by Rowan Report | Feb 7, 2024 | Admin, Recruitment & Retention
by Jen Waldron,
Recruiting caregivers for your home care agency franchise can be challenging enough, but it’s even more frustrating when those same caregivers don’t bother to pick up the phone after applying for your jobs. You may have put in a significant amount of time, money, and energy into trying to find qualified caregiver applicants, only to be repeatedly met with radio silence, missed calls, or unanswered texts.
In my mission to help home care agencies recruit more efficiently, I have identified the top five reasons why caregivers do not pick up your calls and what you can do about it.
1. You are not offering competitive pay or benefits
In a comprehensive study Pew Research found that the number one reason people leave their job is, in fact, for more money. But the number two and three reasons are “no advancement opportunities” and “feeling disrespected at work.” If your compensation package — and your career advancement opportunities — are not competitive, caregivers may choose to ignore your calls and continue searching for better opportunities.
2. Your job ad looks like spam; your hiring process does not stand out from the crowd
Candidates do not read your job description, especially if it is wordy. All job posts look like spam to the applicant, they apply to too many jobs, as many as 16 or more at one time!, and, as a result, they never read job descriptions.
This confusion can lead to candidates feeling apprehensive about texts and phone calls from unknown numbers and explain why they often opt not to answer your phone calls. The screen shot below is an example of how caregiver applicants get too many messages about jobs. To stand out from the crowd, an agency HR team must find a different way to communicate with the applicant about the value and challenges of your jobs.
3. You are not demonstrating professionalism in your hiring process
Caregivers are professionals and they expect you to have a professional hiring process. Many agencies use hiring software built for other industries and, as a result, their hiring process is clunky. On many job boards, applicants “1-click” apply with a job seeker profile they may have made several years ago. When they are followed up with through some sort of automated text system (which they think looks spammy – see pic!), they are annoyed that they are being asked to “apply” again.
4. You have poor online reviews or ratings
Today, people trust online reviews and ratings as much as personal recommendations from friends or family. If your agency has too few positive or too many poor online reviews from clients and/or employees, caregivers may not have confidence in you as an employer. Even if the impression they glean from your reviews is inaccurate, they may choose a competitor whose reviews reflect the culture and work ethic more suitable to their own. Therefore, it is imperative that you invite positive feedback from satisfied clients and employees and respond quickly to negative online reviews. This is critically important to attracting caregivers interested in working for you.
5. Your recruitment process takes too long; caregivers are moving on
The data shows that 57% of applicants today expect to hear back about the position they applied for within 1 week. With regard to retention after onboarding, one of the reasons caregivers leave is they are not given enough hours to make full time work. They say they want those hours to be in the right location and compatible with their scheduling needs and experience level.
You do not want to incur the cost of going through the whole interview, orientation, and hiring process if you do not have the right clients to match their needs and preferences at that time. Therefore, it is vital to streamline your recruitment process and to implement fast and efficient process with the best applicants.
In Summary
As a home care agency owner, it is essential to understand why caregivers may not answer your calls, even after applying for your jobs. Based on our five reasons applicants do not pick up your calls after they apply, there are steps you can take to improve your odds of attracting the best applicants:
-
- Evaluate your recruitment process, compensation package, job description, communication methods, and online reputation.
- Ensure you demonstrate professionalism through your interactions, online and during interviews.
- Make your job description and requirements stand out amongst the spammy looking emails and texts out there today.
- Take steps to eliminate bottlenecks in your hiring process.
By doing so, you will attract the best caregivers who will choose to work with you, and your agency can grow and thrive.
# # #
Jen Waldron is one of the co-founders of Augusta Home Care Recruiting She started working in the senior care industry in 2009 as a professional caregiver in a memory care community. Since then, she has been an executive supporting thousands of home care agencies and other senior care businesses through software solutions. Augusta is an innovative software company designed entirely for home care. The platform gets caregivers to show up to interviews through inspiring confidence in the applicant, speed to hire and identifying top talent.
