Following a year full of ups and downs, one of the nation’s largest home health care providers is striving to become an overall “aging in place company” by increasing its partnerships across the provider and payer spectrum, including by taking on more risk-sharing.
After finishing the implementation of Homecare Homebase on time on Nov. 1 2016 and ending 2016 with hospice flourishing, employee engagement up and turnover down, the next goal is for Amedisys (Nasdaq: AMED) to become a one-stop shop that hospitals and the government will turn to for all aging in place needs, president and CEO Paul Kusserow said at the J.P. Morgan Healthcare Conference Wednesday afternoon.
Headquartered in Baton Rouge, Louisiana, Amedisys has pinpointed an increase in risk as a top priority in the coming years, and to do so it must become more innovative and data-driven. Accountable Care Organizations (ACOs) and similar coordinated and managed care models offer financial incentives for member providers that can lower costs while delivering quality outcomes—but these providers also may be at risk for penalties if they do not hit goals.
“We will need to be innovative when it comes to information and data in the future to be able to take any risk because without information or data, you just can’t take risks,” he said. “We need to build better methods and track better data with the hope of becoming an aging in place company.”
It is no longer good enough to just have exceptional clinical skills—nonclinical skills are just as vital. Even though the company already has a database, it’s more about using the data to the fullest extent and building more analytical capabilities, Kusserow explained.
“We have a rich database, but are building it out even further to be able to predict things like readmission rates,” he said. “Then once we are confident in it we can really start to use that data to make individualized care plans.”
In addition to its own data, Amedisys is currently in discussion with other players in the market about sharing their data, Kusserow added.
“We feel very good about where we’re going in the next few years,” said Kusserow. “We brought on new team members, a new COO and CFO from Kindred. We needed that executional ability, so we went out and got it.”
Written by Alana Stramowski
“The challenge is to find good caregivers or home health aides, CNAs, that will stay with you, show the best face of the company and provide good service,” Lenny Verkhoglaz, CEO of New Jersey-based home care franchising company Executive Home Care Franchising, LLC, told Home Health Care News. “Retaining caregivers is a challenge.”
One solution to the caregiving challenge is to tap into the immigrant labor pool, and Verkhoglaz fears this soon could become more difficult.
Immigrants in Health Care
In some regions of the country, legal immigrants are finding a career path in health care and, specifically, home care.
One New Jersey-based private duty home care provider, Care Assist, has looked to tap a niche workforce by partnering with a nursing home with roots in the Filipino community. The labor pool he has found is eager and qualified to perform home care duties.
In New England, where the population is aging faster than almost another other place in the country, immigrants are working with a Boston-based group to be trained to become healthcare workers, local media and radio outlet WBUR reported.
The training is a method that Verkhoglaz agrees with, particularly as he believes the challenge of finding qualified caregivers is likely to grow in the coming years. At the same time, demand for home care will skyrocket as Americans age.
“The biggest challenge is recruiting, getting good caregivers,” Verkhoglaz said. “We do not lack clients, just quality caregivers. And it will get worse—the ratio of caregiver to client is going to decrease. The number of seniors is expanding over the next five to ten years versus availability of quality caregivers.”
Opposition to Immigration
While recruiting immigrants could potentially expand the labor pool for future caregivers, the incoming Trump administration could pose challenges related to immigration. President-elect Trump has remained staunchly opposed to increasing immigration to the United States.
However, future regulation that would make it harder for immigrants to work legally in the U.S. could put a squeeze on the rising demand for qualified caregivers. Verkhoglaz agrees that immigration restrictions could negatively impact demand for caregivers, and he is a proponent of making immigration easier.
“I’m a huge proponent of legalizing so-called ‘illegal people,’ and providing them with some kind of stable way of remaining in this country,” Verkhoglaz said. “[We can] train them, certify them. There’s got to be smart immigration policy that will allow these underground people to come up and get work. Our industry is in need. [I’m a proponent] of making the process simple so people can take advantage of the work.”
