A behemoth of global business now has tied itself to home care.
Google Capital on Wednesday announced it has invested $46.35 million in Waltham, Massachusetts-based Care.com, Inc. (Nasdaq: CRCM), the world’s largest online marketplace for finding and managing family care. Google Capital, a growth equity fund backed by technology conglomerate Alphabet (Nasdaq: GOOGL), invests in companies that are driving disruption in their markets through long-term technology trends.
Google Capital’s share in the $278 million company makes it the single largest shareholder in Care.com. At present, Care.com connects 11 million families with 8.6 million caregivers in 16 different countries. Care.com deals in senior care, as well as child care, pet care, housekeeping and more.
As part of the deal, Google Capital Partner Laela Sturdy will also join Care.com’s Board of Directors.
“We are thrilled to announce this investment and to partner with Google Capital during our next phase of growth,” Sheila Lirio Marcelo, Care.com’s founder, president and CEO, said in a prepared statement. “Laela will be a great addition to our Board, bringing significant operating and investing experience including nearly a decade at Google/Alphabet. We look forward to bringing that expertise to bear as we innovate our service offerings for our members and corporate clients, while continuing to add value for our shareholders.”
In the past, there has been speculation Google would eventually dip its toes into the senior care industry.
In 2012, the technology giant paid a reported $100 million for Meebo, a company helmed by Seth Sternberg, who is now the CEO of home care startup Honor. Sternberg was coy when Home Health Care News asked whether Honor might also be acquired by the tech giant.
“I didn’t create something with Meebo that is still there changing the world for people, it’s just now integrated into the Google ecosystem,” he told HHCN. “With Honor, I really hope that we fundamentally make the world a better place for seniors, for their families and for the care professionals, and that Honor continues to evolve and continue to do that when I need help as a customer.”
Written by Mary Kate Nelson
After a damning report from the U.S. Government Accountability Office (GAO) on the rising number of Medicare claims appeals and the resulting dramatic backlog of unresolved cases, the latest proposed changes to clear out the backlog have appeared.
Medicare Administrative Contractors (MACs) process an estimated 1.2 billion fee-for-service claims on behalf of the Centers for Medicare & Medicaid Services (CMS) for more than 33.9 million Medicare beneficiaries annually. When Medicare beneficiaries or providers disagree with a payment or coverage decision—if a claim was denied, for example—they may appeal these decisions through the Medicare FFS appeals process. Earlier this year, the GAO found that appeals rates had gone through the roof across all provider levels, including home health.
In 2015, 123 million Medicare fee-for-service claims were denied, or roughly 10% of the more than 1.2 billion claims processed during the year. Of these denied claims, 3.7 million, or 3%, were appealed.
“Several factors, including the growth in Medicare claims—partially driven by the aging population—and HHS’ continued investment and focus on ensuring the program integrity have led to more appeals than Office of Medicare Hearings and Appeals (OMHA) and the [Medicare Appeals] Council can process within the contemplated time frames,” HHS’ primer on its proposed appeal process changes reads.
There are five levels in the appeals process for Medicare Part A and Part B claims, with the first level involving redetermination by a MAC or similar party, and level five involving judicial review in a Federal District Court. For home health and other provider types, appeals at the third level and higher have become especially problematic, due to a shortage in the number of administrative law judges needed to handle ballooning appeals.
For home health and hospice, the number of appeals filed at Level 3 increased from 7,013 in 2010 to 33,816 in 2014, according to the GAO report. For Medicare Part A overall, the number of appeals at this level jumped from 12,938 to 275,791 during that time period.
To mitigate the gloomy appeals process findings, the Department of Health and Human Services (HHS) issued a proposal for new rules in order to address the “unprecedented and sustained increase in the number of appeals.”
