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News Roundup: November 6, 2015

How to Conquer the Tech ‘Fear Factor’ in Home Health

Published by Home Health Care News
By Mary Kate Nelson
November 6, 2015

Wendy Cofran is on the forefront of home health care’s evolution into the digital age. As chief information officer (CIO) of Natick Visiting Nurses Association (VNA), a not-for-profit home health care agency based in Natick, Massachusetts, Cofran has seen her staff through multiple software transitions amid increasing regulations and cost-cutting pressures.

The company has twice achieved five-star ratings—the highest possible—by the Centers for Medicare & Medicaid Services (CMS), placing the agency among the top 2.6% of providers in the nation. The recently introduced star ratings appear on CMS’ Home Health Compare, a platform where consumers can compare Medicare-certified home health agencies’ scores.

Currently, the agency serves about 200 people daily, with 45 professional clinicians and 25 home health aides. After being an early technology adopter in 1994 by designating laptops to all clinicians, Natick VNA has been ahead of the revolution in home health care. The agency has since switched to using iPads throughout the care process, using Brightree as their home health software.

Home Health Care News caught up with Cofran, who shared how technology and data integration has played a critical role in the success of the agency and why the rest of the industry is trying to catch up.

Without an industry standard to collect, store and share data on the same systems or even electronically, where is the home health industry in terms of coming on board with using devices like iPads and utilizing electronic medical records?

There are still plenty of physicians practices that aren’t even on medical record systems. There are hospitals that are on systems that they paid millions of dollars for that are customized, but are now outdated technology. So, that’s the problem.

Right now, what everybody is noticing is that it’s not as expensive to get on board. It can can actually save time and money because it can really change the workflow and reduce a lot of cost. What is happening now is that agencies are either finding a way to get an automated system or they are going out of business. Or, they are being acquired and being automated that way. I think we are getting pretty close to the end of being on paper. It’s going to be really, really hard to exist on paper.

When switching to iPads that included additional point of care data, how did you convince staff to chart their data this way?

The biggest thing you can do is introduce it through their peers. The last thing the staff wants is to see me, as CIO, coming down and saying, “we’re doing this.” The one thing we have learned—we’ve been through three software conversions—is that you have to hold your nose and just jump off the bridge. You can’t only stick your toe in the water. It is so hard. When you run into a clinician that may not want to do it, then you partner them with a strong clinician. Then it’s clinician to clinician as opposed to IT person to clinician. It’s how you sell it.

We’ve been on laptops since 1994. For us to be able to go to an iPad and drop the weight of the product, the technical, cumbersome device that they had to deal with, my staff was thrilled. We knew that’s where our cost savings were going to be and that eventually devices that were connected needed to have a good way to connect with other systems. So, this was where we wanted to go. This is a vision that we had back in 1994, honestly. It’s just taken us this long for all of us to get there.

What are some of the blind spots with using an iPad as the care resource?

Most of our challenges are regulatory. You may think you’ve got a process nailed down and a feature built into the system. You spend all this time, and then they change a regulation.

You’ve got to dance around trying to learn something new or going back to the clinicians and telling them, “I know I just trained you how to do something six months ago, but now I’ve got to train you how to do it the other way.”

What specific regulations are irksome in the process?

The face-to-face regulation. There’s still a lot of paper-based processes that are supposed to be in there for checks and balances. But the reality is, they are time consuming. They force a clinician to focus for maybe 75% of their visit on documenting instead of being focused on the care. And that’s not why they got into this business. They want to take care of patients.

There’s still too much reliance on faxing. Still. As the industry continues to grow, it’s more about sharing the data. It’s important that we have a clinician’s product that can handle all the regulatory changes. I see much more of an openness now to talk to somebody about sharing data and moving patient data forward.

What’s the driving force behind the technology push and the openness of sharing patient data?

I think the patients are now more engaged. I say that because of what cellphones and apps have done across the world. A patient who used to walk into a doctor’s office or a hospital just did whatever they were told. Now, their expectation is, why can’t you see my data? I can book a hotel anywhere in the world, but I can’t tell you the last time I had my blood sugar checked.

I think now you have a patient that is informed. Doctors have to figure out a way to share data because their patients are driving it. Hospitals are hearing it from their patients.

Value-based purchasing is also driving it. If the product is something for our clinicians to use that helps them through their charting and gives us a way to show our outcomes are good, then it allows us to look at efficiencies in the care so that we can then reduce costs, which is what we all have to do.

