News Roundup: March 11, 2016
Tech May Aide the Home Care Industry, but It Won’t Fix It
Published by Home Care Daily
By Valerie VanBooven
March 11, 2016
When considering the many different opportunities that exist for helping to improve the home care industry, technology is constantly seen as a great bastion of opportunity. However, it’s not the only one and according to some, while billions of dollars are being pumped into IT tech firms to come up with valuable solutions to improve access and even quality of care to those who need it, it will still come down to the practices used to provide that level of care and support.
In home care is being seen more frequently as of late as a more cost effective option for long-term care, not only for disabled adults but also for the elderly who may face increasing challenges as they age.
With provisions placed in the Affordable Care Act of 2010 that would provide more financial incentives to improve the cost-effectiveness of home care, there has been a push to find solutions that will be benefits to those who require support. However, the pay and other incentives continue to lag behind.
As Dave Chase, contributor to Forbes, states in the article, Evidence Based Practice, Not Tech Unicorns, Will Fix Home Care:
“…the dichotomy between profits and patient care was recently punctuated by the Theranos controversy, whereby a real-life unicorn grew its valuation $10 billion based on questionable claims and with no peer-reviewed research to support them. There are ways to safely disrupt the home care space, but it’s not focusing on the needs of the investor, but rather the consumer of care.”
The author goes on to add:
“An important catalyst forcing a change to the status quo in home care is healthcare financing reform. The ACA started a cascade of regulatory changes that have been perpetuated by the Medicare Access and CHIP Reauthorization Act (MACRA), which are significantly shifting payment away from fee-for-service (FFS) and toward value-based care.”
Tech firms can certainly provide reasonable solutions that may actually benefit some, but for those chasing the rainbow, so to speak, for the optimal or ideal fix-all solution, it isn’t going to come from technology. It’s going to come from the ground level where the actual caregivers develop strategies and put effort into care for the elderly and disabled.
The challenges the industry is facing at the moment are significant with increased demand and reduced reimbursement rates. Technology may very well be able to bridge the gap between these chasms, but for those hoping for a multi-billion dollar solution to come from tech in home care, according to some it’s better to focus on actual benefits seniors and the disabled can rely on.
CMS Home Health Initiatives Gaining Traction
Published by Home Health Care News
By Kourtney Liepelt
March 11, 2016
Since November, the Centers for Medicare & Medicaid Services (CMS) has rolled out regulation upon regulation affecting home health care, altering the landscape for agencies across the country.
CMS first finalized a rule to incentivize hospitals to work with other post-acute providers for knee and hip replacement procedures through bundled payments for 67 hospital locations. January ushered in the first “Patient Survey Star Ratings” for Medicare-certified home health agencies—scores meant to reflect patients’ experiences—along with the implementation of newly proposed payment policies that tie Medicare payments to higher quality performance in its so-called home health value based purchasing pilot program in nine states. Most recently, CMS announced a proposal in February for a Medicare Probable Fraud Measurement Pilot in five states, which would require preauthorization before agencies see patients.
Whether or not agencies are currently affected by such measures, they need to pay attention and prepare for implementation nationwide, Barbara McCann, Chief Industry Officer for Interim HealthCare Inc., said Wednesday during the 2016 Illinois HomeCare & Hospice Council Annual Conference & Expedition in Lombard, Illinois. Her presentation, titled “Finding the Faults in Our Stars,” focused on finding strategies to improve star ratings, promoting higher care standards and getting ahead of the curve when it comes to CMS initiatives.
“If you don’t feel comfortable with it now, you’re going to be very uncomfortable with it for the next decade,” she said.
Tracking predictable costs related to joint replacements is necessary to show savings, McCann said. Additionally, agencies should focus on establishing a strategy to standardize evaluations of patients, as star ratings depend upon them.
“We need to introduce standards of practice, because this is only the beginning,” McCann said.
