by Tim Rowan | Mar 6, 2024 | Admin, Clinical
by Tim Rowan, Editor Emeritus
[Editor’s note: this article is based on a recorded video interview with Barbara Karnes. To see the full conversation in her own words, click here.]
For longer than most of us have been in home care, in fact, for longer than some home care workers have been alive, Barbara Karnes has lived and breathed hospice. From young nurse in 1980 to administrator to author and video producer, she continues into her mid-80’s to teach young nurses and distraught families about the dying process and the grief experience.
Last autumn, however, she was suddenly transported to the other side of the classroom. The death of her husband, a longtime chain smoker, introduced her to cancer, hospice, death, and grief from the perspective of the heart, after decades of dealing with it only intellectually. Barbara graciously agreed to speak with me late last month. Having been through the experience myself, I thought it best to wait a few months after his death to extend my interview invitation.
“I have always been the kind of person who operates out of the head more than the heart,” she began. “Putting on the shoes of a spouse caregiver, and suddenly living what I have taught for decades, put a whole different perspective on it. Even though I knew better, I sometimes did things I tell people not to do.”
She told me about the urge to do those things. “I kept pushing food and the need for nutrition on him,” she remembered. “Then, one day, I finally realized I was trying to keep him alive while his body was trying to die. And with that realization, I began to do what I always recommend everyone else do, always offer and never force.”
“As a professional, I observe the dying and grieving processes. With my husband, I was feeling it. I was in the shoes, and I responded like a family member, not like a hospice expert.”
I Wanted to Know, But He Did Not
Barbara talked about the anguish of not knowing how much time her husband had left once he was diagnosed. “When he decided that he was not going to treat his cancer with chemotherapy, that included the decision not to bother with a lung biopsy just to see what type of cancer he had. ‘If I’m not fighting it, what difference does it make what kind it is?’ he said, and I couldn’t argue. There are fast and slow kinds [of lung cancer] and I wanted to know which it was so I could prepare myself. With my knowledge, I could have estimated how long his death process would take and known when to begin hospice care. I hoped it was one of the slow-growing types rather than small-cell carcinoma, but I realized that was a wish on my part, not realistic, and not what he wanted.”
Hospice Has Changed
In a side conversation, Barbara reminisced about the way hospice care was conducted in her early years as an RN and turned it into advice for today’s nurses.
“Our goal was always to be there with the family at the moment of the patient’s death. Today, hospice is much more medical, more medication oriented. I like the “End-of-Life Doula” movement today. Their companion model reminds me of the way we used to do hospice.”
As it turned out, he was diagnosed in May and passed away in September. He entered hospice right after Labor Day, even though she called to arrange services the Friday before. “Hospices should not do that,” she asserted. “When people are dying, holidays should not be a reason to delay starting care.” Nevertheless, due to this combination of circumstances, a fast-acting cancer and a slow-acting hospice, the husband of a foremost expert on death and grieving was in hospice for the all too common two weeks.
“To be fair, he was driving himself to massage appointment through August,” she clarified. “It was the day he was unable to get off the massage table that we knew it was time.”
Sometimes the Heart Wins
“It was as though I had a split personality,” she said, as I tried to gently encourage her with more personal questions. “There were parts of me that, from the day he was diagnosed, were thinking about him dying. There were parts of me, intellectually, that knew but didn’t want to see all that was unfolding. It’s a kind of confusion.”
Finally, the renowned Barbara Karnes offered the conclusion I had hoped to hear but was reluctant to directly ask. “I don’t know if my knowledge helped or not. There were signs, but I didn’t want to see them. When you’re in it, it is a different experience than when you’re teaching about it.”
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Tim Rowan is a 30-year home care technology consultant who co-founded and served as Editor and principal writer of this publication for 25 years. He continues to occasionally contribute news and analysis articles under The Rowan Report’s new ownership. He also continues to work part-time as a Home Care recruiting and retention consultant. More information: RowanResources.com
Tim@RowanResources.com
©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report.homecaretechreport.com One copy may be printed for personal use: further reproduction by permission only. editor@homecaretechreport.com
by Kristin Rowan | Feb 28, 2024 | Admin, Regulatory
The Biden administration has recently increased its efforts at antitrust enforcement against some of the largest companies in the U.S. These include Apple, Amazon.com, Live Nation Entertainment, and Alphabet’s Google unit. The enforcement of antitrust laws would restrain monopolies in the U.S. Thus far, the Justice Department has had questionable success in stopping mergers, but continues its crusade on monopolies. The administration has stated the the healthcare industry is a priority in its antitrust efforts.