Written by Amy Baxter
Corridor Group Acquires Transpirus
The Corridor Group Holdings has acquired Transpirus, a leading national provider of outsourced coding, revenue cycle management and strategic consulting solutions for the home health and hospice industry.
With the transaction, Corridor becomes the largest national provider of full service revenue cycle, clinical documentation review, advisory and education services dedicated to home health and hospice.
“Transpirus is a top service provider in our space, with expert staff and an excellent reputation for quality,” Des Varady, CEO of Corridor, said in a press release. “Combining with Transpirus strengthens Corridor’s ability to deliver services at scale and in a tailored way to meet each client’s needs. Additionally, both companies have unique capabilities in technology, consulting and education that further expand the value we can deliver together.”
As part of the transaction, former CEO of Gentiva Health Services Ron Malone, who is now principal of Transpirus, will join Corridor’s board of directors.
“Corridor has a strong reputation for delivering quality services,” Malone said. “The combination of Corridor and Transpirus will leverage our joint capabilities and enhance offerings to our customers.”
The transaction was completed on December 23, 2016.
Always Best Care Announces New Owners
The Philadelphia Main Line location of Always Best Care has been acquired by Michael Friedberg and his partner Di Guo, and will be a family-operated business. The location provides senior care services to those in the Philadelphia metro area and surrounding areas.
Michael’s parents, Richard and Ramona Friedberg, operate the business. They previously owned and operated private vocational schools where they taught, as well.
“We are very happy to have the Friedberg family join Always Best Care,” Jake Brown, president of Always Best Care, said in a press release. “Richard, Ramona and Michael bring a special skill set to our brand, and we feel confident in the level of care they will provide to the Main Line area.”
Michael and Di each own information technology companies that have clients in the public and private sector in a variety of industries.
“Spending most of our lives in the Main Line area, we noticed there was a growing demand for senior services given the aging general population,” Richard Friedberg said. “Providing care to those in need is very close to Ramona’s heart, and mine. We are very sensitive to the personal needs of others and know what it’s like to be caregivers. Always Best Care’s beliefs and wide range of services, as well as its reputation in the industry, made it the natural fit for our family.”
SAFE HOMECARE Opens New Location
Provider of non-medical in-home care SAFE HOMECARE has opened a new franchise location in Aurora, Colorado.
“SAFE HOMECARE is just beginning its national rollout of franchise locations across the United States, forecasting to award nine new franchise locations in 2017,” Adam Krueger, COO of SAFE HOMECARE, said in a press release. “The demographic surge in demand is just beginning to explode with 10,000 people in American turning age 65 every day for the next 20 years.”
Since it was founded in 2014, SAFE HOMECARE is offering franchise opportunities in 33 states.
“SAFE HOMECARE has very high standards of care, professionalism and accountability,” Jeff Krueger, CEO, said. “We know what a great business opportunity SAFE HOMECARE locations will be, and accordingly, we are very selective in awarding franchises to prospective franchisees who recognize the tremendous business opportunity in this booming market.”
Senior Service Provider Enters Partnership for At-Home Continuing Care Program
Friends Life Care Partners, which provides wellness programs, home health care and other personal care services to seniors in the Philadelphia and Delaware areas, and SpiriTrust Lutheran, which provides outreach services to families and seniors in York County, Virginia, are partnering together to launch a continuing care at home program.
“We are delighted to join resources with SpiriTrust Lutheran and bring our distinctive services to the people of central Pennsylvania,” Carol A. Barbour, president of Friends Life Care, said in a press release. “Friends Life Care’s philosophy is centered upon vitality, independence, growth and resilience and enables us to launch and maintain a strong partnership with SpiriTrust Lutheran.”
The program, set to launch early this year, aims to give older adults another option to remain at home longer.