Still, agencies can prepare and continue to face uncertainties. Across the nine states that are now two and a half months into the value-based purchasing pilot, McCann said there are more questions than answers, little to no feedback on how things are going and, in some cases, no benchmark that agencies can reference, as two measures have not been publicly reported to date.
Confusion abounds for the measure relating to discharge to community, for example, because not only has it not been publicly reported, but it is calculated differently across star ratings, how payments will be administered in value-based purchasing, on the Outcome and Assessment Information Set (OASIS) and more.
There is no one single strategy to find success in the changing home health climate, McCann said. In the end, the reality of value-based purchasing and other regulations will teach agencies where their measurements don’t match up. Finding balance between old practices still in play currently and new ones as they come to fruition, though, and making sure that all employees within an organization are aware of and understand changes and impending policies are keys to rise to the challenges presented.
“It’s systems that fail, not usually people,” she said.
Using Data To Help Home Health Workers Manage Patients’ Conditions
Published by Kaiser Health News
By Julie Appleby
March 11, 2016
BALTIMORE — There is little in Ruby’s life that is easy. Nearly blind and unable to walk more than a step or two, the 39-year-old struggles to raise three sons while dealing with a daunting array of health conditions, from diabetes that recently landed her in the hospital to pain from bulging spinal disks.
Without support, odds are she’ll end up back in a hospital. But Ruby, who asked that her last name not be used to protect her family’s privacy, is part of a growing effort to reduce those odds by arming home care aides and other non-medical workers with the power of data.
On a recent Monday, health coach Nhaomie Douyon visited Ruby in the small, rented two-story row house where she lives with her children. Douyon works for the Coordinating Center, a Maryland-based nonprofit that helps organize medical and social needs for clients like Ruby, who live in designated medically underserved areas.
The two chatted in the living room, where a couch and chairs share the space with a bed. White curtains obscure the view outside, where small groups of young people cluster on front steps and some homes have boarded-up windows. Douyon, 28, came equipped with a tablet loaded with a software program that uses predictive analytics to generate patient-specific questions.
The software was developed by Care at Hand, a privately held firm that is among a small but growing number of companies touting products they say can help spot potential medical problems before they require hospitalization. The software was created for use by non-medical workers like Douyon and home care aides who care for millions of elderly, ill or disabled people.
Skeptics note that there are few studies confirming whether the technology accurately predicts problems, prevents hospitalizations or saves money. Still, the business has attracted the attention of venture capitalists and may lead to more health care applications for consumers.
Was Ruby having trouble paying for her medications? Did she feel nauseous? Were her ankles more swollen today? Those were some of the 15 questions the program Douyon’s agency uses generated for Ruby.
When she typed in Ruby’s answer that her ankles and legs were definitely more swollen, it triggered an alert to the nurse manager back at her office. Within a few minutes, nurse Chris Parsons called from the Coordinating Center’s headquarters, asked more questions and directed the pair to contact Ruby’s doctor’s office for medicine that might help. Try to elevate your feet, she told Ruby, and go to the emergency room if the swelling gets worse.
“It’s like bringing a pocket nurse Chris with you,” said Douyon, who is also studying for a master’s degree in public health and has previously worked for groups doing health outreach in Ghana and Haiti.
“It doesn’t just go through medical questions but asks about resources they might need and helps us pick up on certain red flags or the barriers they face,” she said of the tablet.
Another firm, eCaring, is aimed more squarely at home care aides and their agencies. The company’s software allows aides to note a patient’s well-being hour by hour, using colorful icons, such as a toothbrush for recording personal care activities and a happy or sad face for documenting their mental state. It, too, uses the information to predict which patients might be at high risk and send an alert back to a care manager.
“It’s a portrait of what is going on in the home,” said Robert Herzog, CEO and founder of eCaring, a privately held firm that has contracted with home care agencies in New York to use its software programs. “It transforms the home from a black box into a data-rich environment.”