The Wall Street Journal reported on February 27, 2024, that a new Antitrust investigation has been launched into UnitedHealth. This is not the first antitrust action against UnitedHealth Group. In 2022, the Justice Department sued to block UnitedHealth’s plan to buy Change Healthcare. That lawsuit was unsuccessful.
According to the WSJ, The Justice Department has spent the last few weeks interviewing industry representatives in markets where UnitedHealth operates.
Investigators asked about relationship between UnitedHealth and Optum, the health-services arm of the company, which owns physician groups, surgery centers, and pharmacy-benefit managers. They specifically asked about the effects on the doctor-group acquisitions on rivals and consumers.
UnitedHealth has been under scrutiny for some time by the Justice Department. They have twice asked for information about the planned merger with Amedisys, a home health company. UnitedHealth is also facing a private antitrust lawsuit by a hospital system in California, siting strong-arm tactics to exert control over its affiliated physician groups and primary-care doctors.
The DOJ isn’t stopping at antitrust probes. A concurrent investigation is looking into UnitedHealth’s Medicare billing issues, including documentation of patients’ illnesses. The more health conditions a patient has, the higher the Medicare payments. The DOJ is looking into “aggressive documentation” practices by UnitedHealth doctors and other healthcare providers.
Additionally, the merger between UnitedHealthcare and Optum medical groups could violate federal rules that cap the amount a health-insurance company retains from premiums. Health insurance plans should keep 15-20 percent of premiums for administrative costs, with the balance spent on patient care or sent as a rebate back to customers. Because UnitedHealthcare keeps their percentage of premiums and collects additional money from Optum, they may be well above the federal cap.
UnitedHealth has denied any antitrust claims, stating that United Health and Optum don’t favor one another, and routinely work with competitors. UnitedHealth Chief Executive Andrew Witty testified that Optum has an “arm’s length relationship” with United Healthcare.
In an ongoing investigative series about CareMount/Optum, The Examiner News reporter Adam Stone, spoke with an anonymous insider who said, “If they are stopped before they become a monopoly, than that’s great, but they are headed down that road.” That same source has reported massive layoffs, mostly among C-suite executives, in the wake of the antitrust “document preservation notice” from the DOJ.
We will continue following the antitrust lawsuit and the objection to the merger with Amedisys.
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
©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com
by Elizabeth E. Hogue, Esq. | Feb 28, 2024 | Clinical
by Elizabeth E Hogue, Esq.,
After a hospitalized patient suffered a severe choking incident and was placed on life support, his family faced a difficult decision in response to a telephone call from the hospital. They were asked if they wanted to remove life support. The family told the hospital that they did. The hospital subsequently removed life support and the patient passed away. Then came something that no one expected: the patient who was allegedly deceased telephoned his family!
The mix-up started with a call to 911. Medics responded to a call about a choking incident involving a piece of steak. The man who choked was not breathing and was unconscious when they arrived. Somewhere along the line, the patient was misidentified and treated as another patient.
Parents that were called to make life-ending decision for wrong person
The family of the living patient called non-emergency police services to notify authorities that the patient was not, in fact, deceased. The Medical Examiner’s Office retrieved the body from the funeral home, conducted an external examination, and used fingerprints to confirm the deceased patient’s identity. In a gross understatement, a member of the patient’s family said, “Somebody messed up.”
Although the consequences of decision-making by so-called “substitute decision-makers” are not usually so dire, the fact remains that providers and practitioners are obligated to seek informed consent from those authorized to give it when patients cannot consent for themselves.
Here are some questions that providers frequently ask about substitute consent:
If patients cannot consent, who can consent on their behalf?
