,” but “when.” It is the responsibility of the agencies to lower the risk, lower the percentage of “whens,” and encourage reporting. If you’re not sure how to begin, hire a consultant to help you build your safety committee and write your policies. It doesn’t matter how you start implementing safety protocols, as long as you follow through and protect your employees.

# # #

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

1. Obariase, E.; Bellacov, R.; Gillespie, G.; Davis, K. (2025). Assessing Workplace Violence and Policy Impact: A Cross-sectional Study of Home Healthcare Workers. Home Healthcare Now, 43(3), 150-156. doi: 10.1097/NHH.0000000000001345

Painting Pictures

Admin

by Elizabeth E. Hogue, Esq. | Jun 13, 2025 | Admin, Clinical, Home Health, Hospice

by Elizabeth E. Hogue, Esq.

"Painting Pictures" of Patients

Painting Pictures in clinical documentation to achieve positive audit results. As the fight against “fraud, abuse and waste” continues, responding to audits has become an ongoing burden for many providers. Providers have repeatedly been urged to “paint a picture” of patients in clinical documentation in order to help achieve positive results. “Painting a picture” of the patient, however, may have become more difficult as the use of electronic health records (EHRs) has increased. That is, it’s difficult to adequately describe patients’ conditions when there are so many boxes to check and blanks to fill in.

Copy, Paste, Repeat

When it comes to narrative descriptions of patients’ conditions, it is extremely tempting to “copy and paste,” “cut and paste” and/or “copy forward” previous documentation in the EHR. The copy and paste feature allows users to use the content of another entry and to select information from an original or previous source to reproduce in another location. The copy forward capability replicates all or some information from a previous note to a current note, while the cut and paste feature removes documentation from the original location and places it in another location. In addition to the obvious potential problems for quality of care related to the use of these functions, auditors are understandably skeptical of documentation that repeats itself throughout patients’ medical records.

Painting Pictures of Fraud

Auditors are especially likely to deny claims that include documentation that was obviously copied using the above functions, when the information copied “sticks out like a sore thumb.” If hospice staff document, for example, that “the patient eats a lot of Mexican food” over and over in clinicians’ visit notes, auditors are understandably skeptical about whether services were necessary for a hospice patient who seems to have a continuous robust appetite or whether services were, in fact, rendered.

How to Paint the Picture

What does it mean to “paint a picture?” If a home health patient needs wound care or injections of medications, for example, the “picture” must account for why patients or their caregivers are not performing these activities themselves. Clinicians need to describe the following in a “picture” of the patient:

Does the patient live alone or have caregivers?
Why can’t patients do wound care or self-inject medications
Why can’t caregivers perform these activities?
What attempts did clinicians make to assist patients and caregivers to provide wound care and injections?
Why were these attempts unsuccessful?
What attempts were made to find other caregivers – either paid or voluntary – who might provide these types of care?
What were the results of these attempts to find other caregivers?
Despite the initial inability of patients and caregivers to render this care themselves, what efforts did clinicians make to help ensure that they became able to do so?

Get the Picture?

It’s difficult, if not impossible, to paint the above picture using only the boxes and blanks of forms in EHRs. More is needed if providers are serious about positive audit results.

# # #

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.

©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

TEFCA and QHINs: Interoperability 2

Admin

by Rowan Report | May 29, 2025 | Admin, Clinical, Interoperability, Regulatory

by Ben Rosen, Sr. Client Success Manager, Netsmart

Interoperability

What you need to know and how it affects you Part 2

For over two decades, tech companies and government agencies have been moving toward the goal of interoperability in healthcare technology. At long last, standards and protocols are in place — and continually being improved — to support open data exchange networks. As a result, healthcare providers, including human services, post-acute providers, and specialty practices, have more opportunities to participate in alternative payment models and adapt more readily to the evolving payment landscape.

This is part two of a four-part series covering the forces that are driving interoperability, as well as the future vision of open networks, and what it all could mean to your organization. Read Part One Here.

Interoperability in Healthcare

The creation of TEFCA and QHINs

TEFCA (Trusted Exchange Framework and Common Agreement) is a national framework designed to enable seamless, secure sharing of health information across organizations. With respect to EHRs, this framework simplifies data exchange with other providers, payers and public health entities while enhancing compliance with interoperability requirements. TEFCA is touted as a nationwide federal and private data exchange network.

End goal

One of TEFCA’s main goals is to standardize data sharing, therefore reducing the complexity of managing multiple connections and enhancing the interoperability of your EHR with other systems nationwide.

TEFCA was created by the U.S. Department of Health and Human Services’ Assistant Secretary for Technology Policy (ASTP). The ASTP is contracting with the Recognized Coordinating Entity (RCE), The Sequoia Project. The RCE is tasked with governing and maintaining the operations of the entities who are electing to implement the TEFCA network, these entities are referred to as Qualified Health Information Networks (QHINs).

QHINs

The certification process

QHINs are the entities that build the frameworks to allow data exchange as specified by TEFCA and facilitate the national exchange of health information. A single QHIN may represent dozens or even hundreds of healthcare providers, referred to as participants or sub-participants, across sectors (i.e., acute, human services, post-acute) public health agencies, health IT vendors and payers.

Applicants must build their TEFCA connection, which is then subjected to rigorous technology and security testing. QHIN applicants must also sign the Common Agreement that is countersigned by The Sequoia Project. These rigorous standards have a time limit: Each QHIN who applies must have their network built, tested and designated by the ASTP and RCE within 12 months of the application acceptance date. As of this writing there are eight designated QHINs and two candidate QHINs.