The Department is taking a three-pronged approach to tackle the issue, which topped 880,000 cases by the end of fiscal year 2015:
1) Invest in new resources at all levels of appeal to increase adjudication capacity and implement new strategies to alleviate the current backlog
2) Reduce the number of pending appeals and encourage the resolution of cases earlier in the process through new administrative actions
3) Propose legislative reforms that provide additional funding and new authorities to address the appeals volume
HHS is also requesting additional funding for the fiscal year 2017 to increase the agency’s capacity to process and resolve appeals in line with the current volume of cases.
HHS pointed out that “while the volume of appeals has increased dramatically, funding has remained comparatively stagnant,” according to the primer. “Under current resources, it would take 11 years for OMHA and 6 years for the Council to process their respective backlogs.”
However, even with the administrative changes and additional funding, HHS estimated the current backlog of appeals couldn’t be eliminated until 2021.
The proposed changes will be posted to the Federal Register July 5, 2016, and will open for comment until August 29, 2016.
Written by Amy Baxter
Home care workers in the nation’s capital will now earn at least $15 per hour by 2020, thanks to a recently approved bill.
The “Fair Shot Minimum Wage Amendment Act of 2016” stipulates that the minimum wage in Washington, D.C., will jump from $10.50 per hour to $11.50 per hour in July, and will increase by about 70 cents per year until 2020, when it will hit $20 per hour. After that, any additional increases in hourly wage will be linked to inflation, according to The Washington Post.
“D.C. seniors should get the quality care at home they want and deserve, and $15 is a first step to fixing our care crisis,” Michael Thompson, a home care worker in Washington, D.C., said in a prepared statement, according to Fight for $15. “We’re going to keep fighting for our union to make sure everyone gets the care they need and no caregiver is forced to work without pay.”
Meanwhile, in California, more than 440,000 health care workers will see their pay increase gradually to $15 per hour by 2022. In New York, minimum wage will be boosted to $15 per hour first in New York City and then elsewhere.
The movement has led to backlash from the health care industry itself, as providers face staffing and wage pressures on a variety of fronts.
Written by Mary Kate Nelson
Brightree Names New CEO
Brightree, a durable home medical equipment, home health and hospice software provider, has named its new CEO on the heels of its recent acquisition by ResMedin April 2016. Brightree also named Bobby Ghoshal as COO.
Matt Mellott will take over as CEO of the software company, replacing current CEO and president Dave Cormack, who will transition to a multi-year advisory role.
Prior to joining Birghtree, Mellott worked for 12 years at MetBridge Healthcare, most recently as president. Mellott helped grow MedBridge, a sleep disorder diagnostic testing and respiratory therapy company, to include 140 sleep disorder centers and 21 HME locations across 22 states. Prior to MedBridge, Mellott served in a variety of executive finance leadership and CFO roles. He began his career with KPMG.
Cormack has been with Brightree since 2005 and led the company through a period of tremendous growth, helping grow the company from a software-as-a-service startup with 12 employees and fewer than 100 customers into a company with revenues exceeding $100 million annually.
As COO, Goshal will oversee the company’s technology, product management initiatives, business operations and finance functions. Ghoshal was previously vice president of information technology in ResMed’s Americas Group.
Care at Hand Acquired by Mindoula Health
Care at Hand, a digital health startup that focuses on accurately predicting risks to reduce hospital readmissions, has been acquired by Mindoula Health, a tech-enabled case management company focused on behavioral health, for an undisclosed price.
Mindoula Health is a Maryland-based company that has roughly 60 employees and is growing rapidly. Care at Hand will be a wholly owned subsidiary, and will continue to serve the HCBS space while simultaneously becoming the predictive analytics backbone of Mindoula, according to Care at Hand co-founder and CEO Andrey Ostrovsky.
ACHC Partners with Home Care Association of Florida
Accreditation Commission for Health Care (ACHC), a non-profit accreditation organization that offers national recognized accreditation services for home health, hospice and private duty agencies, has partnered with the Home Care Association of Florida (HCAF) to provide Florida-based home care providers special pricing of ACHC services and educational resources.
