OIG Crackdown on Employees Ineligible to Work for Medicare

by Tim Rowan | Nov 15, 2023 | CMS, Editorial, Regulatory

Dear Friends,

I have some news that may be upsetting. Frankly, that is my intention, to frighten you into action.

In August, a Home Health provider in New York paid an $$866,339.25 fine for violating the “Civil Monetary Penalties Law.”* The Chinese-American Planning Council Home Attendant Program had employed an individual, in connection with the New York State Consumer Directed Personal Assistance Program (CDPAP), who was excluded from participation in the New York Medicaid program and was not eligible to furnish services under the CDPAP.

Georgia provider Agape Hospice Care paid $250,993.97 in penalties, the specific amount it had paid in salary and benefits to two unlicensed nurses.

If this law is unfamiliar to you, it is the requirement that you may not employ any individuals who are not eligible to work within the Medicare system.*

This is only one example of a new OIG crackdown!

Bridges MN, a non-profit with services to the disabled, was fined $150,171.96 for employing a single excluded individual.
Vicki Roy Home Health Service paid a $38,000 fine for employing one excluded caregiver.
Providence Health System-Southern California, doing business as Providence Little Company of Mary Medical Centers, which includes two hospitals, agreed to pay $141,562 in connection with the employment of an excluded emergency services technician from Aug. 8, 2016, to June 5, 2019. (Note that this person was employed for nearly three years without the health system knowing, as they are required to know, that he or she was excluded.)
Joseph Health Personal Care Services, doing business as Nurse Next Door, agreed to pay $32,244 in connection with the employment of an excluded constant care attendant from Nov. 2, 2017, to Aug. 8, 2019.

My friends, the list goes on and on, and these are just the Home Health agencies:

Serenity Home Healthcare Services Agreed to Pay $146,000
Professional Home Health Care 2: $77,000
Chinese-American Planning Council Home Attendant Program: $866,000
Visiting Angels of Rhode Island: $158,000

I learned of at least 25 other healthcare providers that were fined under this law. Clearly, the HHS OIG is on the warpath. This is not a regulation you are wise to ignore.

That is why I write you today. I have found an affordable service that performs monthly OIG exclusion screening for you. Doing it yourself would require a dedicated FTE and hours of painstaking work.

I would be honored if you would accept my introduction to the company that provides this service. If the fines I listed above grabbed your attention, you can see that a service of this type is like an insurance policy that costs a fraction of the disaster it can prevent.

The company is called Carosh Compliance Services. The monthly service is called “OIG Express.” I know and trust the founding CEO, Roger Shindell. To contact Roger and learn more about this necessary service, use this link: https://oig.hhs.gov/faqs/exclusions-faq/
Sincerely,

Tim Rowan
Editor Emeritus
The Rowan Report
Tim@RowanResources.com

Principles Provide Insights into HHAeXchange-Gentiva Partnership

by Tim Rowan | Nov 15, 2023 | Vendor Watch

by Tim Rowan, Editor Emeritus

In September, we posted the announcement from HHAeXchange about their inking a deal to provide EMR and EVV software to Gentiva Personal Home Care. We had some questions about the partnership and both HHAeXchange president Stephen Vacarro and Gentiva president Richard Bruner took the time to speak with us.

Background and Context

Gentiva Health Services is a provider of Home Health and Hospice services. Headquartered in Atlanta, the company became an independent business unit of Kindred Healthcare in October, 2014. At the time of the acquisition, it had been a Fortune 100 company with over $1.7 billion in annual revenue.

Today, Gentiva provides in-home care to over half a million patients annually through over 420 locations in 40 states.

The Rowan Report: Can you provide an update about Gentiva and your role?

Bruner: Gentiva Health Services is a network of compassionate caregivers, clinicians, support personnel, and information technology teams who provide superior outcomes for patients across the post-acute continuum. Originally part of Olsten Corporation, Gentiva officially became an independent company on Aug. 6, 1999. Our services include personal care, palliative care, and hospice care. Through our personal care offerings, we deliver services to patients across Texas, Arkansas, Arizona, California, North Carolina and Missouri.

