News Roundup: December 18, 2015
Seniors Embrace Sharing Economy to Age at Home
Published by Home Health Care News
By Mary Kate Nelson
December 18, 2015
Seniors, like their younger, urban counterparts, are participating in the on-demand and sharing economy as both users and providers, The Washington Post reported. The trend could mean seniors living at home longer.
Companies such as Uber, Instacart and TaskRabbit now offer alternatives to past ways of offering senior-oriented services—potentially transforming how the older demographic accomplishes everyday tasks.
“I’m all for all these newfangled things that make life easier,” 88-year-old Sally Lindover told the Post. Lindover uses Instacart, which grocery shops for its users, and rents out her apartment’s second bedroom using Airbnb.
“I like to be here when people come in,” Lindover said. “I like to see them, and they see me, and I can give them some information about the neighborhood.”
Over 50% of Airbnb’s hosts are older than 40, and 10% of them are older than 60, the Post reported. Empty-nesters often have a surplus of rooms to rent, as well as “the life experience to know what it means to welcome someone into your home,” according to Anita Roth, Airbnb’s head of policy research.
Meanwhile, 25% of the drivers at Uber, which recently announced a partnership with AARP, are 50 years old or older.
According to the Post, traditional senior-oriented services are considering the possibility that similar tech companies may steal away their future customers.
“I do view it as both a threat and an opportunity,” said Tom Grape, CEO of Benchmark Senior Living. He added that decision not to move to senior living “is already our biggest competitor, and of course we fully expect that technology will allow people to stay at home longer in the future.”
Attention Medicare Recipients and Advocates: Get Face to Face with a new Paperwork Mess
Published by Huffington Post
By Steve Landers MD,MPH
December 18, 2015
Visiting nurses and other home health professionals are the hidden angels of American health care--they are highly mission driven and in the course of helping people in need they routinely overcome many challenges like bad weather, high crime neighborhoods, traffic conditions, complex health problems and stressed out families--but, they're now confronting a new obstacle, a paperwork mess created by a little known Affordable Care Act (ACA) "face to face" rule. The timing is terrible because home health access and quality is being hurt at the very moment when extra focus on improving home health is needed to prepare for rapidly growing numbers of older Americans.
Buried in Title 6 on the 769th page of the ACA are about 30 straightforward words to ensure doctors have seen patients "face to face" before authorizing home health services paid by Medicare. There have been unfortunate cases of Medicare fraud, ensuring doctors are involved before Medicare pays is well intended and makes sense. However, Medicare officials have turned those 30 or so words into over 35,000 words of confusing and contradictory guidance and regulations--this has resulted in a paperwork and electronic documentation debacle that is souring the situation for nurses and doctors trying to care for vulnerable shut-in patients.
There's a bit of good news; Senators Bob Menendez of New Jersey and Pat Roberts of Kansas have authored a bi-partisan fix to the situation. They should be recognized as true advocates and praised as guardians of home health care for older adults and people with disabilities. However, for their solution to be adopted, more members of Congress need to sign on. This requires citizen input on an issue that is fairly technical; please take a few more minutes to understand the problem.
A good analogy can be made to the well-known scenario of how doctors' prescriptions for medicines are handled by pharmacies (even though in this case we're really talking about doctors' prescriptions for needed home health nursing or physical therapy). Imagine if each prescription had an additional sworn attestation by the doctor that they had seen their patient and the medicine was absolutely appropriate and needed.
Now imagine that in spite of that prescription /attestation, Medicare officials also required pharmacies to assume the doctor didn't know what they were doing when writing the prescription and they must demand photocopies of additional records from the doctor before filling prescriptions. Then, after all the paperwork exchange, imagine if nobody was really sure what Medicare was expecting in the paperwork and feared that an audit could invalidate the essential services because a government reviewer's preferred wording or phrase was missing or was in a different part of the patient's chart.
Imagine the frustration, delays, and harm that would be created for health professionals and people needing medications if this were the norm. Unfortunately, this illustrates the current situation for doctors' prescriptions for needed home nursing and physical therapy services--services that are often urgent and essential for Medicare beneficiaries to get home from hospital and nursing home stays, or to avoid them in the first place.
Ironically, while the paperwork ordeal is burdensome to well-intended doctors and home health caregivers, it is still too easy for fraudsters to pass off falsified documents.
Many organizations have dedicated new staff specifically to deal with all the paperwork and to deal with frustrated doctors being told their medical records aren't good enough, even though doctors are already doing tons of paperwork and electronic recordkeeping. The new paperwork burdens have consumed thousands of work hours in the visiting nurse organization I lead. At a time when more older and disabled patients need extra help, resources are being put into paperwork that could be focused on care. Some doctors have become so frustrated they've threatened to stop ordering needed home health care for patients just to avoid the paperwork.