Benefits of participating in a QHIN

Streamlined Data Exchange
Compliance with Federal Interoperability Mandates
Access to Broader Patient Data
Improved Care Coordination

The market is already seeing regulatory rules and guidance tied directly to TEFCA. For instance, HTI 1 rule laid the groundwork for TEFCA and the HTI 2 rule is expanding on the process for designation, as well as codifying definitions and use cases to be exchanged via QHINs. Overwhelmingly, one of the biggest benefits to using a QHIN will be the increased types of data exchanged via the network.

The Same, but Different

Data exchange via TEFCA will look different than what we are used to with other nationwide networks today, such as Carequality, EHealthExchange or CommonWell. Via TEFCA, QHINs will exchange more robust types of data, referred to as Exchange Purposes, and will deal with higher volumes as a network. A few examples of these Exchange Purposes are clinical documentation (CCD-A), benefits determination data, public health research data, and even lab data, just to name a few.

Another benefit will be seamless connectivity. Other QHINs should integrate with EHRs to facilitate data exchange, acting as a hub that connects your system with other networks, providers and stakeholders.

Coming soon in Interoperability Part 3: Not all QHINs are created equal. How to choose the one that’s right for you.

# # #

Ben Rosen is a senior client success manager and business unit owner for the interoperability solution suite at Netsmart. With more than a decade of healthcare experience, Ben has led numerous initiatives to integrate healthcare systems and enhance data sharing across the care continuum. His dedication to advancing healthcare interoperability drives his active involvement in industry initiatives and standards organizations, where he provides insight for frameworks such as HL7 FHIR, USCDI and others. Ben holds a Bachelor of Science in kinesiology from Kansas State University and a Bachelor of Science in nursing degree from the University of Nebraska Medical Center.

©2025 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in the Netsmart blog and is reprinted here with permission. For more information or to request permission to print, please contact Netsmart.

Elderspeak

Clinical

by Elizabeth E. Hogue, Esq. | May 29, 2025 | Clinical

by Elizabeth E. Hogue, Esq.

Elderspeak

Providers have all heard baby talk. Baby talk is just one kind of elderspeak, i.e., changes in the way caregivers speak to patients, especially elders, regardless of the person’s ability to understand and respond.

Elderspeak includes:

Using a singsong voice, i.e., an exaggerated melodious tone
Changing pitch and tone to a higher level
Exaggerating words
Using terms like “honey” or “dear”
Using statements that sound like questions
Slow speech at a deliberate pace
Speaking at a higher volume than normal
Using simple, basic words
Substituting collective pronouns, such as “we” instead of “you”
Lack of eye contact
Use of so-called tag questions, such as “It’s time to eat lunch now, right?”

For Example:

A daughter visited her father in his apartment in an assisted living facility. She heard an aide trying to get her father to do something. The aide said, “Let me help you, sweetheart.” Dad’s response: “What? Are we getting married?”

Negative Results

Research shows that using elderspeak can diminish patients’ confidence in their abilities. Elderspeak is, after all, based on an ageist assumption of frailty, incompetence, and dependence. It can also be controlling and bossy. The use of “we” instead of “you” implies that patients are not able to act as individuals. Use of elderspeak may result in resistance to care.

When and How to Use Elderspeak

Some elderspeak does help to compensate for changes in cognition, but most of the time it’s confusing or even harmful to use elderspeak because it adversely affects a senior’s ability to understand. What is helpful?

Based on scientific evidence that older adults experience changes in their working memories that affect the way they hear and understand what is said to them, here’s what may be helpful:

Repeat and paraphrase what you say
Simplify and be explicit

Don’t say, for example, “I ate dinner later than usual yesterday, which made my stomach upset, so I missed the class that I enjoy taking.” Instead, say, “I ate dinner late yesterday. My stomach was upset, so I missed the class I like.” In other words, express complex ideas in a chain of simple sentences. Then repeat the main point or say it again another way.

Final Thoughts

Old habits are hard to break, but avoiding elderspeak is important because effective communication is essential to quality of care.

# # #

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.

©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

Clinical

by Rowan Report | May 16, 2025 | Clinical, Interoperability, Regulatory

by Ben Rosen, Sr. Client Success Manager, Netsmart

Interoperability

What you need to know and how it affects you

For over two decades, tech companies and government agencies have been moving toward the goal of interoperability in healthcare technology. At long last, standards and protocols are in place — and continually being improved — to support open data exchange networks. As a result, healthcare providers, including human services, post-acute providers, and specialty practices, have more opportunities to participate in alternative payment models and adapt more readily to the evolving payment landscape.

Interoperability in Healthcare

What's driving the need for change?

Government regulatory agencies, together with payers and healthcare organizations, have long recognized the need to improve care coordination among healthcare providers. Making it easier to share information via a nationwide data sharing network is a critical component of this effort.

End Game

The ultimate goal of providing access to complete, accurate patient information is to help drive down costs to providers and electronic health record (EHR) users. Through exhaustive work and years of innovation, we’re seeing the tangible outcome of this effort. Information now flows seamlessly across multiple healthcare networks. Using a concise view of the data, we can focus on broader population health initiatives that improve outcomes for chronic conditions, reduce emergency department (ED) visits, and prevent hospitalizations. The interoperability market is moving ahead at blazing speeds. Therefore, we must understand the players who are the driving forces behind the movement.

The Interoperability Highway

Who are the players and how do they work together?

Healthcare technology is complex. It’s not surprising, then, that getting the disparate systems to share information seamlessly and securely is a complicated process. In the last decade an increasing number of vendors, organizations, and healthcare players started working together to advance a useful interoperability market.