HCAF is a trade association for the home care sector in Florida. The association, formerly known as Associated Home Health Industries of Florida, was founded in 1989 and is a non-profit association dedicated to serving Florida home car providers and their vendors. HCAF association members will receive also receive discounts on Accreditation University (AU) educational resources that help prepare members for ACHC Addreditation.
“ACHC is proud to partner with HCAF in an effort to provide the Florida-based home care providers with relevant standards, best practices and educational resources,” Matt Hughes, ACHC director of business management and customer service, said in a statement. “We are encouraged by HCAF’s forward-thinking in the development of its association, in support of more than 500 members and their patients.”
Personal-Touch Home Care Adopts Health Recovery Solutions
Personal-Touch Home Care, a New York-based home health care provider with more than 50 locations in 11 states, has added Health Recovery Solutions’ telehealth remote monitoring to serve its patients in its Brooklyn branch. Personal-Touch was founded in 1974 and has 34 offices that are certified home health agencies offering Medicare services.
The company will utilize HRS’ Clinician Connect mobile app, allowing nurses in the field to receive high risk alerts from tablet monitors which the patients interact with. Home care nurses can place video calls, phone calls or text messages directly to the tablets.
Rennova Health Enters Provider Agreement with Tree Rivers Providers Network
Rennova Health, Inc. (Nasdaq: RNVA), a vertically integrated provider of diagnostics and supportive software solutions to health care providers, has entered into a preferred provider network agreement with Three Rivers Provider Network (TRPN), effective May 1, 2016.
TRPN is the nation’s largest proprietary provider network, comprised of more than 1.5 million provider locations, including more than 5,000 hospitals and 100,000 ancillary facilities, including home health.
Under the agreement, more than 200 million members serviced at 1.5 million health care locations across the U.S. will have access to Rennova’s diagnostic testing laboratories.
Written by Amy Baxter
The OASIS guidance manual set to take effect next year now is available, marking yet another step toward standardized collection of post-acute data and potential changes to the Medicare payment system.
The Centers for Medicare & Medicaid Services (CMS) on June 27 posted the OASIS-C2 Guidance Manual online, after having posted a draft version in late December 2015. OASIS-C2 is scheduled to be implemented on Jan. 1, 2017, and replaces the version of the data set that was created to conform with ICD-10 coding.
Among the major differences in the new guidance manual are several items added in response to the Improving Medicare Post-Acute Care Transformation (IMPACT) Act. Passed in 2014, the law requires standardized data to be submitted by various post-acute providers, including skilled nursing facilities (SNF) and inpatient rehabilitation facilities (IRFs), in addition to home health agencies.
The goal of IMPACT is to get an apples-to-apples comparison of outcomes and costs in various settings, with the ultimate goal of adjusting Medicare reimbursements accordingly.
Appendix G of the new manual summarizes the changes from OASIS-C1/ICD-10 to OASIS-C2, including new items/IMPACT Act items. They include but are not limited to:
– M1028: Active Diagnoses, Comorbidities and Co-existing Conditions
– M1313: Worsening in Pressure Ulcer Stats since SOC/ROC
– M2001: Drug Regimen Review: Did a complete drug regimen review identify potential clinically significant medication issues?
Among other items of note, the new Guidance Manual includes instructions on how agencies can adopt pressure ulcer guidelines from the National Pressure Ulcer Advisory Panel (NPUAP). Agencies may adopt NPUAP guidelines but definitions on staging may not align with OASIS scoring instructions. If so, agencies are instructed to rely on the OASIS instructions, the manual states.
Click here to view the entire OASIS-C2 Guidance Manual.
Written by Tim Mullaney
With just over one month before the start of the Centers for Medicare & Medicaid Services’ (CMS) Pre-Claim Review Demonstration for Home Health Services, agencies in the five-state pilot program are eagerly looking for clarification on compliance requirements.