“Friends Life Care offers the first and largest continuing care at home program in the country,” Angela Dohrman, senior vice president and COO for SpiriTrust Lutheran, said. “The Friends Life Care program provides a truly unique combination of care coordination and financial benefit needed to help insure older adults have the resource and support that they will need to remain in their own homes as they age. If home care is ever needed, it will be coordinated by Friends Life Care and provided by SpiriTrust Lutheran’s trusted network of caregivers.”
Health Care Company Rebrands Home Care Services
Penn Highlands Healthcare, located in Pennsylvania, is condensing its four home care agencies into one.
The agencies will still continue to serve in the same areas throughout the state, but will eliminate some challenges that came with operating four agencies, including overlapping service areas, duplication of efforts and different computer and software programs.
The first step was changing the name for all agencies to Penn Highlands Community Nurses. Over the next few months, operations will be streamlined by establishing a central office for administrative, intake and billing services.
Northwell Health Expands Telehealth
Northwell Health is partnering with telehealth solution provider Avizia to expand its telehealth services. Northwell has 21 hospitals and more than 550 outpatient practices throughout the New York metropolitan area, including home care services.
The goal of the partnership is to expand Northwell’s electronic intensive care unit program, which is already in place, as well as the telestroke program that allows neurologists to evaluate stroke patients quickly when an emergency medicine team arrives.
The expansion includes a new implementation of telemonitoring services for home-care patients that use tablets and Bluetooth devices to monitor vitals and record data.
Written by Alana Stramowski
The home health industry is about to be inundated with new regulations after a long-expected update of the Conditions of Participation (CoP) was released by the Centers for Medicare & Medicaid Services (CMS) Monday.
With the introduction of the final rule that defines what is needed to participate in the Medicare and Medicaid programs, home health agencies and industry groups are wading through numerous changes. With an effective date of July 13, 2017, agencies have roughly six months to comply. One area of concern is the implementation time, which is much shorter than what was requested by agencies and home health associations during the comment period.
“We asked for 12-18 months lead time,” Bill Dombi, vice president for law at the National Association for Home Care & Hospice (NAHC), told HHCN. “We are assessing whether the 6 months is sufficient, given the rule outcome.”
When the rule was introduced in proposal form at the end of 2014, industry associations, including NAHC and the Visiting Nurse Associations of America (VNAA), asked for more than a year after publication of the final rule for agencies to comply. VNAA also asked for a a one-year period during which CMS would not sanction home health providers that are not in full compliance. Now, with a short timeline, associations are prepping members on their new requirements.
“With the quick six-month implementation date, VNAA is working to ensure that our members are fully briefed and prepared to comply with the July 13th deadline,” Joy Cameron, vice president of public policy at VNAA, told HHCN.
Home health agencies agree that the six-month period may be too short.
“[A] six-month implementation date is too soon for such a dramatic change in the CoPs,” Ken Miller, clinical educator of New York-based Catholic Home Care, told HHCN.
Despite the short timeline, not all industry groups are bracing for burdensome changes.
“Given the very significant scope and nature of the changes, we hope CMS will exercise discretion and flexibility on enforcement for a reasonable period of time after July 13, 2017 in recognition of the need for significant structure, process and training changes that agencies will need to make to comply,” Teresa Lee, executive director at the Alliance for Home Health Quality and Innovation (AHHQI), told HHCN.
In fact, AHHQI is generally supportive of the changes, which had not been updated in roughly two decades. The Alliance also noted that the final rule did take into account some of their comments from the proposal period in 2015.
“The Alliance supports the newly revised conditions of participation and the focus on patient-centered care, patient rights and value and outcomes-based care,” Lee said. “CMS’s final rule also incorporates several recommendations made by the Alliance.”
The final rule aims to change all conditions of participation and add several new ones, with the potential to cause additional administrative burdens and costs. One such area that association groups are looking into relates to organizational structure and additional communication requirements.
Fortunately, it appears that at least some concerns voiced by home health care groups have been heard in the final rule.