The answer to this question varies depending on the laws of the state in which patients reside. Consent may be provided on behalf of incapacitated adults by:
- An attorney-in-fact, i.e., someone who has authority under a durable power of attorney
- Individuals authorized to consent under state substitute consent statutes
- Guardians or conservators of the person
- Courts
How old must patients be in order to be able to give valid informed consent?
Generally, patients must have reached the age of adulthood before they can give informed consent. The age at which individuals become adults, as opposed to minors, is defined by state law, so the age of adulthood varies from state to state. Practitioners who provide services in multiple states must take this fact into account when obtaining consent. When minors are unable to consent, the general rule is that their parents may give substitute consent on their behalf.
Are there any exceptions to this rule?
Yes. Patients who are not adults, but who seek certain types of care, such as treatment for sexually transmitted diseases, or who are “emancipated” may consent on their own behalf depending on the law in the state in which the patient resides.
What evidence of valid informed consent should practitioners obtain?
Providers may:
- Ask patients to sign a consent form
- Document consent in patients’ charts with or without patients’ signatures on the documentation
- Record consent
- Video the consent process
- Give patients a short written quiz on the material provided and, if patients answer the questions correctly, put a copy in patients’ charts
- Utilize any other credible forms of evidence of consent
The above case certainly illustrates the need to make sure that consent is obtained from appropriate givers of substitute consent and to document their authority.
©2024 Elizabeth E. Hogue, Esq. All rights reserved.
No portion of this material may be reproduced in any form without the advance written permission of the author.
by Rowan Report | Feb 28, 2024 | Clinical
by The National Minority Health Association,
Embracing Change, Empowering Caregivers
In the ever-evolving world of homecare, recruitment and retention pose significant challenges, particularly in California. However, FACT – Family, Adult and Child Therapies, a southern California-based homecare agency, has emerged as a beacon of hope, leveraging the innovative Caring4Cal program to enhance its workforce and service quality.
FACT, dedicated to supporting individuals with developmental disabilities, has a rich history dating back to the 1980s. Originating& from a collaboration of dedicated professionals and parents, FACT has been at the forefront of providing exceptional care and support to a diverse clientele, including minors, adults, and families grappling with a spectrum of diagnoses.
Caring4Cal: A Game-Changer in Caregiver Recruitment and Training
Under the leadership of its Board of Directors and their executive team: Tina Castro (Director of Adult and Employment Services), Lethia Perry (Director of Operations and Human Resources) and Spencer Ludgate (Director of School-Based Services and Controller), FACT has fully embraced the Caring4Cal community health worker recruitment program. This initiative has seen remarkable participation, with 39 staff members taking advantage of the opportunities it offers.
Eligibility and Scope
To participate in Caring4Cal, caregivers must:
- Reside in California.
- Currently work in or aspire to join an eligible job role in home- and community-based settings.
- Eligible roles include a wide array of healthcare professionals like HHA, CNA, RN, LVN, and more.
Partnership and Funding
The National Minority Health Association (NMHA), a pivotal entity in reducing health disparities among minorities, received a substantial grant under the Caring4Cal initiative. Spearheaded by the California Department of Healthcare Access and Information (HCAI), this program is a concerted effort to reinforce the workforce in home- and community-based care. With a strategic collaboration with Nevvon, a leader in e-training solutions for healthcare, this initiative is set to revolutionize caregiver training and retention.
FACT: A Legacy of Excellence and Adaptability
FACT’s enduring commitment to providing holistic, affordable, and quality mental health care is well-aligned with the Caring4Cal program. Their person-centered care approach, accessible locations, and advocacy for independence resonate deeply with the program’s objectives. For over twenty years, FACT has not only adapted to societal changes but has also been a vanguard in accepting and appreciating diverse abilities.
The Future Outlook
With the Caring4Cal program, FACT is not only addressing the immediate need for skilled caregivers but is also shaping a future where comprehensive and compassionate care is accessible to all Californians. This initiative stands as a testament to FACT’s unwavering dedication to its mission and philosophy.
A Call to Action
The success of FACT with the Caring4Cal program is a clarion call to all agencies in the sector. With available funding and training opportunities, it is an opportune time for other agencies to participate and enhance their capabilities. The program not only offers financial incentives but also ensures that caregivers are equipped with state-of-the-art skills to meet the growing demands of the sector.