You have to be able to walk into other partners and say, “Yes, I am a part of the solution to keeping your patients out of the hospital, and here’s how we do it.” They can count on the fact that I’m capturing the data and have the capability to send it to them. It’s an overall recognition by the entire industry, whether it’s a rehab facility, a hospital, a doctor’s practice.

The onus is on us [as home health agencies] to prove that we are needed. If we can’t show that and capture the data, then there’s no reason for anyone to believe us. There’s a need for us to be loud and say we matter.

Hospitals have been doing that. We need to get out there and say you can’t do this without us. We are going to be the people that are driving cost savings because we are the ones keeping them out of the hospital. We are keeping the patients at home.

Why are some agencies or health systems reluctant to adopt new technology and where do you see those agencies in a few years?

It’s the fear factor. For a long time, a lot of agencies didn’t spend money on technology people. Agencies didn’t have tech people. Now, you’re seeing a much more planned approach to technology to see where you can save money, where this will eventually help you save money later. But, they have to invest in it up front. It’s going to cost you, but you can make your money up somewhere else.

With connected devices becoming a bigger part of everyone’s lives, it just means there is more data we have to capture and make decisions on. I think it’s going to be really hard to be a mom-and-pop shop just on that alone. You’ve got a consumer base now that is affected by those.

Commentary: Quality gains, cost reductions make strong case for the modern house call

Published by Modern Healthcare
By Dr. Glen Stream
November 6, 2015

Nearly every day a claim is made that something will make our lives better, healthier, easier. And while many of these claims are interesting, and some become game changers, most are hype.

Nowhere is this phenomenon more prominent than in medicine. Science has produced what only a few decades ago were considered miracles—treatments, pharmaceuticals, diagnostics and surgeries, that have made, for example, many cancers curable or treatable as chronic diseases. Having a stroke or a heart attack is no longer a death sentence. The list goes on.

However, as medicine continues to make huge strides with technology as its partner, we often forget that physicians remain at the center of medicine, and patients are at the center of physician practices. This brings us to an old practice that is becoming new again: the house call.

While traditional house calls never disappeared, their frequency dwindled because they didn't fit into the modern fee-for-service model. However, our interest never disappeared. We have always known their benefit, which, combined with the current focus on value over volume, has caused policymakers to look again at an old but good idea.

In June, the CMS announced that after just one year of its three-year Independence at Home Demonstration (IHD), participating physician practices saved an average of $3,070 per beneficiary—while delivering high-quality patient care in the home.

U.S. Medical Management and its affiliate, Visiting Physicians Association (an IHD participant), represented 25% of the patient care in the demonstration. Participating practices showed high performance on many quality and cost measures, including a 16.4% reduction in expected costs, and reductions in all-cause 30-day readmissions, in-hospital admissions and emergency department visits for ambulatory care-sensitive conditions.

For family physicians like Dr. Thomas Cornwell, this is great but not unexpected news. As the leader of the Home Centered Care Institute in Wheaton, Ill., he has made 32,000 house calls to more than 4,000 patients through his house-call practice. Cornwell calls this Affordable Care Act initiative a part of the perfect storm that is driving an increased demand for modern house calls. Unlike traditional home care, this new version of the house call is based on a medical home; house calls are not a supplement.

Also driving this perfect storm is a quickly aging baby-boomer population, the Medicare and Medicaid fiscal crisis, healthcare reforms, including the CMS' goal to reduce hospital readmissions, and the shift from volume-based to value-based payment.

As a result, house-call physicians are part of an effort to get Congress to pass legislation to move this home-care demonstration into a new house-call benefit similar to how the Program of All-Inclusive Care for the Elderly, or PACE, program became a new benefit. PACE is designed to keep people age 55 and older out of nursing homes by providing community-based care and services.

This would mean more shared cost-savings opportunities. Therefore, more providers would be incentivized to offer home care. And because only about 15% of the people in the U.S. who need home care are receiving it, there is plenty of potential for growth.

An October 2014 study in the Journal of the American Geriatrics Society analyzed the Veterans Health Administration's Home-Based Primary Care Program, which started over 20 years ago and serves more than 30,000 veterans. The study found:

A 24% reduction in total healthcare costs under the program (2002 data), which amounted to an annual savings of more than $10 million.

The HBPC provided four times more primary home care versus traditional home health, but still produced a 63% reduction in hospital costs, and an 87% drop in nursing home costs.

2007 data found a 59% reduction in hospital days, an 89% reduction in nursing-home days and a 21% reduction in 30-day readmissions.

All of these results have piqued the interest of major medical networks looking to better serve their patients while reducing readmissions and costs. And this has family physicians excited about the future of the house call. “Those who have been the pioneers of house calls have known about its value for years,” Cornwell said.