©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 7, 2024 | Regulatory
by Kristin Rowan, Editor,
On Wednesday, January 31, Cigna and HCSC signed an agreement to sell all of Cigna’s Medicare business — including traditional Medicare, supplemental benefits, Medicare Part D offerings, and CareAllies, a value-based care management subsidiary. — to HCSC, a Blue Cross / Blue Shield partner with operations in Illinois, Texas, New Mexico, Oklahoma and Montana. The $3.3 billion deal will quadruple the size of HCSC’s Medicare Advantage population, which numbered 217,623 as of this month.
Medicare Advantage had not been a significant business for Cigna. CEO David Cordani explained that it required resources disproportionate to its size in the company. With 19 million insurance customers, Cigna had a little over a half million in its MA business, a little under a half million Medicare supplement members, and 2.5 million in Part D.
It had previously been reported that Cigna believed divesting its Medicare business would make its merger with Humana more acceptable to regulators. The company completed its HCSC deal even though negotiations with Humana had already broken down. Though inked today, the deal is not expected to close until the first quarter of 2025.
# # #
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 Tim Rowan | Feb 7, 2024 | Admin, Vendor Watch
by Tim Rowan, Editor Emeritus,
Advertising in The Rowan Report comes with a few perks! Our CEO interview with Tim is one of them. Advertisers with a full-year contract receive one annual CEO interview with Tim. If you’re not an advertiser, CEO interviews can be purchased as well. Highlight the expertise of your leadership with a one-on-one industry overview and company update with Tim, published on The Rowan Report website, social media, and YouTube channel.
Click on these titles to view each episode of our “Meet the CEO” video interview series.
Andre Gomez, Bedrock Healthcare at Home, January 2024
Rich Berner, Complia Health, December, 2022
Emmet O’Gara, Sandata, September, 2022
Roger Shindell, Carosh Compliance Solutions, June, 2022. HIPAA risk assessment workshops
Michael Gelman, CareConnect, May, 2022, Workforce Management
Jim Bland, Seniors Home Services, November, 2021, A menu of products from remote patient monitoring to home modifications, all with revenue sharing for home care partners
Ashley Wharton and Jenna Schwartz, Savii, March, 2021, Private Duty Agency Management Software
Eric Becker, CEO, MiliMatch, on technology to improve recruiting and retention
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
© 2024. All content is produced by The Rowan Report. All rights reserved.
by Kristin Rowan | Jan 31, 2024 | Clinical
By Kristin Rowan, Editor
The National Association for Home Care and Hospice joined other advocacy groups this month on Capitol Hill to fight against the looming pay cuts from CMS. Some members of Congress joined the fight for “common sense policies” to expand access to care in the home for Americans.
Rep. Adrian Smith (R-NE-3), who spoke at the event, decried moves against home health, saying “there are cuts looming that are not based on reality” and “we want to make sure reimbursement policies are reflective of the actual realities.” Smith is also the representative who introduce the “Homecare for Seniors Act,” H.R. 1795, which would allow the use of Health Savings Accounts (HSAs) to be used for home care.
Rep. Terri Sewell (D-AL-7) has a personal connection to home care and spoke about how her mother cared for her father through a series of strokes he suffered. She expressed strong opinions about payment reductions that could see home health lose as much as $20 billion dollars over the next ten years. Sewell called the idea “frightening” and said, “I am a big fan of making sure that my constituents have access to quality, affordable health care.”
The Medicare program has admitted that home health is not just a bringing of great care and not just a more cost effective way to provide care, but is a service that provides dynamic value. Care in the home has decreased overall costs by $3.2 billion dollars just in the small segment of value-based payment model test cases. Patients who receive care in the home are re-admitted to the hospital 37% less frequently than those who do not and are 43% less likely to die than patients who do not receive care at home. Still, CMS is looking at additional pay cuts which bring the total payment reduction down 13.72% since 2019. The costs of everything else have increased in that time. According to the U.S. Bureau of Labor and Statistics, the average cost of living has increased 22% since 2019. NAHC President Bill Dombi said, “Where we’re headed in 2024 is that half of all home health agencies will be operating in the red with the cuts facing them in the Medicare program. It’s not a recipe for continued access to care.”