FACT, working with the NMHA and its successful integration of the Caring4Cal program, exemplifies how strategic partnerships and innovative training initiatives can effectively address the twin challenges of recruitment and retention in the homecare industry.
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About the NMHA: The National Minority Health Association is a 501c3 non-profit organization founded in 1988. The NMHA delivers on its mission of heath equity through innovative programs including Health is for EveryBODY™ (www.healthisforeverybody.org), Operation Healthy You™, Equityville™ and The Art Alliance, to name a few. The lack of health equity in underserved, marginalized and hard to reach communities translates into lost lives, adverse health outcomes, higher costs, diminished productivity and declines in quality of life and well-being for everyone. For more information visit www.thenmha.org
by Elizabeth E. Hogue, Esq. | Feb 21, 2024 | Admin
By Elizabeth E. Hogue, Esq.
Case managers/discharge planners continue to come under fire from fraud enforcers for violations of the federal anti-kickback statute. This statute generally prohibits anyone from either offering to give or actually giving anything to anyone in order to induce referrals. Case managers/discharge planners who violate the anti-kickback statute may be subject to criminal prosecution that could result in prison sentences, among other consequences.
A U.S. District Judge in California sentenced an owner of a post-acute provider to eighteen months in prison for one count of conspiracy to commit health care fraud and one count of conspiracy to pay and receive health care kickbacks. From July of 2015 through April of 2019 the provider paid and directed others to pay kickbacks to multiple case managers/discharge planners for referrals of Medicare patients, including employees of health care facilities and employees’ spouses. Recipients of the kickbacks included a discharge planner/case manager at a hospital, and discharge planners at skilled nursing and assisted living facilities.
Payments of kickbacks resulted in over eight thousand claims to Medicare for patients referred to the provider. Medicare paid the provider at least two million dollars for services provided to patients referred in exchange for kickbacks. Because the provider obtained patient referrals by paying kickbacks, the provider should have not received any Medicare reimbursement. The discharge planners/case managers who received kickbacks from the provider also pled guilty and will be sentenced soon.
The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS), the primary enforcer of fraud and abuse prohibitions, says that discharge planners/case managers and social workers cannot accept the following from providers who want referrals:
- Cash
- Cash equivalents, such as gift cards or gift certificates
- Non-cash items of more than nominal value
- Free discharge planning services that case managers/discharge planners and social workers are obligated to provide
Discharge planners/case managers and social workers provide extremely important services that are valued by many patients and their families, but their credibility and trustworthiness is destroyed when they make referrals based on kickbacks received.
A word to managers and all the way up the chain of command to CEOs: whether or not you know when case managers/discharge planners accept kickbacks, the OIG may also hold you responsible.
You may be responsible if you knew or should have known. The OIG has made it clear that your job is to monitor and to be vigilant. A good starting point is to put in place a policy and procedure requiring discharge planners/case managers to report in writing anything received from post-acute providers. Even better, how about a policy and procedure that prohibits all gifts?
Now a word to post-acute marketers: do not give kickbacks to discharge planners/case managers and social workers. It is simply untrue that you must give kickbacks in order to get referrals. The proverbial bottom line is: Do you like the color orange? Is an orange prison uniform your preferred fashion statement? Please stop now!
Reprinted with permission from ©2024 Elizabeth E. Hogue, Esq. All rights reserved.
No portion of this material may be reproduced in any form without the advance written permission of the author.
by Kristin Rowan | Feb 21, 2024 | Admin, Clinical
By Kristin Rowan, Editor
The workforce shortage across the country both in and out of home care is creating increasing demand on workers and added stress on organizations. Added to this is the increasing number of older adults living past retirement age. As more and more “boomers” reach that age, more of them are considering aging in place rather than moving to a facility. High turnover rates among care providers also contributes to the workforce shortage for care at home agencies.
One agency has a plan to increase its workforce by 50% by the end of the year. Right at Home, based in Omaha, Nebraska, has more than 700 franchise locations and employs more than 45,000 caregivers. They intend to add 26,000 additional caregivers to address the growing needs of our aging population.