Through my role as Gentiva’s personal home care president, I oversee strategic planning for the company’s personal care programs, establish protocols and quality standards, drive key initiatives, build sustainable growth, and am responsible for day-to-day administrative operations.

RR: How did the partnership with HHAeXchange and Gentiva come about?

Bruner: Gentiva connected with HHAeXchange years ago through mutual industry contacts and kept up with the company’s progress. Later, when we began to evaluate our Texas agencies’ need for a new solution, we spent 18 months investigating and vetting major vendors in the homecare management software space.

Seeking a third-party, EVV-agnostic, cloud-based system, we narrowed the pool to two vendors who could meet our company’s needs while enhancing caregivers’ mobile experiences through simplified scheduling and coordination options. However, cost effectiveness and EVV prowess factored heavily into the final decision, which led to our selection of HHAeXchange.

RR: The Texas market is notoriously difficult. How does HHAeXchange differ from previous providers that gave up and left the state?

Vacarro: Texas is a large state with hundreds of thousands of patients receiving homecare on a regular basis from an incredibly broad roster of agencies and providers. While no two situations are alike and no two agencies do things exactly the same way, there is a commonality: the services they provide are incredibly valuable.

Because HHAeXchange understands the complex needs of homecare recipients and the critical work agency staffers are tasked with, we put considerable thought into the development of our EVV platform, its implementation, and its continued usage across Texas. We intend to differentiate ourselves and surpass standards set by our predecessors through our commitment to functionality.

We can’t custom-make solutions based on agencies’ and patients’ individual needs, but we can provide a platform with features versatile enough to be convenient and helpful to any user, no matter their agency size, location, workload, technological expertise or experience.

The HHAeXchange team also understands the importance of laying a solid foundation on which to build a new partnership and preparing for key transitions. So, for months ahead of our launch in Texas, our team spent a considerable amount of time hosting informational sessions for caregivers and agency owners and leading road shows throughout the state, demonstrating the EVV platform, answering questions, and getting more acquainted with the market.

I should add that, as part of our partnership with the Texas Health and Human Services Commission (HHSC), our Portal is available at no cost to program providers, financial management services agencies, and Consumer Directed Services (CDS) employers. We’ve taken steps to offer simple and convenient access, enabling homecare providers to easily meet Texas state requirements while offering a streamlined experience for both back-office staff and service providers.

RR: Is HHAeXchange compatible with EVV aggregators in all of the states where Gentiva operates?

Vacarro: Yes, HHAeXchange seamlessly connects payers and providers across the homecare ecosystem. Our platform allows for the accurate capture and transmission of all visit data, regardless of which aggregator a state selects and which EVV vendor and tools a provider uses.

We regularly partner with Medicaid agencies and MCOs in open and closed model states, where our platform is utilized to submit agencies’ data to another aggregator. This is how we work in Pennsylvania, North Carolina and now in Texas, for example.

RR: Thank you, gentlemen. For background on the HHAeXchange-Gentiva partnership, see our September posting of their joint news release at:

Connecticut Home Care Nurse Murdered

by Elizabeth E. Hogue, Esq. | Nov 8, 2023 | Clinical

Untitled Document

by Elizabeth E. Hogue, Esq.

Joyce Grayson, a home health nurse for Elara Caring, was murdered on October 28, 2023, in the home of a patient where she was providing services. Ms. Grayson was reported missing by a family member to the local police department. The family member was also able to track her last location to the home of a patient she was scheduled to visit at 8:00 a.m. on the day of her death. The patient resided at a halfway house for convicted sex offenders. Police have not yet formally identified a suspect in Ms. Grayson’s death.