Some of the larger players in this space include government and regulatory agencies. To understand the role these entities play and how they coordinate with other organizations and efforts, let’s compare the process to building a national highway system.

Building an open data exchange network

Assistant Secretary for Technology Policy and Office of the National Coordinator for Health (ASTP/ONC): This federal agency sets the vision, rules and regulations for health information technology policy. Compare it to the Federal Highway Administration (FHWA), the federal agency that provides stewardship over the construction, maintenance, and preservation for all interstate highways.
Trusted Exchange Framework and Common Agreement (TEFCA): Established by the ASTP/ONC, TEFCA sets the rules for health data exchange over the network. This is similar to plans or blueprints for highway construction. This would also include engineering, construction and safety standards for the highway.
The Sequoia Project (RCE): The Sequoia Project is the Recognized Co-ordinating Entity (RCE) for TEFCA and is appointed by the ASTP/ONC. The Sequoia Project is a non-profit, public-private collaborative that leads the implementation project for nationwide data exchange. They approve and help regulate the TEFCA exchange, via QHINs. The Sequoia Project can be compared to a construction manager that approves contractors and oversees quality control measures to ensure standards are met.
Qualified Health Information Networks (QHIN)s: QHINs are data sharing networks built to operate the exchange network as outlined by TEFCA. In our analogy, QHINs are the highways, and the companies that build QHINs can be compared to the construction companies that physically build and maintain the roadways themselves.

Now that you’re familiar with the entities involved in developing the standards for interoperability and building the data exchange networks that make it a reality, we will next look at how these enhanced capabilities can impact your organization.

This is part one of a four-part series covering the forces that are driving interoperability, as well as the future vision of open networks, and what it all could mean to your organization. Check back for part 2, “How TEFCA affects your technology and what the heck is a QHIN?” coming soon.

# # #

Ben Rosen is a senior client success manager and business unit owner for the interoperability solution suite at Netsmart. With more than a decade of healthcare experience, Ben has led numerous initiatives to integrate healthcare systems and enhance data sharing across the care continuum. His dedication to advancing healthcare interoperability drives his active involvement in industry initiatives and standards organizations, where he provides insight for frameworks such as HL7 FHIR, USCDI and others. Ben holds a Bachelor of Science in kinesiology from Kansas State University and a Bachelor of Science in nursing degree from the University of Nebraska Medical Center.

©2025 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in the Netsmart blog and is reprinted here with permission. For more information or to request permission to print, please contact Netsmart.

Home Care Nurses’ Proud History

Caring for the Caregiver

by Elizabeth E. Hogue, Esq. | May 9, 2025 | Caring for the Caregiver, Clinical

by Elizabeth E. Hogue, Esq.,

It's National Nurses Week!

Home Care Nurses, it’s National Nurses Week, May 6 – May 12, 2025, so we are celebrating the profession of nursing!

Home Health Nurses Have a Proud History

Home care nurses have an especially proud history. Perhaps the definitive book on home care nursing is No Place Like Home: A History of Nursing and Home Care in the United States authored by Karin Buhler-Wilkerson in 2001. As Buhler-Wilkerson makes clear, home care nursing in the U.S. is modeled on care provided in patients’ homes that was initiated by William Rathbone in Liverpool, England, in 1859.

The Start of Home Health Nursing

Rathbone first encountered a home care nurse, Mary Robinson, during the illness of his wife. Rathbone persuaded Robinson to work with him in an experiment to provide care for the sick poor in their homes while simultaneously teaching them how to take better care of themselves. Robinson was so shocked and overwhelmed by the work that she was ready to quit after the first three months. A key difficulty was recruiting nurses for such difficult work. Rathbone then enlisted the help of Florence Nightingale.

Nightingale viewed the care of patients in their homes as one of nursing’s most important tasks and threw her wholehearted support behind Robinson’s efforts. According to Buhler-Wilkerson, Nightingale said, in a widely read article published in 1876, that nurses who visited patients in their homes “were not, she assured her readers, some new form of cooks, relief officers, district visitors, letter writers, store keepers, upholsters, almoners, purveyors, ladies bountiful, head dispensers, or a medical comfort shop; they were simply nurses.” Their goal, according to Nightingale, was to “get people going again” with a “sound body and mind.” Nightingale was unsuccessful in recruiting nurses to help Rathbone and Robinson, so Rathbone started a school to train home care nurses.

The Homecare Model Comes to the U.S.

The model of homecare nursing that developed in England was very attractive to women in the U. S. around the turn of the century. Buhler-Wilkerson describes the ideal home care nurse at this time as follows:

“As nurse-author Mary Gardner suggested, the ideal visiting nurse was a faultless creature ‘possessing all the virtues, combining the experience of age with the enthusiasm of youth, and also having a sense of humor, which is perhaps the only thing which will make the years’ of this kind of work possible.’”

Not for the Faint of Heart

The work was extremely arduous. As Buhler-Wilkerson says in her book:

“Many nurses, while attracted to visiting nursing, found the work too mentally and physically exhausting. Walking long distances in all kinds of weather, climbing endless flights of stairs, cleaning and disinfecting patients’ rooms, changing beds, and being constantly exposed to disease were all part of the visiting nurse’s daily routine. The ‘delicate’ nurse found this an impossible undertaking, but even the strongest became exhausted – even sick – at the end of a day of work…Fatigued, discouraged, and often sick, many nurses left for more lucrative or easier work…As a result, the turnover was high and replacements difficult to find. With a large proportion of the staff leaving, each year seemed a new enterprise.”

Karin Buhler-Wilkerson

No Place Like Home:, A History of Nursing and Home Care in the United States

Sound Familiar?

