Posted by Ken Accardi on Wed, Feb 01, 2012 @ 06:30 AM
Through their outreach to the home care community, Ankota has had a chance to learn a
lot from Stephen Tweed's company, Leading Home Care. We've shared content from Stephen and his team, including his son Jason Tweed, on numerous occasions. Here are some prior posts:
For 2012, Leading Home Care has announced the creation of a video series to help private home care agencies grow and thrive. As an apetizer, we've included the first video in the series, which among other things, cites three reasons why they expect 2012 to be a great year for Private Care, as follows:
To benefit from the full series, you should go to the website for leading home care and subscribe to one of their newsletters. For Private Care, the best is likely to be Private Duty Today.
Ankota provides software to improve the delivery of care outside the hospital. Today Ankota services home health, private duty care, DME Delivery, RT, Physical Therapy and Home Infusion organizations, and is interested in helping to efficiently manage other forms of care. To learn more, please visit www.ankota.com or contact Ankota
Posted by Ken Accardi on Wed, Jan 11, 2012 @ 08:05 PM
Today, there are labor law exceptions that allow home care agencies not to pay overtime to home care caregivers who work more than 40 hours in a week, and there's legislation under review that would change this. The premise is that it's more fair to pay overtime than it is to have the exception. On the surface it sounds simple, but it's not...
The home care lawyer, Elizabeth Hogue, Esq. shared a thorough rundown of the legislation that you can read here.
What makes this tricky is the following:
- Home care doesn't pay well. An average pay rate is $12/hour
- The price of care is generally something like $19/hour
- At one level, $19/hour doesn't sound like a lot, but it's much more than most people can afford (e.g., if 24 hour care is required at this rate, it adds up to $166,440 per year).
- As such, it's difficult to charge the client overtime on a regular basis (most agencies I'm aware of charge extra for holidays, but for week-by-week care, they're going to do everything in their power to avoid having to pay overtime)
- So if a caregiver is now working a 60 hour week and getting paid $720, this legislation is likely to result in their employer cutting them back to 40 hours and cutting their revenue for the week to $480. So the caregiver takes a big hit.
- The patient/client takes a hit too, because they have to work with more caregivers and this is difficult for clients with memory impairment.
- So in the end, legislation to get fair pay for caregivers will actually result in caregiveres losing pay (unless they sign-on with another agency to get the additional hours) and they might have to work back to back shifts.
- It's not pretty!
Bill Dombi, from the National Association of Home Care and Hospice (NAHC, which is
pronounced like "nack") is the person who needs to try to lobby congress to explain that this legislation is more likely to lower the pay for a caregiver than to increase it. But it's one of those "losing battles" because on the surface it seems like it will make it better for the caregivers. I'm glad not to be Bill Dombi...
Does this legislation impact your agency (either positively or negatively)? Please comment!
Ankota provides software to improve the delivery of care outside the hospital. Today Ankota services home health, private duty care, DME Delivery, RT, Physical Therapy and Home Infusion organizations, and is interested in helping to efficiently manage other forms of care. To learn more, please visit www.ankota.com or contact Ankota
Posted by Will Hicklen on Tue, Jan 10, 2012 @ 11:30 AM
Healthcare will continue its acceleration towards a highly mobile model, particularly as Accountable Care models force more and more care outside of the hospitals. More effective and less expensive care can be delivered earlier, with more proactive models mitigating the risk of patients being admitted to hospitals in the first place. Mobile healthcare models can be employed to help transition patients from hospital to home, helping them to recover more quickly and successfully. This requires many differerent types of providers, and providers of all types must coordinate to work together efficiently and effectively. Putting technology and information in the hands of the mobile health worker means that mobile health applications are already booming, and we're just seeing the tip of the iceberg.