This horrible news reminds of steps that staff members and providers can take to protect their staff members:

Staff members should be sure of the locations of patients’ homes and have accurate directions. · Employees should contact their supervisors in the event of threatening circumstances.
During visits, employees should remain alert and watch for signs of possible violence; such as verbal expressions of anger and frustration, threatening gestures, signs of drug or alcohol use, or the presence of weapons.
When employees are verbally abused in patients’ homes, they should ask the speaker(s) to stop. If verbal abuse continues, caregivers should leave patients’ homes and notify their supervisors that they have done so. · If possible, caregivers should identify more than one exit from patients’ homes and keep a clear path to at least one of them.
All employees should read or reread The Gift of Fear by Gavin de Becker and take action when their instincts tell them that they should be fearful. · Management should develop a written policy of “zero tolerance” for all incidents of violence, regardless of source. The policy should include animals! The policy must require employees and contractors to report and document all incidents of violence, no matter how minor. Emphasis should be placed on both reporting and documenting. Employees must provide as much detail as possible. The policy should also include “zero tolerance” for visible weapons when caregivers are present in patients’ homes. Caregivers must be required to report the presence of visible weapons.
Agencies should develop quality indicators that improve efforts to protect staff. Indicators in quality and safety standards should include patient assault and other instances of violence or threatened violence. The results of these indicators should result in violence prevention plans and training programs in de-escalation of violence.
Data systems should be strengthened to monitor the exposure of staff members to aggression. More resources should be invested in measuring aggressive events and specific factors that resulted in exposure, such as patient type.
Ongoing education should be provided to protect staff. Education should focus on intentional actions that staff members must take to recognize, document, and counter threatened or actual violence.

The Connecticut General Assembly recently passed a law to increase protection for healthcare workers that does not include home care providers. Now lawmakers are calling for extension of the legislation to include home healthcare staff. Martin Looney, President Pro Tempore of the Connecticut State Senate told the CT Mirror: “More and more care is going to be provided in a home setting, which is generally a good thing. But if that is true, we need to make sure that the people who are providing that care are safe.”

Amen to that, Mr. Looney! Let’s get to it!

CMS Issues Final Rule for 2024 with Drastic Pay Cut

by Kristin Rowan | Nov 8, 2023 | CMS, Regulatory

By Kristin Rowan, Editor

On November 1, CMS issued its Home Health Final Rule for CY 2024. As expected, the final rule includes drastic pay cuts to Medicare home health services payments. The original proposed rule issued earlier this year included a 5.653% rate reduction, the remainder of the 7.85% reduction from 2020-2021 and an additional 1.636% for 2022, for a total rate reduction of 9.36% overall from the start of PDGM. In a surprising turn, CMS has not implemented the full 5.779% rate cut from the initial proposal, opting instead to introduce the rate cuts over two years. The 2024 rate cut will be 2.890%, half of the full adjustment CMS alleges is still needed. The CMS final rule does not attempt to collect any of the alleged overpayments from 2020-2022, totaling $3,439,284,729.00.

NAHC President Bill Dombi offered this response:

“We continue to strenuously disagree with CMS’s rate setting actions, including the budget neutrality methodology that CMS employed to arrive at the rate adjustments. We recognize that CMS has reduced the proposed 2024 rate cut. However, overall spending on Medicare home health is down, 500,000 fewer patients are receiving care annually since 2018, patient referrals are being rejected more than 50% of the time because providers cannot afford to provide the care needed within the payment rates, and providers have closed their doors or restricted service territory to reduce care costs. If the payment rate was truly excessive, we would not see these actions occurring. The fatally flawed payment methodology that CMS continues to insist on applying is having a direct and permanent effect on access to care. When you add in the impact of shortchanging home health agencies on an accurate cost inflation update of 5.2% over the last two years, the loss of care access is natural and foreseeable.