Dombi, along with many others, is predicting that 50 percent of agencies will be operating in the red after the next round of payment reductions and that without a reversal of these pay cuts we could see the end of care at home altogether with a collapse of the home health payment system.
The advocacy event on Capitol Hill helped raise awareness of the plight of care at home among some policymakers, but more help and advocacy is needed. Please, take a few minutes to click the link below and tell your members of Congress to support the Preserving Access to Home Health Act of 2023.
# # #
Kristin Rowan 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
- Please GO HERE to tell your members of Congress to support the Preserving Access to Home Health Act of 2023
by Elizabeth E. Hogue, Esq. | Jan 31, 2024 | Admin, Regulatory
by Elizabeth E Hogue, Esq.
Providers may have heard or read about the importance of Fraud and Abuse Compliance Plans in their organizations. Despite the wealth of available information about Compliance Plans, many providers continue to express uncertainty about their value. Here are some of the questions providers commonly ask about Compliance Plans:
Why should we have a Fraud and Abuse Compliance Plan?
First, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services has clearly stated that, consistent with the Affordable Care Act (ACA) as described below, all providers are now expected to have current Compliance Plans that are fully implemented.
As a practical matter, when providers establish and maintain Compliance Plans, it clearly discourages regulators from pursuing allegations of fraud and abuse violations.
Technically speaking, the Federal Sentencing Guidelines make it clear that establishment and implementation of Compliance Plans is considered to be a mitigating factor. That is, if accusations of criminal conduct are made, the consequences may be substantially less severe because of a properly implemented Compliance Plan.
In addition, providers with Compliance Plans are more likely to avoid fraud and abuse. This is because Plans routinely establish an obligation on the part of every employee to report possible instances of fraud and abuse, and Plans include training for all employees.
Compliance Plans may help to prevent qui tam or so-called “whistleblower” lawsuits by private individuals, rather than by government enforcers, who believe that they have identified instances of fraud and abuse. There are significant incentives to bring these legal actions since whistleblowers receive a share of monies recovered because of their efforts. Some whistleblowers have received millions of dollars. Compliance Plans make it clear that employees have an obligation to bring any potential fraud and abuse issues to the attention of their employers first. Compliance Plans provide a clear path to resolve fraud and abuse issues internally.
In addition, the federal Affordable Care Act (ACA) requires providers to have Compliance Plans. In short, it’s the law!
Finally, the Deficit Reduction Act (DRA) requires providers who receive more than $5 million in monies from state Medicaid Programs per year to implement policies and procedures, provide education to employees, and put information in their employee handbooks about fraud and abuse compliance. These requirements can be met through implementation of Fraud and Abuse Compliance Plans.
We don’t receive reimbursement from the Medicare or Medicaid Programs. Do we still need a Compliance Plan?
Statutes and regulations governing fraud and abuse also apply to providers who receive payments from any federal and state healthcare programs, including Medicaid, Medicaid waiver and other federal and state health care programs, such as TriCare and the VA. Many private insurers have followed the federal government’s lead in terms of fraud and abuse enforcement. Therefore, providers that don’t receive reimbursement from the Medicare Program must have compliance plans, too.
We hear that the OIG of the U.S. Department for Health and Human Services has provided guidance for various segments of the healthcare industry regarding Compliance Plans.
- Specifically, the OIG has already published guidance for clinical laboratories, hospitals, home health agencies, hospices, physicians’ practices, third-party billing companies, and home medical equipment companies. Should we just use the model guidance that is applicable to us?
The answer is, “No!” Guidance from the OIG is not a model Compliance Plan. Guidance from the OIG consists of general guidelines and does not constitute valid Compliance Plans. In addition, the OIG has made it clear that Plans must be customized for each organization.
We have read that, before implementing Compliance Plans, providers must conduct expensive internal audits that can take many months to complete. Is this true?
While beginning the compliance process with an extensive internal audit is certainly one way to proceed, it is not the only viable way to work toward compliance. It is equally valid to begin with Compliance Plans that are customized for the organization and include training for all employees about fraud and abuse, and Compliance Plans. Then all staff members can subsequently participate in internal compliance activities, including audits, with a process in place to handle any issues that arise as a result of the audits.