Here is some terrific information on the explosive growth of mHealth apps from FierceHealth, on their Fierce Mobile Health site. The article appears in its entirety below, or you can read it here on the FierceMobile Healthcare web site
The mobile health app market will grow to $392 million over the next five years, a 70 percent increase, according to new data from research firm Frost & Sullivan. And it might be quite a bit more than that, as the market has "consistently outpaced forecast growth and revenue," over the past two years, according to Frost senior industry analyst Zachary Bujnoch.
"MHealth apps will continue on a steep growth curve as increasingly sophisticated mobile technologies and relationship-management tools disrupt the market," he said in a statement. "Despite the hype, mobile apps are the single-biggest digital channel since the '90s and the Web."
Healthcare apps, which have developed a reputation for being easily bought--and easily dumped--may be getting more sticky. Frost researchers predict that not only will new users buy health apps, but also that existing customers will continue to buy and use more mHealth apps.
Calling 2011 the "tip of the iceberg," researchers say that low barriers to market entry will continue to lure new vendors, although they note that U.S. Food and Drug Administration oversight and security concerns mean it won't be a hassle-free endeavor for new startups.
"Consumer awareness is mixed, with privacy and security concerns ever present in the mHealth market," Bujnoch said in a statement. "Also, while still overall a good thing, increases in FDA regulation and oversight may dampen innovation."
Note: A releated Frost report, covered by our sibling publication FierceHealthIT, also forecasts growth in the remote patient monitoring market, with a strong mobile component. Frost projects revenues will more than double to $295 million in 2016, up from $127 million in 2010. Interestingly, the report predicts that remote patient monitoring technology will move in a more consumer-facing direction, driving much of that growth.
Even with double-digit growth rate for the past decade, Frost researchers say the market hasn't reached its "billion-dollar potential" because of scalability problems and limited business models.
Subscribe: http://www.fiercemobilehealthcare.com/signup?sourceform=Viral-Tynt-FierceMobileHealthcare-FierceMobileHealthcare
Posted by Ken Accardi on Mon, Jan 09, 2012 @ 09:41 AM
Delirium is likely to be the most costly and debilitating disease afflicting the elderly that you
never heard of. We focus lots of attention on dementia, alzheimers and fall-related issues, and we should, but at the same time delirium is hurting the quality of life for elderly people and costing Medicare over $143 Billion per year according to a study this year in The Journal of American Geriatric Society. The November 2, 2011 New York Times article "Another Hospital Hazard for the Elderly" by Susan Seliger tells a chilling story about the onset of delirium and just how common it is:
Hours before she fell and broke her hip, my mother, 85, lucid and whip-smart, was doing what she always did in the morning: drinking an entire pot of coffee and digesting both The New York Times and The Baltimore Sun.
The next day she came out of the hip surgery just fine. But within 24 hours, a totally different woman seemed to have taken over her capable mind and body.
She was disoriented. “This isn’t a very nice hotel,” she told us in the hospital room. “They haven’t even served cocktails. Let’s go.” My father, sister and I laughed, thinking it was just grogginess from the anesthesia. But then she developed trouble breathing, and the nurses clapped on an oxygen mask and whisked her off to another ward for more intensive monitoring.
Things quickly spiraled out of control. She tried to rip off her oxygen mask and IV tubes. She frantically tugged at the sheets and her skimpy hospital gown. Like the aged Lady Macbeth, she kept saying: “We have to clean this up! Clean this mess!”
They tied her hands to the bed. The medications to calm her down didn’t work. The doctors upped the sedation. Later, the physical therapist could barely rouse her to do the critical rehab on her brand-new hip.
What my family didn’t know at the time, because the doctors did not tell us, was that this frightening transformation was a classic case of hospital delirium — a brain dysfunction characterized by sudden confusion and inattention. It’s one of the most common, dangerous and costly complications of hospital stays for the elderly.