We now implore Congress to correct what CMS has done and prevent the impending harm to the millions of highly vulnerable home health patients that depend and will depend in the future on this essential Medicare benefit. Fortunately, longstanding advocates for home health care, Senator Debbie Stabenow (D-MI) and Senator Susan Collins (R-ME) have introduced S. 2137 to eliminate the rate cuts. We urge the Congress to support this legislation and enact it into law before the end of the year. The 2024 rate cuts must not take effect.”

The final rule includes the following:

A net 3.0% inflation update
A 2.890% Budget Neutrality permanent adjustment
A $3,489,523,364 alleged overpayment in 2020-2022. CMS has not scheduled a collection of the alleged overpayment in 2024 or any other year yet.
Recalibration of the 432 case mix weights with a separate budget neutrality adjustment in the payment rates of +1.0124%
CMS estimates an increase in CY2024 Medicare spending of $140 million ($525 million inflation increase minus the $455 million rate adjustment plus a $70 million outlier FDL change)

HHAs that fail to provide required quality data will have these rates reduced by two percent.

Non-payment-related changes

In addition to the inflation increase and payment adjustments, the CMS Final Rule includes a number of other changes. These changes include amendments for the payment of Disposable Negative Pressure Wound Therapy, removing and replacing OASIS measures in HHVBP, new coverages and payments in IVIG services, the adoption of two new measures and the removal of one existing measure in HHQRP, coverage for lymphedema therapy items under a new Medicare Part B benefit, and revisions to Medicare provider enrollment requirements.

Hospice Provisions

Hospice Special Focus Program (SFP)

CMS is pushing forward with the Hospice SFP. Despite the commonsense suggested changes requested by NAHC and multiple others, CMS is using a flawed algorithm in the structure and implementation of SFP. This flawed algorithm will fail to identify hospices most appropriate for additional oversight and support. This creates the risk of reducing access to higher quality care and directing patients and families to hospices that perform most poorly relative to health and safety requirements. The official stance from NAHC is strong support of the SFPs goal to improve poor performing hospices, but are emphatically against the method in which SFP is being implemented and will continue to advocate for changes to the structure of the program.

Hospice Informal Dispute Resolution (IDR)

The IDR process for hospice is for condition-level survey findings which may trigger an enforcement action. The finalized IDR process allows hospice programs an opportunity to resolve disputes during recertification or reaccreditation for continued participation in Medicare. this allows for settlement agreement prior to a formal hearing, which will save time and money for the hospice agency. NAHC has additional recommendations for the Hospice IDR process that have not been implemented in the final rule.

Hospice 36-month rule

CMS is extending the “36-month” rule that currently applies to home health agencies and hospices, which is designed to prevent the flipping of Medicare certifications to non-vetted hospice owners. There are several exceptions to the rule for hospices. Even if a hospice undergoes a CIMO, a new owner must enroll as a new hospice and undergo a survey or accreditation unless:

The hospice submitted 2 consecutive years of full cost reports since initial enrollment or the last CIMO, whichever is later.
A hospice’s parent company is undergoing an internal corporate restructuring, such as a merger or consolidation.
The owners of an existing HHA are changing the hospice’s existing business structure (for example, from a corporation to a partnership (general or limited)), and the owners remain the same.
An individual owner of an hospice dies

New hospice owners will immediately be placed into the “high-risk” category for screening requirements and will have to submit fingerprints for a national background check from all owners with a 5% or greater direct or indirect ownership interest.

CMS Final Rule Synopsis and NAHC Response

We reached out to NAHC President Bill Dombi after the release of the Final Rule for CY2024. He provided us with a full breakdown of each provision in the final rule and the NAHC stance on each topic.

You can read all of these changes and how NAHC will continue to advocate for changes to the final rule here.

# # #

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 started writing for 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

©2023 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

Big Win for Advocacy in Home Care

by Kristin Rowan | Oct 25, 2023 | Admin, Regulatory

by Kristin Rowan, Editor

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

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

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

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

###

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

CMS News

by Rowan Report | Oct 11, 2023 | CMS, Medicare Advantage, Regulatory

NOW AVAILABLE IN iQIES – Preview Reports and Star Rating Preview Reports for the January 2024 Refresh

CMS just published updated measure for Home Health Outcome Information Set (Oasis) and all HH QRP claims-based measures. These updated measures are no based on the standard number of quarter.