The same description certainly fits home care nursing today. The work of home care nurses is difficult, but crucial to our country. Hats off to homecare nurses today and every day!

# # #

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.

©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

Ensuring HIPAA Compliance in Healthcare Communication

Admin

by Rowan Report | Mar 31, 2025 | Admin, Clinical, HIPAA

by Devin Paullin, CGO at Skyscape Buzz

Ensuring HIPAA Compliance

Communications Requiring HIPAA Compliance

While patient communication requires HIPAA adherence, so does any discussion between other parties. Essentially, any time PHI is discussed, a degree of confidentiality must be involved. For example, the Health Insurance Portability and Accountability Act (HIPAA) requires that sensitive patient data be protected when shared or discussed among:

Healthcare Providers and Patients
- Any time a caregiver, staff member, doctor, nurse, or any other employee communicates with a patient, resident, or client, outside of face-to-face meetings, it must be done securely in a way that meets HIPAA standards.
Healthcare Professionals Among Themselves
- HIPAA compliance must be met when healthcare professionals discuss PHI within their department or collaborate with external departments.
Healthcare Providers and Insurance Companies
- Insurance providers require patient details and sensitive PHI. Still, anything that makes information vulnerable to interception must be fully compliant with HIPAA standards.
Healthcare Organizations and Third-Party Associates
- Third parties that need to handle PHI (e.g., IT consultants, collections agencies, or other vendors) must do so in a way that protects patient data. To safeguard communication, healthcare organizations should ask outside associates, vendors, or agencies to sign a business associate agreement (BAA) and/or Data Processing Agreement (DPA). This is a formal agreement to comply with HIPAA standards and ensure accountability.
Healthcare Organizations and Public Health Authorities
- Some diseases or conditions require healthcare professionals to report to public health authorities (e.g. COVID-19 information during the pandemic). This communication requires stringent security measures and protection of PHI.

Why HIPAA Compliance Matters

In healthcare, effective communication is essential for providing high-quality care. However, without HIPAA compliance, the risk of data breaches increases. Implementing secure, HIPAA-compliant communication systems ensures the protection of Personal Health Information (PHI) while improving overall operational efficiency.

Key Benefits of HIPAA-Compliant Communication

Protects Patient Privacy and Data Security
- HIPAA-compliant platforms use advanced encryption and access controls to prevent unauthorized access. This protects patient information, including medical histories, diagnoses, and test results.
Enhances Communication Efficiency
- Secure messaging platforms streamline communication between patients, caregivers, and healthcare providers. These tools eliminate inefficient methods like phone calls and ensure real-time communication.
Strengthens Collaborative Care
- Providing high-quality healthcare often involves a team of professionals working together. Whether it is a hospital placing a patient in rehabilitation or home care, coordinating with intake team, care team and providers,collaboration is key. HIPAA-compliant communication tools allow these professionals to securely share critical patient information, ensuring everyone has the details they need to deliver cohesive, well-informed care.
Reduces Legal and Financial Risks
- Compliance with HIPAA regulations minimizes the risk of violations, protecting organizations from hefty fines and legal repercussions.
Maintains Patient Trust
- Patients are more likely to engage openly with healthcare providers when they feel confident that their sensitive information is protected.

How to Ensure HIPAA Compliance in Communication

To comply with HIPAA regulations, healthcare organizations should adopt the following secure communication methods:

Encrypted Emails
- Ensure emails containing PHI are encrypted and, in some cases, require patient consent.
Secure Messaging Platforms
- Use platforms specifically designed for HIPAA compliance for text-based communication.
HIPAA-Compliant Voice Calls and Telehealth
- Ensure voice and video communication channels are encrypted and secure.
Patient Portals
- Provide secure portals with two-factor authentication for patients to access their medical information.
Secure File Sharing
- Use encrypted systems for sharing patient documents and medical records.

Implementing HIPAA-Compliant Communication Platforms

Adopting a HIPAA-compliant communication platform requires a thorough evaluation of existing systems and policies. Organizations should consider the following steps:

Conduct a Communication Audit
- Identify all channels currently used for healthcare communication and assess their compliance.
Choose a Secure Platform
- Select an all-in-one communication solution designed to meet HIPAA standards.
Establish Access Controls
- Implement role-based access to ensure only authorized personnel can view PHI.
Provide Staff Training
- Educate employees on the importance of HIPAA compliance and how to use secure communication tools.
Monitor and Evaluate
- Regularly assess communication practices to identify and address vulnerabilities.

Final Thoughts

HIPAA-compliant communication is not just a legal obligation—it’s a commitment to patient privacy, security, and high-quality care. By implementing secure communication platforms, healthcare organizations can enhance efficiency, foster trust, and reduce the risk of data breaches. Investing in compliance is an investment in the long-term success and reputation of your organization.

# # #

Devin Paullin HIPAA Compliance in Home Healthcare

Devin Paullin is an award-winning innovator and executive in Healthcare Technology, having developed successful products, solutions, and partnerships in Life Sciences, Post-Acute Care, SDOH, and Long-Term industries.

He is currently Chief Growth Officer for Skyscape which provides Buzz, an all-in-one, real-time HIPAA-compliant clinical collaboration and communication platform that enables the entire staff (admins, operations, clinicians, caregivers, partners, patients, and families) with the tools to communicate securely, easily, in groups or one to one, and affordable, by any mode they choose. Visit Buzz or contact them to learn more about Buzz by Skyscape today.

©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

Gaslighting Patients and Caregivers

Admin

by Elizabeth E. Hogue, Esq. | Mar 31, 2025 | Admin, Caring for the Caregiver, Clinical

by Elizabeth E. Hogue, Esq.