The three-year program will begin in Illinois on August 1, with Florida and Texas beginning later this year and Michigan and Massachusetts starting in 2017. Despite CMS’ reassurances to home health agencies that no new documentation is required for the pre-claim demonstration, providers from across the country expressed lingering questions Tuesday on a public call with CMS officials.
Notably, multiple home health professionals voiced their concerns over the requirement that a physician’s signature be included in the plan of care within a pre-claim request. Many professionals, including a home care association representative, indicated that securing a physician’s signature can be a significant burden for a home health agency within a shortened timeframe. Currently, it can take up to several weeks to send forms back and forth from a physician before a home health agency can get a signature for a plan of care to submit a final claim.
Physicians “have no skin in the game,” and are unlikely to respond in a timely manner for home health agencies to send in their pre-claim submissions with all the required documentation, one questioner argued. Other agencies pointed out they already spend “a lot of man hours” obtaining physician signatures. Speeding up this requirement worried many.
CMS will perform some educational outreach to physicians in the demonstration states to encourage the pre-claim process, officials responded, but they remained rigid that the requirement will be included.
“The care plan must be signed [by a physician] in pre-claim reviews,” CMS officials said. “We are hearing your concern about needing to educate physicians. We want to be clear we are rolling this out to physicians, as well.”
A physician’s signature is already a requirement for a plan of care in a final claim, officials also stressed. A physician’s order for home health care services is part of a home health agency’s requirement to prove medical necessity as part of its Medicare claims.
The new model requires home health agencies to submit pre-claim requests for approval prior to submitting a final claim, and is set up so that agencies can go through this process while providing care to patients, according to CMS officials.
One Illinois home health care provider preparing for the demonstration in August says the physician signature is just one part of compliance measures that will have to be completed more efficiently and accurately.
“Home health agencies should be more focused on the compliance of their field clinicians,” Marvin Javellana, CEO and founder of Des Plaines, Illinois-based Better Care Home Health Inc., told Home Health Care News. “That means prompt submission of the OASIS, quick and accurate turnaround time for quality assurance and coding in order to generate the plan of care. The next challenge is getting the physician to sign off on the plan of care, which has always been a challenges unless the agency has a relationship with the facility or practice.”
CMS officials also detailed that any non-affirmed pre-claim requests will include a detailed review of why the pre-claim was not affirmed so agencies can resubmit with correct documentation. Agencies can resubmit pre-claim requests as many times as it takes to get approval before a final claim. Pre-claim submissions that are not affirmed do not count toward an agency’s claim denial rate.
“All of this allows for the early submission of the ‘pre-claim review’ documents and gives the agency enough time and submission tries in the event that the pre-claim is denied,” Javellana added. “It is not an added burden if the home health agency is doing it right, but a matter of making it tight.”
Written by Amy Baxter
One of the top ten largest U.S. home health companies is giving away its business to a newly created charity organization in what might be the first succession plan of its kind for the home health care industry.
Founder and President of Pennsylvania-based Bayada Home Health Care, J. Mark Baiada, has decided his “Lasting Legacy Plan” will be turning the business he founded in 1975 into one that serves the public interest. The landmark decision is a highly unusual move for such a profitable, privately-held company, which reportedly earns $1.1 billion in annual revenue. Instead of selling the business, Bayada Home Health Care will be privately owned by a non-profit foundation company.
“We’ve evaluated everything and spent time going through every ownership structure,” David Baiada, the company’s current chief operating officer and son of founder Mark Baiada, told HHCN. “At the end of the day, when you’re thinking about 100-year sustainability, the intergenerational transfer between owners often comes down to money. The reality is that we are focusing on mission before money and a long-term commitment to our patients and employees. The best way to maintain that commitment across generations is to set up a mechanism where the business can’t be sold.”
Above all, the new ownership structure lends itself to ensuring that the company will remain focused on its mission, based in family-owned values and likely to remain operational for the next 100 years, the Baiada family believes.