For additional information, please see the HH Quality Reporting Training webpage and the Home Health Data Submission Deadlines webpage.

©2023 by Rowan Consulting Associates, Inc., Colorado Springs, CO. This article originally appeared in Home Care Technology: The Rowan Report. Click here to subscribe. It may be freely reproduced provided this copyright statement remains intact. editor@homecaretechreport.com

Product Review: This Software Automates Compliance

by Tim Rowan | Oct 11, 2023 | Product Review

by Tim Rowan, Editor

Walking a Thin Line

Home Health owners are used to walking tightropes. Indeed, there are many they are forced to walk every year, if not more often. One tightrope is a daily one. It delineates the fine line between regulatory compliance and risking being accused of non-compliance — and Home Health has a lot of regulations.

Owners, CEOs, CFOs, and boards struggle with a policy of spending money to ensure compliance with regulations or risking the expense of fines and payment denials for being found to be out of compliance.

QAPIplus Automates Compliance

There may be a way to widen that tightrope to make it easier to walk. We participated in a product demonstration last week, courtesy of Armine Khudanyan, CEO/Founder, and Lara Koraian, Lead Software Developer, of QAPIPlus. In our view, automating the many processes involved in ensuring compliance should save many times the cost of a product such as this one. To date, however, we are not sure there is another product like this one.

Everything in one Place

Discussions of strategies to improve compliance occur during team and board meetings. Someone must know all the suspected deficiencies and assemble a meeting agenda. This is the first, and perhaps most important, piece that QAPIPlus automates. By drawing data from nearly every Electronic Medical Records product an HHA might be using, the tool identifies problem areas and creates a complete Quality Improvement meeting agenda, saving hours of work.

Management benefits from a clear, well-organized dashboard that can be customized to display the daily data each person in a position to monitor, flag, or improve compliance needs.

Items the software examines to alert staff about compliance problem areas include:

- Gaps in Emergency Management Planning
- Patient Infections
- Employee Infections
- Medication Errors
- Falls
- “Sentinel” events
- Patient Grievances
- Employee Grievances
- Abuse and Neglect
- Hospital Admissions
- Emergency Department Visits
- More

In addition to automating the assembly of meeting agenda items, QAPIPlus also builds in-service curricula. Recommendations for supplemental training can be used by the HHA or Hospice for individual or group training. The company, however, also offers online lessons, enough to cover most educational needs, from OASIS documentation to wound care.

Quick Clinician Training Modules

We were shown examples of 5-minute trainings — perhaps better described as reminders — that nurses like to use immediately before a visit. “For example,” CEO Armine Khudanyan offered, “a nurse knows a particular procedure will be required in the next patient home. He or she knows the procedure but has not done it in a long time. Our 5-minute “brush-up” can be viewed after parking in front of the patient’s home, and the nurse feels more confident going in.”

These lessons can also be given by Directors of Nursing or QA nurses to individuals who have an issue with some one regulation, perhaps a Condition of Participation about patient instructions, or about one OASIS item. Instead of dragging the entire clinical staff to one of those dreaded Saturday classes, the needed lesson is delivered to one person about one problem area.

Certified and Verified

QAPIPlus is the only quality management software solution to earn CHAP Verification and ACHC Certification for home health and hospice organizations. (The Joint Commission does not have a certification service.)

User Comments

As is our custom, we rarely ask readers to take our word for it. The QAPIPlus leadership let us share a few quotes:

“I would like to thank you and the QAPIPlus platform for helping us achieve the GOLD seal of approval from The Joint Commission Triennial Survey. The surveyor was impressed with the program and the phone application. We were just cruising with the QAPI and in-service, the quickest and smoothest survey ever. Again, kudos to the team and developers. Such an amazing tool!”

