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5/22/2012
1
Working With ACOs and Shared SavingsPayment Plans. What Operational and Policy Changes Will Be Required?
Tim Rowan, Publisher/EditorHome Care Technology Report
RowanResources.com
Nearly 12,000 certified providers
6,500 of them gross $2M or less
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5,500 of them gross $1M or less
CMS prefers to deal with 12,000 providers
Will not long tolerate uncontrolled growth in the number of Medicare certified agencies
PPACA gives CMS several pruning tools:1. Fraud abatement2. Overpayment control3. Moratorium on awarding new certificates4. The Replacement for PPS…
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Free‐Market Pruning:AmedisysLHC GroupLHC GroupGentiva
Government Pruning:RHHI denialsZPIC extrapolationsMAC auditsMAC auditsRAC overpayments“After PPS”
October 14, 2010: $35 M Armenian Medicare Crime Ring Broken UpLos Angeles, New York, New Mexico, Ohio, Georgia
September 7, 2011: 91 Medicare Providers ArrestedBaton Rouge, La.; Brooklyn, N.Y.; Chicago, Dallas, Detroit, Houston; Los Angeles and MiamiAngeles and Miami.
September 12, 2011: Maxim Settles DOJ Medicaid Fraud Accusation for $150 Million; criminal charges pending
October 3, 2011: LHCGroupSettles Therapy Abuse Accusations for $65 Million; Amedisys and Gentiva under investigation
February 28, 2012: The Curious Case of Dr. Jacques Roy
April 21, 2012: Four Arrested in Baton Rouge for $37 Million Scheme
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May 2012107 arrested7 cities
illi$450 million
Obstacles to Opening New Agencies
36‐month rule3‐Tier Surveyor System3‐Tier Surveyor System3 risk levels for new agencies determine limited, moderate or high categorical screening levels
Accountable Care Organizations
Payment Bundling
Shared Savings Plans
Pay for Performance
76 million Baby Boomers
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If you liked IPS…
1995: 7 500 Medicare certified home health 7,500 Medicare certified home health agencies
1999: 5,000 Medicare certified home health agencies
2012: 12,000 Medicare certified home health agenciesagencies
2017: ???
Penalties if 30‐day readmission rate remains above threshold:
FY13 (10/1/2012) 1% of FY13 (10/1/2012): 1% of annual Medicare paymentsFY14 (10/1/2013): 2% of annual Medicare paymentsFY15 (10/1/2014): 3% of annual Medicare payments
Where will these people turn for help?
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Home Care Providers with SkillsLow HH Compare readmission scoresproactive readmission prevention measures in place?place?with helpful technologies implemented▪ home telehealth▪ medication management▪ PERS▪ fall prevention▪ patient educationstrong data analysis demonstrating the effect of those technologies
Home Care Providers with Visible Skills
Preventing rehospitalization of home care patients is not the same as the hospital knowing an agency can reduce their admissions
New sales orientation programFrom asking for referrals to promising resultsFrom discharge planner to CFOFrom “My agency can care for your patients”
to “My network can manage your patients’ care”
Let’s start at the very beginning
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Home Health, SkilledHome Care, non‐SkilledHospice and Palliative Care ProvidersRehab HospitalsLong Term Care Skilled Nursing FacilitiesAssisted Living CentersHome Medical EquipmentGroup Homes
Home Health
HospiceHome Medical
Equipment
Physician
Case Manager LTC/SNF
Group Home
Rehab Hospital
Assisted Living
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Community Health Innovation Network
Accepts patients most at‐risk for readmission
Coordination and patient education begin in the hospital, before discharge
Nurse Care Coordinator manages plans of care and assigns each patient to a care location. When possible, patients go to the location of their choice.
Home Health
HospiceHome Medical
Equipment
Physician
Case Manager LTC/SNF
Group Home
Rehab Hospital
Assisted Living
Employed by various members of the network, not by the network itself
L l hi hLoyalty hierarchy:1. patient (considering comfort, care needs and
outcomes)
2.payer
3. each healthcare provider within the network
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Patients are tracked by the Network a full 90 days after hospital discharge
appointment remindersppreminders to follow care plan and dietreminders to take medications as prescribed teach about all relevant community services they would previously have had to seek out on their own
1. One of twelve local hospitals agreed to a 90‐day pilot, no permanent commitment, CHF and COPD patients only.
Aft d d d i i th h it l 2. After 90 days and zero readmissions, the hospital insisted the Network expand to its five other locations.
3. Today, all thirteen area hospitals participate; all chronic conditions are accepted.
4. 167 participating physicians
First eight months: Network served ±100 patients
Total hospital readmissions = 1 (For a procedure unrelated to the patient's chronic condition)
A handful of patients have expired, but all of those deaths were expected and occurred in comfort, under the care of hospice nurses.