“We are please that CMS will permit HHAs to use any form of communication, including secure electronic communications, to facilitate patient knowledge and understanding of the care being delivered,” Lee told HHCN. “This is consistent with the Allaince’s recommendation to permit electronic transmission of the plan of care information to patients and allowing for the flexibility on the means one might use.”
One of the new CoPs mandates expanding care coordination between a patient’s physician with an “integrated communication system that ensures that patient needs are identified and addressed” and that care is coordinated across all disciplines, according to CMS. The expansion requires home health agencies are in “active communication” with the physician(s).
Introducing more regulations between physicians and home health agencies could prove to be tricky; regulations related to the Pre-Claim Review Demonstration (PCRD) that require documentation from a physician earlier in the claims process has been challenging for some participating agencies. The issue even became a focal point in CMS’ education outreach to improve PCRD affirmation rates.
Another major change in the final rule centers on documentation requirements. While home health agencies have already seen their documentation requirements change rapidly over the past few years, thanks to initiatives within the IMPACT Act and Pre-Claim Review Demonstration (PCRD).
Under the new CoPs, home health agencies are required to provide additional documentation to patients and caregivers, including written information about upcoming visits, medication instructions, treatments administered, instructions for care that the patient and caregivers perform, and the name and contact information of a home health agency clinical manager.
Agencies also have to provide comprehensive patients’ rights that clearly enumerate the rights of home health patients and steps to ensure the rights are assured at all times.
“Of particular interest for us are the patient rights changes, which could be a significant implementation and operational burden for home health agencies,” Dombi said. “In addition, we are focusing on the changes related to infection control and the discharge summary.”
However, the language related to patient rights appears to have softened from the initial proposal. Specifically, CMS clarified that home health agencies are not expected to provide this in writing in every language, the Alliance told HHCN.
Furthermore, there is a new requirement for a data-driven, agency-wide quality assessment and performance improvement (QAPI) program that evaluates and improves agency care for patients.
“I think the biggest challenge is the development and implementation of the QAPI regulations,” Miller told HHCN. “New conditions that will likely be costly and burdensome are the QAPI.”
While it remains to be seen which is the most costly new provision, there’s no doubt that the new CoPs come with a significant pricetag: an estimated $293.3 million in the first year, according to the final rule.
Written by Amy Baxter
The market values of the three largest publicly traded home health care companies continued to rise in December, according to the latest Home Health Index by Stoneridge Partners.
The index, which tracks the market values of Almost Family (Nasdaq: AFAM), Amedisys (Nasdaq: AMED) and LHC Group (Nasdaq: LHCG), rose 5.42% in December from the previous month. The index also rose in November and October.
Market indexes showed strong gains as well, with some hitting new record highs amid a newly-established investor confidence that has been dubbed the “Trump rally” in anticipation of the incoming Trump administration.
“The Trump rally appeared to continue in December for most of the public home health companies,” Rich Tinsley, president of Stonebridge Partners, said in a statement. “With notable acquisitions and new hires coming through before the end of the year, home health is poised for more gains heading into 2017.”
All three of the largest home health care companies saw their stock prices rise in December, outpacing the S&P 500, which rose 1.54% in December.
Almost Family, which secured a $350 million revolving credit facility for a previously announced joint venture acquisition in December, saw the biggest gains for the month; its share price rose 6.78%, according to the Index. The Louisville-based home health provider announced it would acquire an 80% ownership stake in the home health operations of Community Health Systems (NYSE: CYH) in a $128 million deal. The deal, which was completed Jan. 3, 2017, creates the largest public hospital-home health joint venture in the nation.
Lafayette, Louisiana-based LHC Group, which also recently entered into a joint venture with a hospital group, continued to see its share prices climb in December, rising 6.58% from the previous month. However, the year-to-date stock price is down 1.08%
Amedisys had a modest uptick in its market value in December, with its gaining 2.87%. Year to date, the stock price is up 9.26%. The Baton Rouge Louisiana-based providers has undergone significant changes in its executive leadership in 2016, including hiring a new CFO, COO and chief clinical officer. CIO Martin Howard left the company in October.