“Since our founding in 1975, I have owned Bayada 100%,” Baiada said in a statement. “After years of study, thought and prayer, my family and I decided that this innovative succession approach gives us the best chance to perpetuate our mission and protect the company from ever being sold. Our dream is to touch millions of people worldwide and provide home health services with compassion, excellence and reliability for 100 years or more, long after we are gone.”
Mark Baiada plans to step down as president on August 17, 2017**, his 70th birthday. He will assume the role of chairman of the board of the foundation, which has yet to be created.
Bayada Home Health Care operates more than 300 offices in 22 states and employees more than 23,000 home health professionals. The provider offers home health, adult nursing, assistive care, pediatrics, hospice and habilitation care services.
Mission Over Money
The decision potentially leaves a lot of money on the table for Baiada, who has chosen to forgo a succession plan to pass the business to one of his children or sell to another entity. Upon stepping down, Mark Baiada’s son, David Baiada, who currently serves as chief operating officer of home health, hospice and quality for the company, will be named Bayada’s president. Mark Baiada will oversee the transition of the ownership to the new foundation and continue to advise the company.
“In earnest we have been working on this for 10 years,” David Baiada told Home Health Care News. “We’ve spent a lot of time trying to be thoughtful about our long-term vision and our values—what we call The Bayada Way. The decisions we’ve made have been to create an ownership and governance structure that creates the highest likelihood that we will be able to make that come true.”
The non-profit foundation will become the Bayada’s majority owner over the next three to five years. Eventually, the charitable foundation will own roughly 80% of the business, and family and employees will own the remaining 20%.
“You’d be surprised how difficult it is for a man to give away a $1 billion business,” Mark Baiada told HHCN. “[We are] going through the process of engaging the IRS to establish a private charity and then transferring the shares to that [entity].”
The move will ensure that Bayada’s mission—The Bayada Way—remains as the top priority of the company instead of profits. The mission seeks to serve clients at home and support charitable initiatives, including financial assistance for its own employees in the face of catastrophic life events or circumstances.
Bayada has come a long way since its inception over 30 years ago, and has continued to expand not only in the United States but abroad with a $10 million investment into a home health provider in India in 2014. Bayada has recently entered into partnerships and joint ventures with major health networks in New Jersey and Philadelphia.
“For decades, I have turned down countless offers to sell Bayada,” Baiada said. “If we sold the company, the new owner’s primary purpose would be to make money, which is not our primary purpose. Bayada’s primary purpose is to care for our clients and honor, respect and support our people.”
The company will continue to hammer out details of the transition throughout this year and into 2017.
Written by Amy Baxter
**Editor’s Note: This article has been updated from a previous version that noted J. Mark Baiada’s step-down date was August 17, 2016. Baiada will step down in 2017.
Depending on where you live in the United States, you could wind up paying significantly more or drastically less for home health care. Now, there’s data that indicates just how much more someone in North Dakota and other expensive markets can expect to pay on an annual basis, compared with someone in Louisiana, or another more affordable state.
In certain Northern states, and outside of the continental U.S., home health care will cost you a pretty penny, according to state-specific information insurer Genworth Financial (NYSE: GNW) recently pulled from its 2016 Cost of Care report.
The median annual cost of a home health care aide is highest in the following places:
1. North Dakota – $63,972
2. Alaska – $61,776
3. Minnesota —$59,488
4. Hawaii – $57,772
5. Massachusetts, New Hampshire and Rhode Island — $57,200
Genworth’s 2016 Cost of Care Survey, which was published in early May, included information on how much the cost of care increased in each state over the past five years. Genworth’s new data, released June 28, includes the annual, monthly and daily median costs of assisted living care, home health care, adult day health care and nursing home care by state.
Home health care is generally the least expensive in the Southern parts of the country, the data show.
The median annual cost of a home health care aide is lowest in the following places:
50. Louisiana – $36,608
49. Alabama – $37,752
48. Mississippi – $38,896
47. Arkansas, Georgia, North Carolina and Tennessee – $41,184
Meanwhile, the median annual cost of a private room a skilled nursing facility is lowest in in Oklahoma, Louisiana and Missouri, and highest in Alaska, Connecticut and Massachusetts.