After 18 months: 90‐day hospital readmission rate = 8%
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HomeSNF
Assisted Living
Long Term Care
Group Home
Major changes are comingNew payment systems try to save MedicareHospital incentivesFraud control measuresFraud control measures
Survival depends on your ability to adapt to these changes; change your thinking from:
‘Referrals’ to ‘partnerships’‘Competing’ to ‘cooperating’ with other post‐acute providers‘Manual’ to ‘technology assisted’
“Delta Study of Hospital Readmissions and Home Care” deltahealthtech.com/research/projects/hospitalizations/
Home Care Technology ReportHome Care Technology ReportHomecaretechreport.com/article.asp?id=1356
Homecaretechreport.com/category.asp?id=7
CMS.govHealth Information Exchanges
Coordinated Care Demonstration
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Point‐of‐care automation
Electronic Medical Record
Health Information Exchanges (HIE)
Home TelehealthVital signMed managementPERS
Point‐of‐care automation
Electronic Medical Record
Health Information Exchanges (HIE)
Home TelehealthVital signMed managementPERS
1. When and Where?
2 Diagnosis: Chronic Inaccuracy 2. Diagnosis: Chronic Inaccuracy
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1. The finite human memory
2. Inaccuracy results in lower revenue
OASIS accuracy degrades by the minute from patient’s home to nurse’s home.
(Eidetic (photographic) memory is either a myth or is found in .001% of the population depending on which scientific theory you believe If the population, depending on which scientific theory you believe. If you are that rare individual, you may disregard #1.)
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SIS Consistency Between Clinicians in a Training Settingmparison of 400 Class Attendees over Three Years
rage Decrease in Accuracy Among the Groupsument Imm2 Hours Post A4 Hours Post Assessment
93.0% 78.8% 62.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%93.0%
78.8%
62.0%
Document Immediately 2 Hours Post Assessment 4 Hours Post Assessment.0%
10.0%
20.0%
30.0%
40.0%
Findings reported by one outsource coding service organization: 80% average clinical documentation error rate nationwide
Within that 80%:20% of cases are found to be familiar, comfortable, result in upcoding
80% of cases are less familiar, harder to code correctly, result in downcoding
Net revenue across the board is $300 loss per Medicare episode
Point‐of‐care automation
Electronic Medical Record
Health Information Exchanges (HIE)
Home TelehealthVital signMed managementPERS
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Count on hospitals selecting post‐acute partners that can most easily exchange p y gpatient data with their existing EMR software.
Have you asked your vendor to outline their plans to help you upload and download
ti t i f ti t l l HIE?patient information to your local HIE?
Point‐of‐care automation
Electronic Medical Record
Health Information Exchanges (HIE)
Home TelehealthVital signMed managementPERS
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At Least 9 TypesVital sign monitoringGeneral condition Q&AVideo visitsVideo visitsPERSVoice recognitionPOTsPatient portals & Social networkingMotion detectionMedication management
Platforms:
Vital sign monitoringGeneral condition Q&AVideo visits
Familiar Vendors:
American Medical Alert Corp.American Telecare Inc.Bosch (Health Hero)
PERSVoice recognitionPOTsPatient portals & Social networkingMotion detectionMedication management
Purchase or Lease-to-own
( )Bosch (ViTel Net)CardiocomCare Innovations (Intel/GE)Continuity HealthHoneywell HomMedIdeal LifeInfopia USAMEDITECHPhilipsViterion (Bayer)
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Platforms:
Vital sign monitoringGeneral condition Q&AVideo visitsPERS
New Vendors:
Acadian Telehealth Monitoring Advantage Home TelehealthAvery Telehealth
PERSVoice recognitionPOTsPatient portals & Social networkingMotion detectionMedication management
Per patient per month rentalCall center services
yConnections365Guardian Medical Monitoring HealthCOMPharos InnovationsSmartLinkTelehealth 360VRIWebPlus
Be Creative:
Some hospital‐affiliated agencies are tracking cost savings to the hospital and receiving bonuses.Managed care contracts some agencies have received Managed care contracts: some agencies have received payments or renegotiated contracts based on demonstrated cost savings. Private Duty: patients are increasingly willing to pay to keep monitors upon home care discharge.
HHS will step up its focus on patient‐centered care
HHS will decrease its concern for the survival of individual providers, increase its efforts on survival f th h lth t it lfof the healthcare system itself
Hospital readmission penalties kick in on October 1, 2012
Home health care agencies are going to adapt or die.
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Working With ACOs and Shared SavingsPayment Plans. What Operational and Policy Changes Will Be Required?
www.RowanResources.com