We have all sorts of policies and procedures in our organization. Why do we need something else called a Compliance Plan?
Compliance Plans are specific types of documents that routinely address fraud and abuse issues that providers do not usually cover in internal policies and procedures. In addition, providers may not gain benefits under the Federal Sentencing Guidelines described in paragraph one (1) above if there is no formal document called a Compliance Plan.
We just spent a lot of money to become accredited or reaccredited. Doesn’t certification mean that we are in compliance?
On the contrary, Compliance Plans appropriately address potential fraud and abuse issues. They also include mechanisms for helping to ensure compliance, such as processes for identification and correction of potential problems that are not addressed during the certification process. In other words, organizations may be accredited, but fail to meet applicable compliance standards for fraud and abuse.
Will the fact that our organization has a Compliance Plan make any difference regarding the outcome of fraud and abuse investigations and the imposition of Corporate Integrity Agreements (CIA’s)?
Yes, it may make a considerable difference, based on statements from the OIG. If providers have Compliance Plans in place during investigations that are current and fully implemented, the OIG may be less aggressive in pursuing potential violations. Enforcers are likely to ask for information about Compliance Plans and related policies and procedures. Enforcers are now also likely to ask providers to show them how much money they have spent on fraud and abuse compliance activities!
When the OIG discovers problems with fraud and abuse in organizations, providers are usually asked to develop and implement a Corporate Integrity Agreement (CIA). The OIG often requires CIA’s to include a process for stringent monitoring by the OIG on a continuous basis. These monitoring activities can be extremely burdensome to providers in terms of both time and money. Providers with valid Compliance Plans may not be asked to develop and implement CIA’s.
Now is the time for all providers to recognize and act upon the need to establish and maintain Compliance Plans. “Working on it” is no longer good enough.
©2024 Elizabeth E. Hogue, Esq. All rights reserved.
No portion of this material may be reproduced in any form without the advance written permission of the author.
by Tim Rowan | Jan 31, 2024 | Clinical, Marketing
by Tim Rowan, Editor Emeritus
Counter-intuitive but true. Over-the-top customer service, intended to delight rather than merely satisfy, creates no more customer loyalty than very good customer service.
Speaking to a crowded room at last week’s Home Care 100, Ian Goddard, of Challenger Performance Optimization, Inc., raised a lot of eyebrows when he presented findings of an extensive research project that surveyed 125,000 customers and 5,000 customer service reps across a range of unrelated industries.
- Lousy customer service discourages return customers.
- Good customer service increases customer loyalty.
- Great service leads to a high level of loyalty, but that is as high as it goes.
Over-the-top, he called it “delight service,” results in the same level of loyalty as great service.
Most people have heard the stories. Anyone who has taken a sales training class know about the Nordstrom’s employee who refunded money to a customer who was dissatisfied with a tire. She had bought the tire at that location when the building housed a tire store, before it was a Nordstrom’s.
Goddard told a similar one about a stuffed giraffe that was left behind at a Ritz-Carlton when the family left for the airport. At bedtime, the giraffe’s poor little owner was distraught. Dad called the hotel and soon began to receive photos of the giraffe “on vacation” but coming home soon. The enthusiastic employee took pictures of the giraffe sunning himself by the pool, having a drink at the cafe, and sleeping in a big comfortable bed. The little guy was at peace and slept well. The father flooded social media, singing the praises of Ritz-Carlton. “I’ll never stay anywhere else,” he proclaimed.
According to the Challenger survey, that enthusiasm does last for a while, but not forever. If that grateful dad’s next vacation is in a city without a Ritz-Carlton, or if there is another upscale hotel with a better price, loyalty takes a back seat. His social media campaign, of course, has a long-lasting ripple effect. Word of mouth today is online, not over the backyard fence.