Home care leaders have repeatedly asked Medicare to fix this. We have offered more effective and less disruptive approaches to addressing fraud. In spite of the extensive outreach, the situation on the ground remains unsatisfactory. The Menendez/Roberts fix offers a ray of hope. But, more members of Congress must sign on to make this happen. If you are concerned about home health quality and access for yourself or your loved ones please urge your Senators and Representatives to take action.
Home Health Weighs Risks, Rewards of Bundled Payments
Published by Home Health Care News
By Amy Baxter
December 18, 2015
With bundled payment programs already underway, home health agencies are making strides to position themselves as preferred providers to hop on board the coordinated care trend.
The Centers for Medicare and Medicaid Services (CMS) recently finalized the model for Comprehensive Care for Joint Replacement (CCJR) that bundles payments through coordinated care between health organizations. The model is just the latest version of CMS’s test models for bundled payment structures that incentivize home health agencies to work with hospitals and other acute care providers.
The Rise of Bundled Payments
CMS began the bundled payment initiative in 2013 and has been continually rolling out new models. The CCJR model reflects that more of these programs could be aimed at specific procedures to improve quality of care and reduce the cost of the most common health care services.
As the health systems continue to shift and incentivize value-based purchasing structures, home health will become more important, according to Steve Wogen, chief growth officer at CareCentrix. CareCentrix is a home health coordination company that works with payors and providers to create managed care networks.
“The role of home health is absolutely critical to anything that happens in the future of value-based purchasing models,” Wogen told Home Health Care News. “CMS and payors, at this point, are making it very clear that this type of care is the future. The home is where the patients want to be and where patients should be and can be take care of as an alternative to acute care.”
Home Care by Black Stone, a home care and home agency that was recently acquired by Almost Family, is already involved in multiple bundles with its partners, according to CEO David Tramontana. Getting involved in these programs has enabled the home health company to position itself as a preferred provider and share in the potential savings incentives.
“Taking risk is an opportunity to learn in the bundled payments,” Tramontana told SHN. “The only lever that you have to actually gain financially in the bundled payment for a home health provider is if you improve your own readmissions based upon your historic costs. When I look at the bundled payment program, I think it’s an opportunity for us to work with providers upstream that are taking risks and develop those preferred provider relationships.”
The company has had to expand its ability to measure and capture patient data, and the investment has been one of the biggest expenses and risks of coming on board with bundled payments. However, data points like hospital readmission rates are the most important metrics to become a preferred partner with hospitals and other post-acute providers.
“The best position for a home health agency in a bundled payment scenario is to help providers reduce the risk of readmission for their patients,” Tramontana told SHN.
Risks and Rewards
Investing in data is a critical decision home health agencies must make.
“The data analytics firm you choose is really important to understand how to choose the right bundles and then manage the cost within those bundles.” Tramontana said.
There’s also a downside to these bundles that home health agencies will have to consider despite being able to capture more data, says Tramontana. Not all home health agencies are able to take on a longer timeline for Medicare reimbursement claims under bundled payment programs.
“The greatest challenge is that the data is not as timely as you would like,” Tramontana warns. “Until the claims are actually paid by CMS, you won’t know the actual cost of care for your patient, and it probably takes about six months to have good visibility on what the total claims were for each individual episode.”
While there is some risk involved with these models, home health agencies arguably play a pivotal role in ensuring the health of patients along the continuum of care.
“It’s the role of the home health agency and the nurse to ensure that the patient understands their discharge orders, appropriately manages their medications, has the follow-up visits that they need to have to ensure that they’re not being readmitted to the hospital unnecessarily,” says Wogen. “When you get it right, the impact is material.”
One specific success story Wogen points to was in Florida, where CareCentrix aligned a hospital and a home health agency by overlaying a single care plan for every patient leaving that hospital. Through better coordination between the health care setting, skilled nursing facility utilization dropped from 40% to 11% of patients. Hospital readmissions sunk from 10% of patients to just 2%, according to Wogen.
“Everyone recognizes and realizes at this point that we’re going to have shortages in acute care facilities and beds as you have a shifting demographic in older individuals,” says Wogen. “The home is going to have to be more of a viable option for providing care.”
Signs a Tech Startup Could Be a Good Home Health Partner
Published by Home Health Care News
By Tim Mullaney
December 18, 2015
When Lively launched in 2013, the aging-in-place technology startup had $7.6 million in funding and had access to resources as one of the first participants in Aging 2.0’s GENerator accelerator.
Fast-forward to 2015, and the company—which offered monitoring solutions through in-home sensors—had hit hard times. With no staff left on the payroll, Lively was acquired for an undisclosed sum earlier this month by GreatCall, a company that offers health and safety services through proprietary senior-friendly mobile devices, as well as Apple and Android platforms.
While there has been much chatter in recent months about the startup boom in tech products for seniors—including innovations meant to enable aging-in-place—the Lively acquisition has turned the conversation to the inevitable busts that will come in this space.