Gaslighting

Gaslighting, According to:

Nurse Professional Liability Exposure Claim Report: 4th Edition issued by Nurses Service Organization and CNA, for the period from 2016 to 2019 nurses who prvided services to patients in their homes; including those providing home health and hospice, and palliative care; were the most vulnerable of all nursing specialities to professional liability claims.

A Dubious Distinction

This is the first time that nurses in home care topped the list since the reports were first compiled in 2008. Home care nurses accounted for 20.7% of claims, which represents an increase of 12.4% over the previous number reported in 2015. Adult medical/surgical nurses topped the list in past reports.

Tell me Why

These factors may contribute to increases in claims against home care nurses:

Lack of institutional support for home care nurses that is routinely received by nurses in hospitals and other facilities
Growing popularity of home care
Rising acuity of home care patients
Lack of 24-hour oversight of patients
Absence of equipment in patients’ homes that is readily available in institutional settings to help identify patients at high risk for negative outcomes

According to the Experts

However, the nonprofit organization Emergency Care Research Institute (ECRI) says that eroding trust is a major threat to patient safety in 2025. ECRI ranks “gaslighting,” or dismissing concerns of patients and caregivers, as the top issue. In other words, nurses aren’t listening to patients and their caregivers! There is an old adage that says that if practitioners would just listen to their patients, patients will tell them what is wrong (i.e., the diagnosis). Perhaps, then, the best way to avoid negligence and resulting lawsuits is to listen to patients and caregivers.

Gaslighting Safeguards

Other strategies that nurses can use to protect themselves from malpractice claims include:

Stay up to date on education and training
Document assessments of patients in a timely and objective manner
Go up the chain of command when concerned about the well-being of patients
Maintain files that demonstrate character; such as letters of recommendation, notes from patients, and performance evaluations

Of course, complete, accurate and contemporaneous documentation may provide the best defense of all!

Final Thoughts

An increase in malpractice claims against home health and hospice nurses is a significant new industry development. It’s time to move risk management, with a focus on listening to patients and caregivers, higher up the list!

# # #

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.

©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

Enabling Care Through AI

Admin

by Rowan Report | Mar 31, 2025 | Admin, Artificial Intelligence, Clinical, Partner News

by John Crighton, CTO at Curantis Solutions

Enabling Care Through AI: Ethical Issues

Recently, artificial intelligence (AI) has become an essential component of healthcare organizations. AI is revolutionizing hospice and palliative care by enhancing patient care and optimizing workflows. Its impact is undeniable in these sensitive and life-changing fields. At Curantis Solutions, we are proud to apply AI-driven solutions to support caregivers while upholding ethical standards, enabling care through AI.

The Importance of AI in Hospice and Palliative Care

Hospice and palliative care are primarily based on empathy, understanding, and individual approach. When applied correctly, AI can enhance these core principles in several ways:

Improving Efficiency
- Some of the time-consuming tasks, such as entering assessment notes, reviewing recent documents before a patient meeting, or creating a summary of recent documentation in preparation for a team meeting, can be performed or assisted by AI. By automating these administrative tasks, caregivers can spend more time providing direct patient care.
Predictive Analysis
- AI tools can analyze the patient’s data and predict the possible changes in the patient’s condition, which will help to prevent complications.
Individualized Care Plans
- Based on the patient’s history, AI can help clinicians in the development of care plans that are more accurate in meeting the needs of the patient. Although the idea of using AI in hospice and palliative care is fascinating, it is crucial to approach this issue with caution and always pay attention to ethical issues.

Ethical Issues in the Use of AI in Hospice and Palliative Care

As the industry incorporates AI into our products and agencies, we need to consider ethical implications such as those shown below:

Privacy and Data Protection Issues
- Hospice and palliative care deal with the patient’s private details. At Curantis Solutions, we ensure that all AI-powered tools comply with the highest security and privacy standards, safeguarding patient data at every step.
Bias and Fairness
- The way AI systems are developed, they are only as good as the data that is used in their development. At Curantis Solutions, we strive to recognize and eliminate any possible prejudice in the AI systems that we develop to benefit all patients.
Transparency and Accountability
- It is important that the caregivers and the patients know how the AI is being used and how the decisions are made. We try to make our AI solutions as transparent as possible, and we ensure that the final decisions are always made by humans. Hospice and palliative care are very personal. This field is defined by the human component, and AI should only supplement it and not replace it. The solutions that we provide are intended to assist clinicians in order to maintain the sanctity of every patient.

A Future of Kindness with the Help of AI

The healthcare sector is changing rapidly, and AI is coming in to improve hospice and palliative care. At Curantis Solutions, we are proud to apply AI in a way that enhances the human factor, ethical values, and the capacity of the caregivers to offer the best care possible to the patient. Therefore, it is possible to envision a future where technology and empathy coexist to ensure that every patient gets the care they require. Leverage AI to reduce administrative burdens for hospice and palliative care.

About Curantis Solutions and AI

The goal of Curantis Solutions is to assist hospice and palliative care providers in the provision of patient-centered and compassionate care. This post discusses how AI can be used in this mission and how it can be done ethically.

We accomplish this in the following manner:

Working in partnership with specialists
- We partner with clinicians, ethicists, and AI experts to guarantee that our solutions are appropriate for the context of hospice and palliative care).
Revisiting the Model
- AI is not set and forgotten; it needs to be assessed and improved on an ongoing basis. We also regularly check the efficacy of our AI tools to ensure that they are accurate, fair, and reliable.
Enabling Care Teams
- Our solutions which are supported by AI are meant to support the skills of the care teams and not to replace them. Thus, we lessen the burden of documentation to allow the providers to focus on the patient and their families more often.