Ariel Avila

Administrator, St. Agatha Home Health

“I have peace of mind that things are in order and that compliance is less of an issue to be concerned about.”

Director of Nursing, Home Health Agency

“The surveyor looked over the QAPIplus reports for about 15 minutes, and said ‘Okay, perfect. You guys have everything here,’ and that was that.”

Supervisor, Patient Care Services, Home Health Agency

This last comment brings up one final point that the QAPIPlus team said was important to make. “We have heard two types of comments from surveyors,” CEO Khudanyan added. “One is from surveyors who see the dashboard we customized just for them. They call it unique, easy to use, and comment on how much time it saves them to have everything in one place that they usually have to find by searching several applications on the screen and hundreds of papers in drawers. The second comment is from surveyors who walk into an HHA or Hospice after having used QAPIPlus at other agencies. They use words like ‘thank heavens’ when they see that this agency uses it too, knowing how easy their audit is going to be.” She added that it is hard to estimate the value of hosting a happy surveyor.

The Rowan Report rates QAPIPlus “worth serious consideration” for Home Health agencies and Hospices.

# # #

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

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

Transformative Trends in Home Care: Strategies for Successful Business Sale

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

by Greg Schriber

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

Transformative Trends

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

Strategic Positioning for Sale

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

Managing the Sale Process

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

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

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

Should Insurance Companies Own Home Health Agencies?

by Kristin Rowan | Sep 13, 2023 | Editorial, M&A, Regulatory

by Kristin Rowan, Editor

UnitedHealth Group Makes Bid to Buy Amedisys after Acquiring LHC Group

Amedisys is one of the leading providers of home health, hospice, and other healthcare at home services. It operates more than 500 locations in 37 states and the District of Columbia. After acquiring Contessa Health in 2021 for $250 million, Amedisys added hospital-at-home, SNF-at-home, and palliative care to its list of services.

Optum Outbids Option Care Health

In May of this year, Option Care Health and Amedisys issued joint statements announcing a merger of the two companies in an all stock-option bid. Option Care Health provides home and alternate site infusion services, while Amedisys provides home health, hospice, and high-acuity care. The merger was valued at $3.6 billion. It would have increased stockholder value, increased access to care across the United States, and created a network of more than 16,000 health care professionals, according to the joint statement.¹

By June 26th, Option Care Health confirmed the termination of the merger and a $106 million termination payment from Amedisys, after Amedisys accepted an all-cash bid from UnitedHealth Group.²

UnitedHealth Expanding Service Options

UnitedHealth Group acquired LHC Group earlier this year for $5.4 billion.³ That acquisition folded LHC Group into UnitedHealth Group’s Optum. The acquisition came after increased demands for home care services. UnitedHealth Group considered this a move toward value-based care. The Federal Trade Commission stalled the merger with requests for additional details in mid-2022. Despite the FTC probe and a shareholder lawsuit, the deal was ultimately approved and the LHC Group delisted its stock on February 22.⁴

New Merger Faces Federal Scrutiny

Optum and Amedysis expected concerns over anti-trust issues surrounding the merger, according to a joint statement from the two groups. The Department of Justice recently asked for more information.⁵ The request will push back the timeline for the merger. Amedisys believes there is little geographic overlap between Amedisys and LHC Group and that the scrutiny is a result of other UnitedHealth Group acquisitions.

Optum Remains Optimistic

In a press release about the merger, Optum CEO Patrick Conway, M.D. said, “Amedisys’ commitment to quality and care innovation within the home, and the patient-first culture of its people, combined with Optum’s deep value-based care expertise can drive meaningful improvement in the health outcomes and experiences of more patients at lower costs, leading to continued growth.”⁶

Even with the recent acquisitions and mergers, if this deal with Amedisys proceeds, Optum will have only a 10% market share across the U.S. For this reason, as well as the demand for home care far exceeding the supply, Optum believes this merger will be approved.