Effortless Customer Service
The survey discovered that there is, however, one customer service experience that impacts loyalty more than any other, even more than service that delights a customer. “Your customers do not want to talk to you,” Goddard asserted. “The most important experience is the one that requires the least effort on the part of the customer. The customer service rep who acts as your advocate cuts through red tape, solves your problem, and takes steps to avoid you having to call again about the same thing. Advocacy is the characteristic of the rep who creates loyalty. Think of your own customer service experiences. If you have to work, or wait on hold, to get a problem solved or to fix something broken, you come away unhappy, meaning less loyal to the brand, even if your issue is finally resolved.
Out of eight personality types typically found in customer service positions, Goddard said, the “controller” type is the most effective. This is the agent who says, “Hold on, I’m going to take care of this for you,” and then comes back a few minutes later with, “all done, problem solved.”
Avoid the Next Service Issue
Goddard told the story of the customer with a broken vacuum cleaner belt. The service rep recognized the issue and told him, “Your replacement part is already on its way.” When he received two belts instead of one, he called back. She said, “We have learned that some customers have trouble installing the belt and they break it the first time. So, we send two, hoping they will learn what they did the first time and install it correctly with the second part.”
“Thinking forward like this vacuum cleaner company does cost a few extra cents with every replacement, but avoids a far more expensive service rep interaction in the future and cements customer satisfaction,” Goddard explained.
Effortless Service in Home Care
Ryan Iwamoto, owner of 24 Hour Home Care, interpreted this way of thinking about customer loyalty for our industry. Asking, “How do we get effortless experience into our organization?” he partnered with a company called Tethr that listens to and analyzes phone conversations. It then coaches the customer service person on ways to improve effectiveness, think like an advocate, and improve satisfaction. Realizing that his caregivers are much like customers, he uses Tethr for them as well.
From the start of the Tethr implementation to the present, advocacy on all calls increased from 26.3% to 34.1%. Difficult calls decreased from 8.3% to 7.9%. Average call length decreased from 4 minutes, 15 seconds to 3 minutes, 52 seconds. Customer Effortless Score, which was tracked at the company, region, office, and individual level, increased 39 percent. Phone calls tracked came from all customers: clients, caregivers, and referral sources.
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. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com
by Kristin Rowan | Jan 31, 2024 | Admin, CMS, Regulatory
By Kristin Rowan, Editor
The National Association for Home Care and Hospice joined other advocacy groups this month on Capitol Hill to fight against the looming pay cuts from CMS. Some members of Congress joined the fight for “common sense policies” to expand access to care in the home for Americans.
Rep. Adrian Smith (R-NE-3), who spoke at the event, decried moves against home health, saying “there are cuts looming that are not based on reality” and “we want to make sure reimbursement policies are reflective of the actual realities.” Smith is also the representative who introduce the “Homecare for Seniors Act,” H.R. 1795, which would allow the use of Health Savings Accounts (HSAs) to be used for home care.
Rep. Terri Sewell (D-AL-7) has a personal connection to home care and spoke about how her mother cared for her father through a series of strokes he suffered. She expressed strong opinions about payment reductions that could see home health lose as much as $20 billion dollars over the next ten years. Sewell called the idea “frightening” and said, “I am a big fan of making sure that my constituents have access to quality, affordable health care.”
The Medicare program has admitted that home health is not just a bringing of great care and not just a more cost effective way to provide care, but is a service that provides dynamic value. Care in the home has decreased overall costs by $3.2 billion dollars just in the small segment of value-based payment model test cases. Patients who receive care in the home are re-admitted to the hospital 37% less frequently than those who do not and are 43% less likely to die than patients who do not receive care at home. Still, CMS is looking at additional pay cuts which bring the total payment reduction down 13.72% since 2019. The costs of everything else have increased in that time. According to the U.S. Bureau of Labor and Statistics, the average cost of living has increased 22% since 2019. NAHC President Bill Dombi said, “Where we’re headed in 2024 is that half of all home health agencies will be operating in the red with the cuts facing them in the Medicare program. It’s not a recipe for continued access to care.”
Dombi, along with many others, is predicting that 50 percent of agencies will be operating in the red after the next round of payment reductions and that without a reversal of these pay cuts we could see the end of care at home altogether with a collapse of the home health payment system.