# # #

John Crighton is a seasoned technology leader, with over 25 years of experience in software development innovation and best practices.

John most recently served as the Chief Technology Officer for Lightning Step, a Behavioral Health SaaS EHR with over 100,000 users. John served on the executive team that scaled the business, contributing to the 40x revenue growth and eventually to a successful exit. Prior to that, John managed a custom development team at Openlink Financial and was responsible for product quality at SolArc Software. John was part of the management team that led Mission Critical Software to a successful IPO and went on to management roles with JMI Software, NEON Systems, and NetIQ.

John is a veteran of the US Army, and graduated Summa Cum Laude from the University of Houston with a Bachelor’s of Business Administration.

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in the Curantis Solutions blog and is reprinted in Healthcare at Home: The Rowan Report with permission. For further permission to reprint, contact Curantis Solutions.

Dementia Care Model Test

Clinical

by Rowan Report | Mar 21, 2025 | Clinical, CMS, Partner News

FOR IMMEDIATE RELEASE

Contacts: PocketRN
William Leiner
Chief Operating Officer
will.leiner@pocketrn.com

Daughterhood
Becca Dittrich
becca@daughterhood.org

PocketRN and Daughterhood Announce a National Strategic Partnership to Test Medicare Dementia Care Model Developed by Centers for Medicare & Medicaid Services

Guiding an Improved Dementia Experience (GUIDE) Model, a Centers for Medicare & Medicaid Services Innovation Program, Aims to Increase Care Coordination, Support for Caregivers

WASHINGTON, D.C., MARCH 18, 2025 – Today, PocketRN, a leader in virtual nursing, and Daughterhood, a leading non-profit organization empowering family caregivers with community and resources, announced they will form a National Strategic Partnership to test the Centers for Medicare & Medicaid Services (CMS) alternative payment model designed to support people living with dementia and their caregivers.

Under CMS’ Guiding an Improved Dementia Experience (GUIDE) Model, PocketRN will be one of almost 400 participants building Dementia Care Programs (DCPs) across the country, working to increase care coordination and improve access to services and supports, including respite care, for people living with dementia and their caregivers.

Launched on July 1, 2024, the GUIDE Model will test a new payment approach for key supportive services furnished to people living with dementia, including: comprehensive, person-centered assessments and care plans; care coordination; 24/7 access to an interdisciplinary care team member or help line; and certain respite services to support caregivers. People with dementia and their caregivers will have the assistance and support of a Care Navigator to help them access clinical and non-clinical services such as meals and transportation through community-based organizations.

“We couldn’t be more thrilled to bring our revolutionary nurse-led care model to the millions of dementia patients and families who need it most. With PocketRN, patients and families get unwavering support from a Nurse for Life as they navigate the complexities of managing dementia at NO cost to them. Nurses are hands-down the best clinicians to be the ‘glue’ for patients and their families throughout their dementia journey–they’ve been doing so forever, and it’s high-time their work is valued by our system.”

Jenna Morgenstern-Gaines

CEO, PocketRN

“We are so excited to embark on this partnership that will bring invaluable expertise and resources to the dedicated dementia caregivers in our Daughterhood community. Dementia caregiving is a uniquely complex and deeply emotional journey—one that requires not only knowledge and support but also compassion and resilience. This partnership will further empower caregivers with the tools, guidance, and encouragement they need to navigate this journey with confidence, connectivity, and care.”

Anne Tumlinson

Founder, Daughterhood

PocketRN and Daughterhood’s partnership in delivering the GUIDE Model will help people living with dementia and their caregivers have access to the education, supports, and services they need to feel more empowered and less alone in their journey – including unique “circle” community groups, podcasts, educational videos, and other curated resources. The GUIDE Model also provides respite services for certain people, enabling caregivers to take temporary breaks from their caregiving responsibilities. Respite is being tested under the GUIDE Model to assess its effect on helping caregivers continue to care for their loved ones at home, preventing or delaying the need for facility care.

More information on CMS’ GUIDE Model

# # #

About Daughterhood

Daughterhood is a 501(c)(3) organization that fosters community that empowers individuals to navigate the practical and emotional complexity of caregiving. Its unique blend of “circle” community groups, blogs, podcasts, and curated partner resources gives family caregivers emotional relief along with real, practical, and tangible solutions to navigate the stress, overwhelm, and confusion they often face – and to do so with the support of others on a similar path. For more information, visit https://daughterhood.org/ or engage with Daughterhood on LinkedIn, Facebook, and Instagram.

About PocketRN

PocketRN gives patients, families, and caregivers a Nurse for Life. Its mission is to close the gap between home and healthcare by: enabling nurses to care proactively and continuously at the top of their license, enabling caregivers with peace of mind and the confidence to support others, and enabling patients to access whole-person, trusted, empathetic care when and where they want it. PocketRN is the glue that holds together fragmented experiences in care so that partners, clinicians, patients, and families get back more of what they need: quality time. For more information, visit www.pocketrn.com or engage with PocketRN on LinkedIn, Facebook, and Instagram.

More Violence in Care at Home

Admin

by Elizabeth E. Hogue, Esq. | Mar 21, 2025 | Admin, Caregiver Safety, Caring for the Caregiver, Clinical

by Elizabeth E. Hogue, Esq.

Violence Against Home Care Providers Continues

Violence in Care at Home Continues…

Sadly, but not surprisingly, the violence against field staff caring for patients in their homes continues. Here’s a recent example:

On February 28, 2025, a hospice nurse in Texas was accosted inside a patient’s home while she was attempting to provide care. The man who accosted her inside the home followed her outside with a rifle and fired at her as she fled. The nurse was uninjured, but her car was struck by at least one bullet.