Opinion

Should a company that brokers health insurance also be allowed to be the provider of care? In this author’s experience, job-based healthcare insurance does not come with many options. There may be different levels of care to fit your budget, but the insurance company is already chosen by the employer. This means that employees and their families choose to have health insurance or not but cannot choose the insurance company.

Home Care, Hospice, Post-Acute Care, Palliative Care, and other in-home services are very personal. The company you choose and the care provider you get have to fit your needs and personality and there is a high level of trust needed to allow a stranger into your home when you are in a vulnerable state. If the insurance company is also providing the care, the option to find a care provider that suits the level of trust needed almost disappears.

Oversight

In 2021, President Joe Biden signed an executive order for more vigorous oversight of the healthcare market. Mergers and acquisitions are being scrutinized more heavily to preclude monopolies of care. The FTC and DOJ, in response to this executive order, have proposed updates to antitrust guidelines that will make healthcare mergers and acquisitions more difficult.⁷

Medicare Advantage

Medicare beneficiaries enrolled in Medicare Advantage has now reached 50%, making insurance companies more involved in senior care than ever before.⁸ Insurance companies only recently increased the percentage of revenue spent on patient care to 80%, up from as low as 50% before 2010.⁹ Given these facts, it may be worth questioning whether the insurance companies have too much control over care now, and if the acquisition of care providers by insurance providers should be eliminated completely to avoid a complete takeover of healthcare by insurance companies that already focus more on profit than people.

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

¹https://investors.optioncarehealth.com/news-releases/news-release-details/option-care-health-and-amedisys-combine-creating-leading
²https://investors.optioncarehealth.com/news-releases/news-release-details/option-care-health-confirms-termination-merger-agreement
³https://www.reuters.com/markets/deals/amedisys-agrees-unitedhealth-buyout-offer-scraps-option-care-deal-2023-06-26/
⁴https://www.fiercehealthcare.com/payers/unitedhealth-lhc-group-close-54b-merger-deal
⁵https://www.healthcaredive.com/news/unitedhealth-amedisys-second-request-doj/690612/
⁶https://www.unitedhealthgroup.com/newsroom/2023/2023-06-05-optum-offers-to-combine-with-amedisys.html
⁷https://www.medicaldevice-network.com/news/unitedhealth-acquisition-under-doj-scrutiny/?cf-view
⁸https://homecaretechreport.com/article/3549
⁹https://www.commonwealthfund.org/publications/issue-briefs/2019/jul/how-aca-medical-loss-ratio-rule-protects-consumers-insurers

EEOC Sues Licensed Home Care Agency for Discrimination

by Tim Rowan | Aug 23, 2023 | CMS, Regulatory

by Tim Rowan, Editor

Home Care Agency Removed Black and Hispanic Home Health Aides from Assignments to Accommodate Racial Preferences of Clients, Federal Agency Charges

There is a question that appears on social media chat pages with great regularity. What does a home care agency do when a client places it in a difficult legal position? The family of a Spanish-speaking grandmother asks for a Spanish-speaking caregiver. An elderly white gentleman insists on a white, English-speaking caregiver.

For agencies across the country, the only reasonable answer to this question is, “I don’t like my choices.” Those choices are to either offend, likely lose, a client, or risk violating Equal Employment Opportunity laws. It is common knowledge that home care clients have ample options should they become disillusioned with their current agency. In this situation, an agency has to choose between confronting a client’s racial bias and risk losing the client, or accommodating a client and losing a federal lawsuit. In other words, here we have the very definition of “no-win.”

With a recent action, the EEOC has put our entire industry on notice which option it expects. On July 31, the federal agency issued a public news release announcing it has filed a lawsuit against a New York agency. Four Seasons Home Care is a licensed personal care agency under a corporate umbrella with sister companies that offer Nursing and Rehabilitation, Certified Home Health, a Dialysis Center, Pharmacy, and an Adult Health Day Care Center. The company was faced with this common dilemma and made a choice of which the EEOC disapproved.