The advocacy event on Capitol Hill helped raise awareness of the plight of care at home among some policymakers, but more help and advocacy is needed. Please, take a few minutes to click the link below and tell your members of Congress to support the Preserving Access to Home Health Act of 2023.
# # #
Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com
©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report.homecaretechreport.com One copy may be printed for personal use: further reproduction by permission only. editor@homecaretechreport.com
Please GO HERE to tell your members of Congress to support the Preserving Access to Home Health Act of 2023
by Kristin Rowan | Jan 24, 2024 | Clinical, Regulatory, Vendor Watch
The Arizona Healthcare Cost Containment System (AHCCCS American Rescue Plan (ARP) Program has awarded a grant to a collaborative group of care providers, solutions providers, and educators. On January 18th, Arizona home care agency Cypress HomeCare Solutions announced they have been selected at the recipient of this program award along with solutions provider PocketRN and educator Nevvon. As a team, they will implement services that improve client and provider experiences while also creating health system savings.
Last week, we spoke with PocketRN CEO Jenna Morganstern-Gaines. “Nevvon and PocketRN are working with Cypress to implement [the use of] PocketRN by Cypress’s caregivers to study cost of care, experience for clients, families, and the care team, and outcomes,” explained Morganstern-Gaines. She further explained that part of the requirements of the grant is to issue quarterly reports and a final evaluation of the program after one year. They are currently through the first phase of the study, which was to onboard patients, families, and caregivers.
PocketRN is a telehealth platform that engages in “whole person clinical care.” It is a flexible, virtual nursing and clinical service application that wraps clinical care around non-medical care in the home. The use a proactive approach by assigning a virtual nurse to each patient who continues to check in with the patient and the family to provide coaching and assistance and to help coordinate care.
“There’s a real reason we use the phrase ‘nurse you back to health’ and not ‘doctor you back to health’. The person that will help follow through is the nurse and PocketRN provides you a one-to-one relationship with a nurse that will follow through with all of your care providers to ensure that you are ‘nursed’ back to health.”
CEO, PocketRN
We will be following this ongoing study and providing updates from the reports we receive.
Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news .She also has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com
©2025 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com
by Tim Rowan | Jan 24, 2024 | CMS, Regulatory
by Tim Rowan, Editor Emeritus
T
he battle for stable Home Health reimbursement rates continues full speed ahead on Capitol Hill, but the advocacy organizations engaged on the front lines of that battle are losing ground. The Partnership for Quality Home Healthcare and the National Association for Home Care and Hospice have deployed weapons from educating Congressional staffers to suing CMS. Those traditional methods appear to be insufficient, as the specter of draconian rate cuts casts a larger and larger shadow.
Missing from the conflict is the only effective weapon, flooding lawmakers with messages from their constituents.
According to Joanne Cunningham, CEO of the Partnership, the time is now to bring that weapon to the front. She told over 600 attendees at this week’s Home Care 100 event in Scottsdale that she and Bill Dombi have done everything they can up to now, adding that the only way to stop $3.5 to $5 billion in Medicare cuts is for every person of voting age whose livelihood depends on Home Health care to call or write their House Member and Senators.
STEP ONE: A "Must-Pass" Bill
“Preserving Access to Home Health Act of 2023,” is a pair of bi-partisan bills introduced into the House and Senate in the summer of 2023. (S.2137/H.R. 5159) They would prevent CMS from making new cuts to the PDGM payment system, both now and in the future, by blocking annual “recalculations” that traditionally use flawed formulae.
The bills would require MedPAC to perform more comprehensive calculations before it makes recommendations to Congress. Currently, the Commission only considers revenue and profit margins from traditional Medicare. They determine that Home Health margins are too high without looking at the small-to-negative margins providers accrue from Medicare Advantage, Medicaid, the VA, and private insurance. Medicare profit margins make it possible for HHAs to care for patients with stingier payers. Reducing those margins too far, which MedPAC recommends every year, would remove access to care for millions of beneficiaries.
STEP TWO: Educating Congress
Ms. Cunningham emphasized that elected officials, as well as bureaucrats who write the regulations to implement the “will of Congress,” have yet to understand the impact in-home care has on overall healthcare spending and access to care. “We have to get bureaucrats to look at our data,” she said. “We know we save the trust fund more than we take from it, and we know that we are turning patients away because we cannot pay enough to attract clinicians in sufficient numbers. We have to educate them all.” She offered a few concrete suggestions.