Amedisys remained acquisitive through the end of the year. Despite grim earnings in the third quarter of 2016, Amedisys recently penned a deal that will make it the largest personal care provider in Massachusetts.
The share price for Addus HomeCare (Nasdaq: ADUS) has jumped 55.49% year to date, according to Stoneridge. For December, the share price rose just 1.01%. Addus, based in Downers Grove, Illinois, is not tracked in Stonebridge’s Home Health Index because little of its revenue comes from Medicare.
Addus began 2016 by naming a new CEO, Dirk Allison, and the company continued to add new executives throughout the year.
Written by Amy Baxter
Join Complia Health with our thought leadership webinar series for January featuring the topic “Care Coordination Improving Clinical Outcomes.” Presenting will be Kathleen Spooner, Clinical Product Specialist of Complia Health’s product team.
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Despite its resistance, the U.S. Department of Health and Human Services (HHS) must comply with a previously announced timetable for clearing a massive Medicare appeals backlog after all, the U.S. District Court for the District of Columbia has decided.
The Medicare appeals backlog grew exponentially in recent years due, in part, to more aggressive Medicare integrity efforts and an aging U.S. population. Of the 658,000 claims in the appeals backlog, some are home health claims.
The American Hospital Association’s (AHA’s) four-year plan to clear the backlog is a “thoughtful and reasonable” approach to a “complex problem,” U.S. District Judge James Boasberg writes in a Memorandum Opinion dated Dec. 5, 2016.
HHS has previously called the timetable, which necessitates the huge Medicare appeals backlog be cleared by 2021, “impossible,” adding that the project requires additional funding from Congress and would force the agency to violate Medicare law by paying claims that lack merit.
Though HHS Secretary Sylvia Burwell claims that “she is hard at work, progress is in sight” with respect to clearing the Medicare backlog, her “latest brief does not provide enough evidence of progress to tilt the scales,” Boasberg writes.
So, as it stands, however, HHS must achieve a 30% reduction of backlog cases by December 31, 2017; a 60% reduction in backlog by December 31, 2018; a 90% reduction in backlog by December 31, 2019 and clear all of the backlog by December 31, 2020.
“Satisfying the statutory demands for both accuracy and timeliness will no doubt prove challenging, but such is the task at hand,” Boasberg writes.
The Court did decide, however, that it will not automatically enter default judgments in all qualifying appeals on Jan. 1, 2021, as doing so could potentially endanger the Medicare Trust Funds.
Now, if Burwell fails to meet the aforementioned end-of-year deadlines, the plaintiffs may move for default judgment or to otherwise enforce the writ of mandamus, the Court decided.
Written by Mary Kate Nelson
The Centers for Medicare & Medicaid Services (CMS) has issued its final rule outlining the Medicare and Medicaid Conditions of Participation (CoP) for home health agencies. Prior to the new finalized rule published Monday, the CoPs had not been updated in roughly two decades, when many of the requirements were first created.
The new rule was long-expected after a draft proposal was introduced in late 2014. The rule needed to be finalized within a three-year window and will be published on the Federal Register on January 13, 2017.
The conditions govern how home health agencies can qualify to participate in Medicare and Medicaid. The new CoPs are estimated to cost $293.3 million to implement in the first year and $290.1 million in subsequent years. The CoPs will be effective July 13, 2017, CMS stated in the rule.
“Our priority is to ensure that Medicare and Medicaid beneficiaries who receive health services at home get the highest level of patient-centered care from home health agencies,” Kate Goodrich, CMS chief medical officer and director of the Center for Clinical Standards and Quality for CMS, said in a press release. “Today’s announcement is the first update in many years to Medicare and Medicaid home health agency rules and reflects current best practices for in-home care, based on recommendations from stakeholder and medical evidence.”