Reaction to the announcement, reprinted verbatim below, has already begun to appear on social media sites, including LinkedIn and home care groups on Facebook. One eloquent comment came from the CEO of an organization that serves an elderly client base made up of elderly people, mostly first-generation, who come from dozens of other countries and speak dozens of languages.

He pointed out that, in a diverse market like New York, it is common for patients and clients to express preference for an aide who can relate to their culture and speak their language. He even mentioned data that shows a connection between culture match and care effectiveness. The reason there has been a push to achieve diversity in the caregiving community expressly for the purpose of culture matching.

What stood out to this writer is that some of the language violates a journalistic rule, specifically the one against revealing the author’s bias within an otherwise facts-only story. In the second paragraph, the phrasing “including by removing Black and Hispanic” caregivers implies that the entire lawsuit is about disadvantaging these two groups. By looking beyond any implied meaning and parsing the language as written, one can see that removing these two specific ethnic groups is part of the accusation, but the writer offers no clue as to whether “part of” means 10 percent or 90 percent of the people discriminated against were Black and Hispanic.

Without this knowledge, one is led to assume that the entire accusation is that Four Seasons discriminated against Black and Hispanic caregivers. However, it is just as possible, based on the vague term “including,” that other ethnic groups were also victims of discrimination. It is just as possible that some Black and Hispanic caregivers were recipients of bonus work hours when assigned to clients who requested a caregiver with their cultural or language backgrounds. Sadly, the bottom line is that the language of the news release does not actually say what it appears to say. We will have to wait for the case to arrive in court to know what percentage of Four Seasons policy discriminated against minorities and what percentage help them.

Complete Announcement From EEOC

NEW YORK — ACARE HHC Inc., doing business as Four Seasons Licensed Home Health Care Agency, a Brooklyn-based company that provides its clients with home health aides, violated federal law by removing aides from their work assignments due to their race and national origin to accommodate client preferences, the U.S. Equal Employment Opportunity Commission (EEOC) charged in a lawsuit filed today.

According to the EEOC’s lawsuit, Four Seasons routinely would accede to racial preferences of patients in making home health aide assignments, including by removing Black and Hispanic home health aides based on clients’ race and national origin-based requests. Those aides would be transferred to a new assignment or, if no other assignment were available, lose their employment completely.

Such alleged conduct violates Title VII of the Civil Rights Act of 1964, which prohibits employers from discriminating against employees on the basis of race and national origin.

The EEOC filed suit, (EEOC v. ACARE HHC d/b/a Four Seasons Licensed Home Health Care, 23-cv-5760), in the U.S. District Court for Eastern District of New York, after first attempting to reach a pre-litigation settlement through the agency’s conciliation process. The EEOC seeks compensatory damages and punitive damages for the affected employees, and injunctive relief to remedy and prevent future discrimination based on employees’ race and national origin.

“Making work assignment decisions based on an employee’s race or national origin is against the law, including when these decisions are grounded in preferences of the employer’s clients,” said Jeffrey Burstein, regional attorney for the EEOC’s New York District Office.

“It is long past the day when employers comply with the discriminatory requests of its clients or customers, to the detriment of its Black and Hispanic workers,” said Timothy Riera, acting director of the New York District Office.

The EEOC’s New York District Office is responsible for processing discrimination charges, administrative enforcement, and the conduct of agency litigation in Connecticut, Maine, Massachusetts, New Hampshire, New York, northern New Jersey, Rhode Island, and Vermont.

More information about race discrimination can be found at eeoc.gov/racecolor-discrimination. More information about national origin discrimination can be found at eeoc.gov/national-origin-discrimination.

The EEOC advances opportunity in the workplace by enforcing federal laws prohibiting employment discrimination. More information is available at eeoc.gov. Stay connected with the latest EEOC news by subscribing to our email updates.

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©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

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