-
- Data, data, data. The most effective policy argument starts with independent analysis from outside the industry.
- Tell stories. Elected officials and their staffers respond to real-life experiences of people within their districts and states. A group from Inhabit Health, for example, sat Congressional staffers down and told them about individual patients who had been kept out of hospitals and EDs, about great care they had received. They added summaries of their typical patients as well.
- Listen. Staffers will challenge your assertions and ask hard questions. They will help you identify your ‘Achilles Heels.’ See this as helpful preparation for meeting the Member or Senator.
- See them at home. Cunningham underscored the importance of making appointments and meeting with House members and Senators away from DC, for two reasons.
- “A lot of people approach a Member on the way out of a church they both attend. What they don’t realize is that they are one of ten who will do the same thing between the church door and his car, from ten different industries. You just become ‘part of the clutter’ and are quickly forgotten.”
- Back home advocacy is the most important thing you can do; it is even better than going to DC. Their main interest is re-election and they respond to messages from constituents. The purpose of advocacy is to cut through the noise. At home, you can say, “Hey, I know you; you’re my neighbor; listen to me!”
- Repetition is key. When you write a letter, it goes on a list. Staffers count up how many constituents have written about each issue. The best strategy is to make them feel pressure from back home. Marshall all the political pressure you can, but fill it with data.
Ms. Cunningham told about leading a group of Home Health providers from Oregon to meet with Senator Ron Wyden in his home office. To make their case for Home Health reimbursement support, they showed him their books, which proved that MedPAC is wrong about Home Health profit margins. They changed his mind. She said that meeting was so powerful and successful, it has become a model for working with other states.
STEP THREE: Expose Medicare Advantage
The Partnership’s goal is to ensure alignment of the MA home health benefit with traditional Medicare – as all Medicare beneficiaries are all entitled to the same home health benefit, regardless of the payor.
“MedPAC met during the first week of January to discuss Medicare Advantage. The meeting, which included a focus on the methodology of payments, was contentious at times.” Cunningham said. “In its January 12 report to Congress, The Medicare Advantage Program: Status Report, MedPAC forecast that CMS will overpay MA plans as much as $88 billion in 2024, based on prior year behavior.”
Higher coding organizations have a competitive advantage because they receive larger payments for enrolling the same beneficiaries as other organizations, and they can offer more extra benefits and attract new enrollees simply because of their coding efforts
Principal Policy Analyst, MedPAC
MA’s focus on extras such as Silver Sneakers, vision care, and basic dental care, along with low or zero premiums added to the Medicare Part B premium that all beneficiaries pay, are what MA plans emphasize in their annual barrage of TV commercials. Never mentioned on TV or in direct mail brochures are two practices that impact many times more dollars than gym memberships and low premiums. The undeserved $88 billion mentioned in the MedPAC report comes from exaggerating initial assessments of plan enrollees. Payments from Medicare to a plan hinge on patient acuity. When improperly padded, acuity robs the trust fund and pads insurance company profits.
The second downplayed practice is on the care side of the equation. The largest MA plans have often been found to deny procedures that traditional Medicare standards would have covered. When they do pay for care, especially Home Healthcare, they pay rates below traditional Medicare rates, often lower than provider costs. Cunningham concluded her comments with a description of the Partnership’s efforts to bring pressure from MedPAC and the HHS OIG to force MA plans to comply with regulatory requirements. “We are all of one mind regarding MA. I think we are going to see practices change.”