Other firms, such as Honor in California and Hometeam in New York, offer more consumer-directed services, such as apps that home care aides use to log their daily observations. The companies have each drawn low, double-digit million dollar funding from well-known venture capitalists, including Marc Andreessen, a cofounder of the Silicon Valley venture firm Andreesen Horowitz, Yelp cofounder and CEO Jeremy Stoppelman, and emerging technology investor Lux Capital. The apps help families hire and schedule home care aides, and then keep the family informed about how mom is doing with texts, pictures and updates on daily activities.
One big question is who will pay for the technology? Agencies using programs aimed at consumers can build the cost into their home care services, charging consumers more than agencies that didn’t use the technology. Herzog at eCaring says his firm pays for the tablets and gets a low-cost data package for internet use — which the tablets require — from Verizon. It then builds those costs into its contracts with hospitals or insurers. The Coordinating Center, which uses Care at Hand in Baltimore and other locations in Maryland, similarly builds those costs into its contracts. It also receives grant money from the state and other agencies for its care coordination efforts.
Thomas Scully, the former top administrator at the Centers for Medicare & Medicaid Services and now an attorney who advises clients on health care issues and a general partner in a private investment firm, said the idea behind these firms is good. But, he added, their growth potential may be limited because the expense of the tablets and software will make the home care services more expensive. “All of this is part of the answer, but it has to show economic savings,” said Scully.
Watching For Evidence Of Success
Billions are spent nationally each year on avoidable hospital admissions, prompting measures to prevent more of them. The federal health law, for example, created financial incentives for hospitals to reduce readmissions.
The new software fits into this focus. But obstacles remain, including the big question of whether they actually work better than other efforts aimed at this goal.
The companies themselves — mainly small, privately held ventures — say they have data showing significant reduction in hospitalizations and costs.
“Non-medical workers are able to make some guided observations that predict if a patient will be at risk of going to a hospital,” said Andrey Ostrovsky, a doctor who is CEO and founder of Care at Hand.
For example, a study done by consulting firm Avalere, with Ostrovsky co-authoring, reviewed the records of more than 2,200 patients using the technology. It concluded that hospital admissions dropped 29 percent for patients who had three or more hospital visits the prior year. It showed an overall 14 percent decrease in admissions among all those studied.
But not everyone is convinced that arming home care workers with software programs will prove to be an effective strategy.
“It’s more theory than reality,” said Bob Kocher, a partner at Venrock, a venture capital firm in California. After reviewing the firms out there, Kocher said his firm decided not to invest yet, although “I have no doubt that 10 years from now, we will improve the training of home care workers and have much better diagnostic tools in the home — and it will work.”
Still, the ranks of elderly Americans are growing rapidly and most want to avoid nursing homes. “The industry is placing a big bet that technology will be the missing variable … to allow us to care for a large elderly population at home,” said Jared Landis, practice manager at the Advisory Board, a firm that consults with hospitals.
’Just One Tool’ In A Larger Effort
For Ruby, the tablet is just one piece of a much larger effort by the Coordinating Center, which has also enrolled her in the practice of a local primary care doctor, signed her up for an appointment at an eye clinic and is seeking an alternative to a medication she was prescribed that wasn’t included on her insurance plan.
She is motivated: “I want to be here to see my kids walk across the stage at high school graduation, to see when they have kids.”
That combination — a motivated patient and a broad effort to coordinate her care — may help prevent Ruby from returning to the hospital with high blood sugar levels or other problems.
“The tablet is just one tool. We were reducing readmissions without it, but when we implemented it, we were able to squeeze out a little more,” said Carol Marsiglia, senior vice president of strategic initiatives at the center.
A Magic Wand for Home Care
Published by Home Health Care News
By Kourtney Liepelt
March 11, 2016
A magic wand-like device for home care under development through a multi-university project could help doctors monitor their patients between visits from afar.
The prototype bears the name “Wanda” and is part of a $10-million, five-year grant from the National Science Foundation to Dartmouth College, Johns Hopkins University, the University of Illinois Urbana-Champaign, the University of Michigan and Vanderbilt University. It’s aimed at developing ways to protect patient confidentiality amid a health care shift from hospitals and doctors’ office to the home, the Associated Press reported.