Genworth’s data slightly contradicts that of Lincoln Financial Group (NYSE: LNC), the Radnor, Pennsylvania-based arm of Lincoln National Corporation. The most expensive states for home health care are Minnesota and Alaska, and the least expensive are Louisiana and Mississippi, according to Lincoln Financial’s recent analysis.
Written by Mary Kate Nelson
The Centers for Medicare & Medicaid Services (CMS) has proposed reducing Medicare home health payments by 1% in CY2017, or $180 million. The proposed changes to the Medicare home health prospective payment system (HH PPS) follow the federal agency’s proposal to increase hospice payments by 2%, or $330 million for 2017.
In 2015, care for 3.4 million beneficiaries of home health services from approximately 11,400 home health agencies cost Medicare approximately $17.8 billion in 2015. Home health agencies (HHAs) are paid a national, standardized 60-day episode payment for all covered home health services, adjusted for case-mix and area wage differences, according to CMS.
The proposal reflects a combination of adjustments to home health payments, inducing a 2.3% home health payment update or $420 million increase and a $420 million decrease in the rebasing adjustment to the national, standardized 60-day episode payment rate, the national per-visit payment rates and the non-routine medicare supplies conversion factor. The proposal also includes a $160 million decrease reflecting the effects of a 0.97% decrease adjustment to the national, standardized 60-day episode payment rate for a case-mix growth impact of -0.9% and the effects of the $20 million decrease or 0.1% decrease in the proposed increase to the fixed-dollar loss ratio used in determining outlier payments.
CMS is also proposing to adopt four new payment determination measures for 2018 to meet the requirements of Improving Medicare Post-Acute Care Transformation Act (IMPACT) of 2014. These measures include preventable hospital readmission rates, total estimated Medicare spending per beneficiary, discharge to the community and medication reconciliation.
Home health agencies in the nine states where CMS is currently underway with its Home Health Value-Based Purchasing (HHVBP) Model will see their payments adjusted—either upward or downward—based on each HHA’s total performance score on a set of measures. The first payment adjustment of 3% will begin in 2018, followed by a maximum adjustment of 5% in 2019, 6% in 2020, 7% in 2021 and 8% in 2022. The nine-state pilot program is taking place in Maryland, Massachusetts, Florida, Washington, North Carolina, Arizona, Nebraska, Iowa and Tennessee.
The payment proposal is one of several rules for 2017 that reflect the agency’s strategy to create a better health system that values quality over quantity and focuses on specific reforms, including better health outcomes, preventing disease, helping patients return home, care management and greater efficiency and coordination.
CMS reduced home health payments for 2016 by 1.4%, or $260 million.
The federal agency has also put forth several changes and improvements related to the HHVBP model to help HHAs develop their public reporting. CMS proposes calculating benchmarks and achievement thresholds at the state level rather than the level of the size-cohort and change the definition of “benchmark” to refer to the meant of the top decile of Medicare-certified HHA performance on the specified quality measure during the calculated period for each state. The agency also proposed requiring a minimum of eight HHAs to qualify as a size-cohort, as well as remove four measures from the quality reporting and increasing the timeframce for submissting New Measure data from seven calendar days to 15 calendar days at the end of each reporting period to reflect weekends and holidays.
Specifically, CMS could remove four measures including Care Management: Types and Sources of Assistance, Prior Functioning ADL/IADL, Influenza Vaccine Data Collection Period and Reason Pneumococcal Vaccine Not Received. The proposal also includes an adjustment to the reporting period and submission date for the Influenza Vaccination Coverage for Home Health Personnel measure to an annual submission instead of a quarterly submission. Lastly, the agency would like to add an appeals process with the existing recalculation process and a new reconsideration process.
Written by Amy Baxter
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