Home Health Care News recently spoke with David Inns, president and CEO of GreatCall, about what separates a successful startup and what senior care providers should look for when they’re thinking about piloting or working with a fledgling tech company. And one of his key messages might not be intuitive to providers: Don’t look for products designed to solve your problems.
HHCN: There’s been a boom in senior care-related tech startups, and now there’s talk about which will survive and which will fold. Is it fair to say that some weeding out will be happening?
Inns: I don’t think that’s different than any high-profile, new, interesting space in technology. It attracts a lot of venture capital, startups, people start moving, and then there’s consolidation in the space.
HHCN: How would you characterize where Lively was at in the lifecycle of a startup?
Inns: Lively was still very early-stage. They had had some good traction getting some pilots going with commercial entities. They had an interesting approach in the marketplace with a lot of awareness, but still was in those early stages. And when I look at the entire space, that is where most of the players remain. And it’s not actually unique to independent aging solutions. It applies to connected health in general as a category.
I see independent aging [startups], they’re nascent and anticipated to grow, but few companies have gained significant traction in the marketplace. No one’s rolled out across a large senior living community or player. No health system is 100% rolled out across its base with connected health technology. There are a lot of piecemeal solutions being put together and pilots happening. It’s an issue with the whole category.
HHCN: And that’s what is needed, scalable solutions?
Inns: What’s really needed by most of the industries being targeted are scaled, reliable solutions. We’re talking about people’s lives at stake, based on the quality and reliability of the service being provided. A Silicon Valley startup that just decides to start serving seniors hasn’t necessarily put thought into the details and the fact that lives are at stake. Fall detection can’t just be some engineers in a back room who played around with an accelerometer and put it in a device and called it fall detection.
HHCN: So what are some things that a senior care provider should be looking for in a startup, if they’re looking to do a pilot or get in on the ground floor of a new technology?
Inns: You have to do a quality or safety audit. Look at things like redundancy, what their training programs are, if there are certifications involved in the devices they use. Privacy and security of the data is another big issue. I think even a startup, if it’s a reputable startup, should’ve thought through those things.
After that, stability. Looking at the financials of a startup. It’s totally common practice, if you’re going to do a deal with a company that isn’t scaled and profitable, to look at the financials to alleviate concerns that there may be an imminent bankruptcy or acquisition soon after completing the deal. For any startup, the financials aren’t going to look great, but how bad is it? Who are the investors behind them?
HHCN: We’ve heard that people are anxious about startups founded by people without industry knowledge. Is that a fair concern?
Inns: Another key thing is how well they know the senior market. One of the big things we always see is people coming forward with cool technology solving the problems of the senior living facility or home health agency or family caregiver, but any technology that has come from the top-down as opposed from the customer forward is seriously at risk of not having any kind of impact.
If it’s not a solution that has first and foremost considered the needs of the older consumer, so they’ll engage and use these technologies daily and hourly, it will absolutely fail. If it’s a cool product trying to solve the problem of an entity rather than engaging the senior, it has to meet both needs. Far too many technologies I see today are coming backward into the problem.
HHCN: Can you think of an example?
Inns: I remember a product people were really excited about was shoes you would give to your mom that would track gait changes. You would get notifications if her gait was changing. Basically it was a health predictor of falls and strokes and changes in her gait. That was a really cool idea and solves some problems for the health care provider, but try to tell your mom she has to wear the same pair of ugly shoes every day.
HHCN: What has GreatCall done right, that now it is playing the role of growing through acquisitions?
Inns: Because we got into the industry early and managed to scale to significant size, with 1,000 staff members now, and taking all the feedback from customers we talk to and leveraging that into product development, that’s a huge advantage we now have. It’s the advantage of scaled larger player in a space with smaller players. The disadvantage you start to have as you get bigger is speed in innovation. We’ve made that a priority for ourselves to always be coming out with new products and solutions as quickly as new startups.
HHCN: What are the plans for integrating Lively?
Inns: It’s still early, so it is not 100% clear where we’re going to go. What attracted us to Lively was we liked the feel they’ve created around their product set and marketing and PR—this energy around making aging technology more fun and lively, and this buzz of being a Silicon Valley startup, that was leveraged really well in making them an interesting technology that had a really great positioning in the industry.
Some of the tech is complementary to what we’re doing. We don’t have any in-home sensors, which we think are applicable to a lot of our clients, including commercial entities in the senior living space. All ours are personal mobile products, so [Lively] could provide enhanced features.
HHCN: And you’re currently working with commercial clients in senior care?
Inns: I will say that as a company, we have really in this last year expanded our focus on the senior living industry, and with some successful relationships, we’ve been moving our tech into senior living companies. Currently, we’re more geared toward independent living and as we innovate, and with Lively’s product, assisted [living] can become more interesting as well. We’re definitely interested in anyone who wants to talk us.