Recruitment and retention issues are not specific to care at home, but the compounding factors of a larger aging population and higher turnover rates make it a pressing issue. It may seem like a lofty goal to increase an already large workforce by another 50% when many businesses are struggling to hire at all. Right at Home has implemented several strategies to reach this goal:
- Preferred partnerships with job boards
- Collaborations with local and national job platforms working directly with franchise owners
- Technology solutions
- Increased efficiencies in the office gives staff more time and energy for hiring and onboarding
- Electronic onboarding resources and automated communication within applicant tracking systems to simplify hiring process
- Engagement platforms to reward and recognize caregivers to lower turnover rates
- Cultivating an appealing culture
- Becoming the employer of choice in each demographic area
- Breaking down the caregiver experience into micro elements for a better experience for caregivers
Creating partnerships with job boards and using automated processes for hiring are the simplest of these tasks to implement right away. Larger job boards like Indeed and Monster may not be willing to collaborate, but local colleges may be an easier route. They typically have job boards with smaller pools of applicants who are already partitioned into fields of study. No matter the size of your agency, there are technology solutions to reduce the time spent with onboarding and applicant tracking that are cost effective and increase efficiency. If you’re looking for one, we’ve reviewed several over the years.
Cultivating an appealing culture may be more difficult. An appealing culture is subjective and vague. Right at Home mentions breaking down the caregiver experience into micro elements. Even if you know what those micro elements are, improving the experience is the goal but not a plan. In a recent conversation with home care agency owner Bob Roth, he mentioned the difficulties of establishing leadership and creating culture in a dispersed workforce. This topic bears additional scrutiny and we will have some upcoming articles on creating culture in the next few weeks.
# # #
Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com
©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report.homecaretechreport.com One copy may be printed for personal use: further reproduction by permission only. editor@homecaretechreport.com
by Kristin Rowan | Feb 21, 2024 | Clinical, Regulatory
By Kristin Rowan, Editor
Federal Waiver Program
In 2020, CMS launched a hospital care at home program to help increase patient capacity during the height of the Covid-19 pandemic. The study included 300 hospitals and thousands of patients receiving care in their home using a hospital at home waiver. Outcomes of the study showed that patients had greater ability to stand up and move around at home than would have had in a hospital and that in-home caregivers were better able to educate patients on home to care for themselves once they were able to see the social determinants of care in the home. CMS also reports only 7.2% of patients were required to be transferred to a hospital.
Hospital Study
Mass General Brigham conducted its own study alongside CMS and analyzing outcomes of diverse patients, including socially vulnerable and medically complex patients. The findings of their national analysis showed that within 30 days of discharge, 2.6% of patients used a SNF, 3.2% died, and 15.6% were readmitted. Findings were consistent among all groups, including those who generally have worse outcomes: patients of Black and Latine race and ethnicity, dual-eligible patients, and patients with disabilities.
Health System Study
In April of 2020, Kaiser Permanente conducted an 18-month study on the scalability of “Advanced Care at Home” (ACAH). The patients all required hospital-level care and were first admitted to the program through the emergency department. Some were admitted to the hospital, and some were instead admitted to the Kaiser ACAH program, where a team of nurses, physicians, nurse practitioners, and a pharmacist developed a care plan.
This study increased its daily census from 7.2 per day to 12.7 per day at the end of study. The average episode of care decreased from 7.43 days to 5.46 days and readmission rates dropped from 11.52 percent to 9.24 percent. These patients were less likely to experience delirium than patients admitted to traditional hospital settings. The researchers noted the limitation of the study as being too small to develop precise comparisons.
Limitations of Acute Hospital Care at Home
Currently, the only patients eligible for AHCaH are those who have been evaluated in a hospital or emergency department. Kaiser has extended this to patients seen in their own urgent care offices in areas where they don’t own a hospital. Kaiser has served a few thousand patients through this program, but they estimate there are more than 1.1 million eligible patients. Rural patients who don’t live near a hospital or emergency department have the same trouble accessing AHCaH that they do accessing hospital and physician care now.