Then, still armed, the man went back inside the patient’s home where he stayed close to the patient while pointing his rifle at deputies. Law enforcement officers were able to communicate with him and de-escalate the tense situation. The man was booked into the county jail on a charge of aggravated assault with a deadly weapon and bond was set at $250,000.

By the Numbers

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

Violence Policies Needed

First, regardless of practice setting, management should develop a written policy of zero tolerance for all incidents of violence, regardless of source. This policy should include animals. The policy must require employees and contractors to report and document all incidents of threatened or actual violence, no matter how minor.

Beyond Reporting

Emphasis should be placed on both reporting and documenting. Employees must provide as much detail as possible. The policy should also include zero tolerance for visible weapons. Caregivers must be required to report the presence of visible weapons.

UCHealth SAFE Program

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

Encourage staff members to STOP if they feel unsafe for any reason.
If danger is not imminent, workers should pause to generally ASSESS their environments. Staff members should think about what happened and observe what is currently happening. Is there, for example, mounting frustration or anger?
Staff should then FAMILIARIZE themselves with the area. Who is the patient? Where is the patient? Are there any factors that might escalate behaviors? Staff members should also consider putting themselves in positions where they have a route to escape, if necessary.
ENLIST help. Getting help may, for example, include pushing panic buttons on mobile devices.

In Their Own Words

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

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

Chris Powell

Chief of Security, UCHealth

Final Thoughts

Every caregiver matters. The healthcare industry has lost caregivers to violence on the job in the past. Let’s do all that we can to avoid similar events in the future.

# # #

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.

©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

HIPAA Compliance in Communication

Clinical

by Rowan Report | Mar 21, 2025 | Clinical, HIPAA, Regulatory

by Devin Paulin, Skyscape

The Critical Importance of HIPAA Compliance in Home Healthcare Communication

The Rise of Messaging Apps and Healthcare Communication

Nearly 44% of the global population (3.5 billion people) rely on messaging apps to communicate. Unfortunately, available consumer SMS, text, and even “secure” messaging apps like WhatsApp, Apple Message, or Google Messages do not come with safety and security features specifically required to be compliant in the healthcare industry.

Still, consumer SMS apps are quite often used for healthcare communication in which Personal Health Information (PHI) is shared, and many individuals don’t understand the level of risk or that this is a violation of the law.

HIPAA Compliance in Communication Advantages

Group and Individual texting are a proven, timesaving, real-time communication tool in healthcare, and must be done through a HIPAA-compliant messaging platform. Secure platforms can improve privacy and security while maintaining compliance in such a sensitive industry.

There are many reasons why HIPAA compliance is vital for secure communication in home healthcare.

HIPAA Compliance in Communication - Not Just for Doctors and Nurses

HIPAA compliance is not just for medical clinics and hospitals. HIPAA compliance extends to all types of services that hold healthcare information. Physical Therapy, Personal Care, Home Health, Wellness, Behavioral Health, Assisted Living, and many more all fall under HIPAA. Most importantly, ALL providers, staff members (full or part-time), contractors, and third-party partners who come in contact with PHI are subject to HIPAA law, violations, and fines.

We're too Small for Violations to be Noticed, Though

Wrong. We regularly speak to many owners and staff members of large and small Home Health Care, Assisted Living, Hospice and Palliative, Mobile Imaging, PT and Rehabilitation, and Behavioral Health across the country. Many openly operate under the false assumption that their business is too small to be noticed by the U.S. Department of Health and Human Services (HHS) and the Office for Civil Rights (OCR), who is responsible for enforcing the HIPAA Privacy and Security Rules. That is not how it works.

Complaints logged by those within or close to your business alert the OCR to possible HIPAA violations. These can be from current and former staff, patients, clients, business partners, or anyone who claims to have witnessed a HIPAA breach. This can include disgruntled employees and whistleblowers. Even for companies that are HIPAA compliant, any breach is to be reported by an employee assigned as the security officer.

HIPAA Compliance in Home Healthcare by Type

HIPAA mandates compliance for all communications involving PHI. Some key examples include:

Provider-to-Patient Communication
- Secure platforms are necessary when caregivers contact patients outside of in-person visits.
Provider-to-Provider Communication
- Sharing PHI within or between departments must meet HIPAA standards.
Provider-to-Insurance Communication
- Insurance companies require sensitive patient data, which must be securely transmitted.
Provider-to-Third-Party Communication
- Any third-party associates handling PHI must have a signed Business Associate Agreement (BAA) and adhere to HIPAA regulations.
Provider-to-Public Health Authorities
- Reporting communicable diseases or pandemics requires secure communication.

Consequence of HIPAA Violations

HIPAA violations can have severe consequences, including:

Financial Penalties
- Fines range from $100 to $50,000 per violation, depending on the level of negligence.
Reputational Damage
- Data breaches erode patient trust, leading to a damaged reputation.
Legal Consequences
- In cases of willful neglect, organizations may face lawsuits or criminal charges.

Final Thoughts

Understanding and adhering to HIPAA regulations is crucial in home healthcare. Compliance not only safeguards sensitive information but also strengthens patient trust and ensures ethical operations.

# # #

Devin Paullin is an award-winning innovator and executive in Healthcare Technology, having developed successful products, solutions, and partnerships in Life Sciences, Post-Acute Care, SDOH, and Long-Term industries.