The Partnership for Quality Home Healthcare was established in 2010 to work in partnership with government officials to ensure access to quality home healthcare services for all Americans. Representing community- and hospital-based home healthcare agencies nationwide, the Partnership is dedicated to developing innovative reforms to improve the program integrity, quality, and efficiency of home healthcare for our nation’s seniors.
pqhh.org
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 Tim Rowan | Jan 24, 2024 | Regulatory
Untitled Document
Analysis by Tim Rowan, Editor Emeritus
P
erennial Home Health enemy MedPAC angered a different group last week by releasing a status report on insurance companies participating in the Medicare Advantage program.1
The report details the way in which giant, for-profit, health insurance companies improperly increase per-customer payments by upcoding their health assessment at enrollment, and then slash costs by denying coverage for healthcare services that traditional Medicare would have honored. MedPAC was also critical of the practice of requiring prior authorizations, backed up by utilization review algorithms that are supposedly intended to “minimize furnishing unnecessary services” but which effectively increase denials for necessary care.
According to the report, MedPAC expects CMS to pay MA plans $88 billion in 2024.
On January 12, a meeting to discuss the report ended in what one reporter politely described as “a kerfuffle.” Other witnesses to the meeting chose to describe it as a shouting match.
“One member, Brian Miller, MD, MPH, of Johns Hopkins University in Baltimore, accused panel leadership of issuing a negative status report on MA plans’ market dominance, saying it had been ‘hijacked for partisan political aims to justify a rate cut to Medicare Advantage plans.’
“Miller said the analysis … ‘appears to be slanted to arrive at a foregone conclusion in order to set up and provide political cover’ just before the Centers for Medicare & Medicaid Services prepares its annual rate notice for MA plans, expected in coming weeks. ‘The chapter reads like attack journalism as opposed to balanced and thoughtful policy research.'”2
Report authors fired back, citing numerous ways MA plans generate higher revenue, including enrolling people who are relatively healthy, known as favorable selection. They then vigorously scan patients’ medical histories and charts to code for health factors that generate higher per-capita payments, known as coding intensity, often spending less on services. Coding intensity is also the difference between a risk score that a beneficiary would receive in an MA plan versus in fee-for-service. Though MA plans skew toward healthier enrollees, MedPAC found that MA risk scores are about 20.1% higher than scores would be for the same beneficiaries had they enrolled in Fee For Service Medicare.
Namath, Walker, Shatner and Brokers
Criticism of MA plan behavior did not only come from MedPAC commissioners and report authors. For example, Lynn Barr, MPH, founder of Caravan Health, which was acquired by CVS Health through its acquisition of Signify Health, exposed what the annual TV ads do not make clear, that their 800 numbers go to brokers, not to any one plan.
“This is not the big, lovely, glowing success that everybody says it is. And we continue to create policies that drive people into these plans. Medicare allows money paid to MA plans to be used for broker commissions as high as “$600 to recruit them, plus $300 a year every year that they stay in the MA plan.
“We have allowed MA to buy the market, and that is why MA is growing. It’s not because the quality’s so great. People don’t love the prior auth, people are leaving their plans a lot. Aside from Medicaid, Medicare is the least profitable payer for doctors. And at the same time, we give all this money to the plans. It’s unconscionable.”
Adding to the “kerfuffle” with a powerful anecdote, Stacie Dusetzina, PhD, of Vanderbilt University Medical Center in Nashville, Tennessee, noted that even cancer patients often have trouble getting necessary care because of the plans’ limited networks. She referenced a January 7 NPR story3 about an MA enrollee who could not get the cancer care he needed from his MA plan, and could not get out of the plan without facing 20% in expensive copays. In all but four states, supplemental plans that could pick up the difference can reject patients with costly conditions.
“When you are 65 and aging into the program,” Dr. Dusetzina summarized, “you are healthy at that time and may not be thinking about your long-term needs. [If you did], it would push you to think harder about the specialty networks that you may or may not have access to when the MA plan is making your healthcare decisions.”
1 A 30-page slide presentation is available to the public at medpac.gov/wp-content/uploads/2023/10/MedPAC-MA-status-report-Jan-2024.pdf. The complete report is available only to MedPAC commissioners. The charts on slides 26 and 27 show how MA plans learned to pad profits in 2018 and increased the practices exponentially since then.
2 Cheryl Clark, MedPage Today January 16, 2024 medpagetoday.com/special-reports/features/108275
3 npr.org/2024/01/07/1223353604/older-americans-say-they-feel-trapped-in-medicare-advantage-plans
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. 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