The CMS waiver for AHCaH has been extended through December 2024. Beyond that, it is unclear how hospital care at home will be reimbursed. Some providers have offered hospital care at home to risk-based patients in a VBC model. Not all eligible patients will qualify for the waiver or VBC reimbursement. Without specific provisions from CMS to reimburse hospital care at home for all Medicare and Medicaid patients and coverage from private insurance, the hospital at home program will remain limited.
The current model for AHCaH includes technology support for the patient using a tablet, smartphone, or other device. This requires that the patient have a broadband internet connection in the home, which eliminates eligibility for rural patients who are already underserved.
Final Thoughts
There is a lot of support for Hospital Care at Home among providers, health systems, and consumer insurance companies. Support for home health, hospice, palliative care, and supportive home care has not been as strong. As these larger players start to see the cost and outcome benefits of care in the home, a few things may happen.
First, hospitals, payers, and physician groups may start to recognize the value of care at home and be more open to creating referral partnerships with care at home agencies. Home care is a small percentage of total care reimbursed by Medicare and Medicaid and we could see that increase.
Conversely, these providers may realize that care at home is lucrative and will extend their own AHCaH models to include post-acute and hospice care, cutting out home care agencies altogether. Care teams are constructed around a Hospital Care at Home patient. Including a post-acute nurse who is familiar with the patient history would provide additional continuity of care.
Either way, I see the support for the Hospital Care at Home program as beneficial to home health. Branches of health care that were previously averse to extending patient care into the home are now supporting it. Increased adoption of telehealth and other technology platforms increase the possibilities for integrating with home health and hospice providers. Interoperability between Hospital Care at Home and Post-Acute Care at Home may finally become a reality.
We will continue to report on the AHCaH waiver as the deadline to renew comes closer.
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Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com
©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report.homecaretechreport.com One copy may be printed for personal use: further reproduction by permission only. editor@homecaretechreport.com
Sources:
CMS (2024) Acute Hospital Care at Home Data Release Fact Sheet. Retrieved from: https://www.cms.gov/newsroom/fact-sheets/acute-hospital-care-home-data-release-fact-sheet#:~:text=In%20response%20to%20challenges%20faced,inpatient%2Dlevel%20care%20at%20home.
Mass General Brigham (2024) Study of National Data Demonstrates the Value of Acute Hospital Care at Home. Retrieved from: https://www.massgeneralbrigham.org/en/about/newsroom/press-releases/study-of-national-data-demonstrates-the-value-of-acute-hospital-care-at-home#:~:text=In%20addition%2C%20within%2030%20days,and%20have%20fewer%20adverse%20events.%E2%80%9D
mHealth Intelligence (2023) Kaiser Permanente Study Shows Scalability of Hospital-at-Home model
by Kristin Rowan | Feb 21, 2024 | Clinical, Editorial
By Kristin Rowan, Editor
The news this week has been filled with stories about former president Jimmy Carter, 99, who entered hospice care last year. His wife, Rosalynn Carter was in hospice care for only a few days before she passed away in November. Advocates and hospice providers are hoping that Carter’s length of care in hospice will help increase awareness of what hospice care really is. 
Hospice care is a misunderstood service. Many people equate hospice care with dying. While it is true that patients are only eligible for hospice care if they have a life-ending illness with no hope of cure, hospice care involves a lot more than easing a patient through the end-of-life transition. Physical symptoms are eased with medicine and the patient’s emotional well-being is supported as well. Just as importantly, the family’s emotional needs are met through hospice care.
The Carter family’s high profile has shed some much needed light on hospice care in general. The vast difference in length of care between the former first lady (three days) and the former president (one year and counting) has also highlighted the degree to which hospice care can be administered.
The hope for many, in light of the public coverage of Carter’s hospice care, is a change in long-term care coverage to cover the gap between hospital care and hospice care. Medicare does not have a long-term care benefit, so patients either go without this needed care or pay for it out of pocket. Detractors argue that new taxes would have to be levied in order to fund this type of care, making the change politically difficult.
I would argue that long-term care benefits could be used to pay for step-down care instead of hospice care and would not need a separate budget. After all, isn’t that what palliative care aims to do? Home health care aids in recover and hospice care maintains quality of life during end-of-life care. Palliative care is the bridge that spans the two, when a patient is not going to recover, but isn’t ready or eligible for hospice care. Adding Medicare and Medicaid coverage for palliative would lower the overall cost of hospice care and add much-needed service for the patients that fall between the gap.