He is currently Chief Growth Officer for Skyscape which provides Buzz, an all-in-one, real-time HIPAA-compliant clinical collaboration and communication platform that enables the entire staff (admins, operations, clinicians, caregivers, partners, patients, and families) with the tools to communicate securely, easily, in groups or one to one, and affordable, by any mode they choose. Visit Buzz or contact them to learn more about Buzz by Skyscape today.

©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

Nursing Facility Compliance Guidance

Admin

by Elizabeth E. Hogue, Esq. | Mar 13, 2025 | Admin, Clinical, Regulatory

by Elizabeth E. Hogue, Esq.

Nursing Facility Compliance Guidance

Takeaways for Hospices

In November of 2024, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services issued revised “Nursing Facility Industry Segment-Specific Compliance Program Guidance.” This guidance describes:

Risk areas for nursing facilities
Recommendations and practical considerations for mitigating risks
Other important information that the OIG believes nursing facilities should consider when implementing, evaluating, and updating their compliance and quality programs

Guidance Extends to Post-Acute Providers

The guidance targets nursing facilities. Howeve, it also clearly states that post-acute providers other than nursing facilities should use the guidance in their compliance efforts. The OIG says: “We encourage all long-term and post-acute providers to establish and maintain effective compliance and quality programs.” Guidance for nursing facilities, for example, specifically addresses relationships between nursing facilities and hospices.

The OIG...

First...

acknowledges that nursing facilities may arrange for hospice services for patients who meet the eligibility criteria and who elect the hospice benefit.

Then...

reminds facilities and hospices that requesting or accepting remuneration from hospices may subject both parties to liability under the federal anti-kickback statute. This applies if the remuneration may influence nursing facilities’ decisions to do business with hospices or induce referrals between the parties.

Goes On...

points out that nursing facilities that refer patients for hospice services who do not qualify for the hospice benefit may be liable for submission of false claims.

Nursing Facility Compliance Guidance OIG

Additionally...

says that hospices are permitted to furnish noncore services under arrangements with other providers or suppliers, including nursing facilities. State Medicaid Programs pay hospices at least 95% of the Programs’ daily facility rate. Hospices are then responsible to pay facilities for patients’ room and board.

Finally...

provides a list of suspicious arrangements between nursing facilities and hospices, including: (1) referrals of patients to hospices to induce hospices to refer patients to facilities, and (2) solicitation or receipt of hospices of goods or services for free or below fair market value, including nurses or other staff to provide services at facilities for nonhospice patients and monetary payments for:

referrals of patients to hospices to induce hospices to refer patients to facilities
solicitation or receipt of hospices of goods or services for free or below fair market value
- solicitation of nurses or other staff to provide services at facilities for nonhospice patients
- monetary payments for:

- - Room and board for patients in excess of what nursing facilities receive directly from Medicaid if patients are not enrolled in hospices. Additional payments must represent fair market value of additional services actually provided to patients that are not included in Medicaid daily rates.
  - Additional services for residents that include room and board payments to hospices from Medicaid Programs
  - Additional services for patients that are not included in room and board payments from Medicaid Programs at rates that are above fair market value
  - Provision of services by nursing facilities to hospice patients at rates that are above fair market value

Final Thoughts

Hospices are surely under fire these days from fraud enforcers. Engaging in the practices described above is likely to draw attention by enforcers and possible enforcement action.

# # #

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.

©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

Humana Thyme Agreement

Clinical

by Kristin Rowan | Mar 7, 2025 | Clinical, Hospice, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

Palliative Care for Medicare Advantage Members

Cancer is one of the highest leading causes of death in the United States, second only to heart disease. The challenges for cancer patients are not only physical, but emotional and financial as well. The consequences of these challenges are often devastating to the patient and their families. Providing additional care, support, and pharmaceutical interventions through value-based care can improve patient outcomes and reduce out-of-pocket costs.

Thyme Care

Thyme Care is a Nashville-based cancer treatment center that operates in seven states. The centers provide not just treatment, but cancer care navigation, designed to work within the value-based framework, keeping the patient at the center of care. Thyme Care includes an oncology care team, a patient app with multiple resources and 24/7 access to support. Patient surveys track symptoms and reduce barriers to care. This approach combines cancer treatment and palliative care for whole-person cancer care support.

Palliative Care

Palliative care works alongside medical care to improve the quality of life for the patient, addressing physical, emotional, and spirtual needs. Strictly speaking, it is not medical care, and not specifically covered by most insurance plans. The out-of-pocket costs for palliative care can be extremely high, making this kind of care an inaccessible amenity for most patients.

Value-Based Care

Value-based care reimburses care providers partially based on patient outcomes and patient satisfaction. Providers also share the financial risk of care with health insurance companies. Care providers who can both improve outcomes and patient satisfaction can be reimbursed more through health insurance plans, which can cover the costs of palliative care, even when it is not explicitly covered by the plan.

Humana

Humana is a payer with plans for Medicare, Medicaid, and Individual/Family beneficiaries. The Medicare Advantage value-based care plans allow Humana to disperse payments for covered services in partnership with care provider teams across a patient’s care journey. The better the outcome and satisfaction, the more Humana can pay a provider for care. Better outcomes often means reduced hospital visits, a longer time at home before requiring skilled nursing facilities, and lower costs.

Humana Thyme Palliative Care Collaboration

The recently announced partnership between payer and provider will give eligible patients access to palliative care support as part of the whole-person cancer care navigation provided by Thyme. Humana patients can also receive, as needed, 24/7 virtual care, medication guidance, symptom management, chronic condition management, community-based resources, financial assistance, transportation, food assistance, and/or access to stable housing.

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. She also has a master’s degree in business administration and marketing and 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