Currently, there are more than 5 million Medicare and Medicaid beneficiaries receiving home health care from nearly 12,600 home health care angelicas participating in Medicare and Medicaid nationwide. Many industry groups, including the Visiting Nurse Associations of America (VNAA) and the National Association for Home Care & Hospice (NAHC), were generally supportive of the initiatives introduced in the draft proposal back in 2014.
“We do agree with many of the main principles the CoP, the conditions, were trying to get at, which was patient-centered care,” Joy Cameron, vice president of public policy at the Visiting Nurse Association of America (VNAA), said during a policy update call with members Monday. “It will be interesting to see the difference between the draft and now, because a significant amount of time has passed.”
At the same time, the groups were actively engaged during the comment period and hoped to make several changes and clarifications to the proposals.
Content of the Final Rule
Specifically, the finalized rule includes several updates to the CoPs. As summarized by CMS in its announcement of the rule, they include:
—A requirement for an integrated communication system that ensures patient needs are met, care is coordinated and that there is active communication between a home health agency and the patient’s physicians.
—A requriement for data-driven, agency-wide quality assessment and performance improvement (QAPI) program that evaluates and improves agency care for patients at all times.
—An expanded patient care coordination requirement that makes a licensed clinician responsible for all patient care services, such as coordinating referrals and assuring plans of care meet patients’ needs.
Other CoPs that are included in the final rule related to ensuring documented communication, care coordination and a comprehensive patient assessment that ensures all aspects of patient wellbeing. The rule also requires clearly stated comprehensive patient rights and the steps to assure those rights.
During the proposal period, industry groups voiced their concerns over some of the new CoPs, including allowing enough time for a new QAPI program and an ample implementation period to comply with all new requirements. Groups also voiced concern over how new communication requirements are documented and what actions home health agencies must take.
A Long Time Coming
As stated, the rule is the first update in decades of the fundamental requirements for home health agencies to participate in Medicare and Medicaid. However, the waiting was not for lack of trying. A proposed rule was published by CMS in early 1997 that would have revised the entire set of HHA CoPs.
Unfortunately, thanks to the sheer amount of comments and “rapidly changing nature of the HHA industry at that time,” the rule was never finalized in its entirety, according to CMS. Instead, just the OASIS rule was finalized in 1999.
Prior to publishing the proposed CoP changes in 2014, CMS took into account comments from the 1997 period, the agency stated.
Written by Amy Baxter
The new year will not bring new home health agencies to Florida, Illinois, Michigan, or Texas. The Centers for Medicare & Medicaid Services (CMS) is once again extending a moratoria on new HHAs in those states.
CMS first barred new Medicare-certified home health agencies in select counties in 2011, under authority granted by the Affordable Care Act. Since that time, the agency has repeatedly extended the ban on new providers and expanded the moratoria to whole states. The scope also has been expanded to bar new HHAs from being certified for Medicaid and the Children’s Health Insurance Program in the selected states.
The latest six-month extension was announced in a Federal Register entry Monday.
The purpose of the moratoria is to combat fraud, waste, and abuse. The affected states all were identified as fraud hotspots.
“CMS relied on law enforcement’s longstanding experience with ongoing and emerging fraud trends and activities through civil, criminal, and administrative investigations and prosecutions,” the Federal Register entry states. “CMS’ determination of a high risk of fraud, waste, or abuse in these provider and supplier types within these geographic locations was then confirmed by CMS’ data analysis, which relied on factors the agency identified as strong indicators of risk.”
State partners such as Medicaid agencies supported the extension and determined that it would not prevent beneficiaries from accessing care, according to the entry.
The temporary moratoria does not prevent an HHA from changing ownership, in most cases, and does not prevent changes in location for existing practices.
Home health provider groups have sharply criticized CMS for taking an overly broad approach to combating fraud through initiatives such as pre-claim review. However, organizations including the National Association for Home Care & Hospice (NAHC) and the Visiting Nurse Associations of America (VNAA) generally have supported the moratoria, saying that they recognize the need to root out bad actors.
Written by Tim Mullaney
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