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Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com
©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report.homecaretechreport.com One copy may be printed for personal use: further reproduction by permission only. editor@homecaretechreport.com
by Elizabeth E. Hogue, Esq. | Feb 14, 2024 | Admin
by Elizabeth E. Hogue, Esq.
Two former Amedisys employees claim that they were fired in retaliation for alerting management to possible violations of the federal False Claims Act. They then filed a whistleblower, or qui tam, lawsuit [Pilat v. Amedisys, Inc., No. 23-566 (2d Cir. Jan. 17, 2024)]. In their whistleblower suit, the employees claim that they complained internally to supervisors about suspected fraudulent practices and refused to engage in such practices.
The employees, for example, recommended against recertifying patients, but supervisors overruled the recommendations and recertified patients again. One of the employees then refused instructions from his supervisors to recertify the patient yet again. The employee said that the patient was completely independent and it would be “unethical” to do so.
The employees also expressed concern to supervisors about the inability of nurses and therapists to keep up with a large volume of patients. One employee said he had to schedule visits for three times as many patients as was safe. The employees explained that many patients were seen for only a few minutes rather than an appropriate amount of time. The employees said that one nurse was assigned to make eighty-six visits during one week and another was assigned to make seventy-eight visits. Amedisys billed for the visits anyway.
In addition, former employees identified multiple specific instances in which clinicians were instructed to document false information about patients. The false documentation was then used to support treatments for which patients did not qualify or to recommend unnecessary treatments. Supervisors, for example, instructed employees to fraudulently document that a fifty-year-old man whom an employee was treating was not independent and needed assistance to climb stairs. The patient did not need such assistance.
The employees further claimed that a female patient in her late fifties with early onset Parkinson’s disease received services during an episode of care. The severity of her condition was overstated in order to continue treatment.
Perhaps the most vivid example provided by the employees involved a female patient who was approximately seventy years old who had a neurological disorder that limited her mobility. The patient’s condition did not prevent her from leaving home or from driving. Supervisors repeatedly overruled employees’ recommendations to reduce visits even though she was completely independent and it would be “unethical” to provide more intensive treatment. The employees were also told not to document a leg injury that the patient suffered in a car accident because documentation of the accident would make it clear that she was not actually homebound and that she did not meet eligibility requirements of the Medicare Program.
Providers must take seriously employees’ concerns regarding possible fraudulent and abusive practices. Most whistleblowers take their concerns to their employers first. It is only when employers ignore their concerns or, even worse, retaliate against employees for raising issues in the first place, that employees turn to outside enforcers for assistance in pursuing their concerns. Whether or not the allegations of employees are valid, providers must take them seriously. Thorough investigations are required in order to demonstrate to employees that there is no problem or that the problem has been corrected.
Although this case involves home health services, the message applies to all types of providers. The message from this case and numerous other lawsuits is clear: Don’t shoot the proverbial messenger who brings information about possible fraud and abuse violations. There is a very heavy price to be paid.
©2024 Elizabeth E. Hogue, Esq. All rights reserved.
No portion of this material may be reproduced in any form without the advance written permission of the author.
by Kristin Rowan | Feb 14, 2024 | Product Review, Vendor Watch
By Kristin Rowan, Editor
For those of us who didn’t grow up with a smartphone in our pockets and every tool imaginable available on the internet, mobile apps are still a bit of a mystery and a marvel. There are 25 categories of mobile apps, including gaming, finance, education, business, dating, travel, and health. Development, testing, and execution of an app that actually works is difficult, time consuming, and expensive, so it may seem out of reach for most small businesses. Last week, we spoke with the creators of an app that not only coordinates care for your patients and families, but makes it seem like you have your own agency app.
The Story
Dr. TJ Patel, PT DPT, grew up in India, where he studied physical therapy. After landing his dream job, he started to notice a lot of patients returning to the hospital because they got an infection or just didn’t know how to care for themselves. There was no one providing care after discharge; there was no concept of home based care. Patel soon learned that if he was passionate about home-based care he needed to move to a country that had the infrastructure already built because it didn’t exist there.