Goals for the device relate to safety and simplicity.
“Quite frequently in the computer security business, we invent things that are super secure but hard to use, and people don’t understand them,” said Tim Pierson, doctoral student and Wanda’s creator. “We set out to make something that my parents and in-laws could use.”
The wand relies on Wi-Fi to operate, and the prototype currently consists of a ruler with two attached antennas. Plug it into a Wi-Fi router, and it acquires the network name and password. From there, it can be detached and pointed at a medical device to connect the latter to the network, as well.
For example, if a doctor sends a patient home with a Wi-Fi-enabled blood pressure cuff, the patient can simply point the wand at the cuff rather than manually enter a password to establish a Wi-Fi connection. And once the connection is made, blood pressure readings will be transmitted to the doctor’s office.
“One of the good things about this system is that the user doesn’t even have to know that information,” Pierson told the AP. “The wand can get it from your Wi-Fi router and impart it on the device. We talked to a lot of people who have Wi-Fi in their homes and have no idea what their password is.”
However, one implication the wand concept is that the medical device must have wireless capabilities.* It would also need to run roughly 20 lines of software to identify Wanda’s Wi-Fi packets and decode the information sent by the wand, Pierson told Home Health Care News.
HHS gets to value-based reimbursement goal ahead of schedule
Published by Healthcare Finance News
By Mike Miliard
March 11, 2016
Barely a year after announcing its ambitious plan to tie reimbursement to quality of care, the U.S. Department of Health and Human Services announced March 3 that 30 percent of Medicare payments are now tied to alternative payment models, such as ACOs.
The goal was reached nearly a year ahead of schedule, according to HHS, which touts the fact that more than 10 million Medicare patients are now getting higher-quality and more coordinated care.
In January 2015, HHS set big goals to move 30 of Medicare to value-based arrangements by the end of 2016. With 121 new ACOs announced in January, along with higher provider participation than expected in other alternative payment programs, the agency says it has already achieved it.
It's thanks in large part to Affordable Care Act-enabled initiatives such as the Medicare Shared Savings Program and the Center for Medicare and Medicaid Innovation, which allowed for the testing of new cost- and quality-conscious APMs, said HHS Secretary Sylvia Burwell.
"Improving the quality and affordability of care for all Americans has always been a pillar of the Affordable Care Act, alongside expanding access to health care," said Burwell in a statement. "The law gives us the tools to put patients at the center of their care, improve quality and help make care more affordable over the long term."
At HIMSS16 this week, more than 40,000 healthcare professionals from around the country gathered in Las Vegas, many of them here to learn about technologies and strategies that can help them achieve the benchmarks necessary for value-based payment models: interoperability tools for more coordinated and connected care, data analytics for population health, patient engagement technology and more.
"We reached this goal in partnership with the thousands of providers who collaborated with us in innovation," said Patrick Conway, MD, deputy administrator for innovation quality and chief medical officer at CMS, in a statement. "It's in our common interest – as patients, providers, businesses, health plans, taxpayers – to build a health care delivery system that delivers better care; spends health care dollars more wisely; and makes individuals and communities healthier."
There are 477 Medicare ACOs participating in the Shared Savings Program and the Pioneer ACO Model combined In 2014, these programs generated a total net savings of $411 million. ACOs represent about three quarters of progress toward the goal announced today, according to HHS, which says these gains will continue to increase over the course of the year, with the start of the Comprehensive Care for Joint Replacement model and the Oncology Care Model in 2016.
Today's estimates were evaluated by the independent Centers for Medicare & Medicaid Services Office of the Actuary, which multiplied the number of Medicare beneficiaries in alternative payment models by the expected cost of their care, then comparing that figure to projected Medicare fee-for-service spending. As of January 2016, CMS estimates roughly $117 billion out of a projected $380 billion Medicare fee-for-service payments are tied to APMs.