Dr. Patel moved to the U.S. and received his masters in kinesiology and doctorate in physical therapy. He was working in home health within a week and did 27,000 home visits in his fifteen year tenure. During this time, Patel noticed that in healthcare, “the right hand does not talk to the left hand.” Communication was a huge pain point and Patel set out remedy that.
By combining care management, care delivery, and what the patient wants into one centralized location, it creates connectivity to all care providers for a patient. Thus, Care Coordinations was designed.
The Concept
Care Coordinations is a tech solution for an impactful experience for patients, caregivers, and families. It opens the lines of communication between the parties customized for each patient.
Patient Channels include all caregivers associated with the patient. Users both inside and outside the organization can be added to the channel. Each patient channel is a secure, private channel for all internal and external care providers. The patient channel can include smaller groups within the channel.
Care Circles include the primary agency caregiver, patients, and family members. The app allows for unlimited two-way communication that protects the personal information of the caregiver. This removes the need for the caregiver to use a personal cell phone or give the patient access to personal information like social media profiles. The two-way communication inside the app is HIPAA compliant, unlike standard text messaging.
Group Channels are non-patient specific for other members of your agency to feel connected, especially in a remote working environment. Department specific group channels for marketing, sales, or HR can also be created. Management functions allow for one-way communication to all employees, anonymous employee surveys, and read-only access to all other channels.
CAHPS Survey
The patient and family experience is captured in the CAHPS survey and impacts agency reimbursement rates. Care Coordinations includes a mock CAHPS survey for patients and families that goes out before the CAHPS survey. The agency can make any needed adjustments to the patient and family experience prior to the actual CAHPS survey, improving scores and reimbursement rates.
Additional Features
Care Coordinations integrates directly with EMRs to upload an episode of care.
Robust read-receipts allow you to see if caregivers have seen a notification inside a communication channel.
Phone and video call capability inside the app adds additional secure communication.
Remote patient monitoring is built in with integrations with more than 500 devices to monitor blood pressure, pulse ox, weight, blood sugar, and temperature.
Direct communication to the agency allows the patient or family to notify the agency in the event a caregiver does not show up for an appointment.
Similar to the user experience with Uber and Lyft, the map feature alerts the patient that the caregiver is in route and estimates time of arrival with a pictogram of a car.
Optional 24/7 functionality to allow the patient to contact the agency after hours. Your call center can input details of the call into the app for real-time updates and assist with reaching other family members in case of an emergency when calling 911 is not necessary.
Post-visit surveys are customizable and can help struggling caregivers to improve and recognize high-performing employees.
The Good, The Bad, and The…Just kidding, there’s nothing ugly
Overall, we found the Care Coordinations app to be useful and well-designed. The app is charged on a per patient basis, making it more cost effective to include multiple care providers in one patient channel for increased connectivity. The available integrations, ability to upload files and videos, HIPAA compliant communication, and familiar messaging structure all point to ease of adoption.
As we’ve noted before, many home health nurses are technology adverse and will fight against the adoption of anything new. Care Coordinations stresses the legality of HIPAA compliant communication and not using your personal cell phone as selling points for nurses. Still, we know this isn’t always enough to convince a steadfast (read stubborn) care provider. Caregiver benefits and a gamified system to track timeliness, survey results, and other metrics may add some incentives for those harder-to-convince nurses.
The Uber-like experience for the patient and family to see where the caregiver is and when they will arrive is a great feature. On the flip-side, there is no tracking of the caregiver on the agency side. With increased reports of workplace violence in home-based care, a feature that allows the caregiver to alert the agency of any change in schedule, without constant tracking of caregiver movements, would allow the caregiver and agency some peace of mind.
I found Care Coordinations to be robust and detailed. Current EMR integrations include Axxess, Kantime, and HomeCare HomeBase, all through Worldview. Direct integrations are in the works. As Care Coordinations adds features and integrations, we are bound to hear more from and about them.
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Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com
©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report.homecaretechreport.com One copy may be printed for personal use: further reproduction by permission only. editor@homecaretechreport.com