This two part story in the New York times continues by teaching us the signs of delirium and how it can be prevented. The following items in particular caught my attention:
- Once delirium occurs, the patient has a 62% chance of dying in the next year
- Delirium can be prevented in 30 - 40% of cases
- The best people to detect and counteract delirium are caregivers who know the person well and are able to detect when they're not normal
- Home Care Caregivers can greatly assist in the prevention and recovery from Delirium with steps as simple as getting the person up to walk a little bit each day
This topic is too important to stop here, so here are the next steps:
Can your agency put an awareness and education program in place to help prevent and recover from delirium? Can you offer hospital companion services with caregivers who can advocate for your clients, alert hospital staff when something's not right, and make sure that the hospital is doing the right things?
Ankota provides software to improve the delivery of care outside the hospital. Today Ankota services home health, private duty care, DME Delivery, RT, Physical Therapy and Home Infusion organizations, and is interested in helping to efficiently manage other forms of care. To learn more, please visit www.ankota.com or contact Ankota
Posted by Will Hicklen on Wed, Jan 04, 2012 @ 05:34 PM
Sometimes we at Ankota come across good articles on the websites of other organizations and we like to share them with our readers. Today's post is such a piece posted last week by Horizon Care Services on their web site, which I read on the National Association of Professional Geriatric Care Managers' LinkedIn Group. The article is How Seniors Survive Medicare Hospital Discharge. For those who do not know this Horizon, they are a well regarded organization in Florida providing home healthcare, private duty and, pointedly, Geriatric Care Management (GCM) services in beautiful Miami-Dade, Palm Beach and surrounding areas.
The article points out that a recent Harvard study shows avoidable readmissions account for more than $12 BILLION of Medicare spending annually. Other studies peg this number as high at $17 BILLION spent by Medicare on hospital readmissions that should have been avoided. Whichever number tickles you best, it's a whole lot of money spent wastefully. Moreover, these readmissions needlessly cause stress and heartache on patients and their families.
Seniors are particualrly vulnerable when being discharged from the hospital. Numerous studies show that general alertness and ability to stay attentive is diminished after being discharged from the hospital and typically requires months to recover from, regardless of the original reason they were admitted to the hospital. Clearly, assistance is required. It is well known that bringing an elderly parent home from the hospital can make family members anxious and few are trained or equipped to handle the task. It's not just an issue of lifting mom up from a wheelchair and into the bath, it extends to a complex maze of coordinating numerous services and multiple service providers, and even filling and monitoring medications. We can no longer leave the primary caregivers--the family members--alone to handle these transitions...it's costing the system at least $12 billion each year and undue stress to patients and their families.
There is a tremendous opportunity to help improve transitions from hospital to home, beginning with the process of planning for discharge. Discharge should pair the right resources to the right plan of care to assure that patients receive the care and follow up they need to help them recover well at home. Professional resources must be made available to help with transitions and assure that the right kind of medical care and personal support is available. Fortunately, products like Ankota's Care Coordination technology can assist with the planning and delivery cycles, assuring greater efficiencies, lower overall healthcare costs and healthier patients.
The home healthcare ecosystem-- the many tens of thousands of companies that provide home healthcare, private duty care, and other related services-- is especially well suited to be the delivery model for this type of care. The HME provider is needed to provide equipment and supplies, the pharmacy needs to fill medications, and nurses and aides must be coordinated with appropriate care plans. They all need technology and expertise to bring these providers into a well coordinated "network" that operates efficiently, coordinates services, and can deliver needed products and services in mobile healthcare models.
The discipline of organizing and providing these services for the elderly is often called Geriatric Care Management. It's not just for care after discharge, it's also for helping to care for the elderly on an ongoing basis. These are experts that are well trained in the best practices of caring for the elderly, knowing what services they need, and bringing them together in a well coordinated and monitored, accountable plan.
The providers in the home health care ecosystem that stop thinking of themselves solely as a "Private Duty agency," or an "HME delivery company" or a "Home Healthcare agency" or a "Rehab or Therapy agency" and start looking at their role--and value--in coordinated care and accountable care models WILL WIN. That's where the greatest opportunities and the highest rewards await them. Engage with Geriatric Care Managers, or in many cases, providers should employ Geriatric Care Managers to lead their involvement.
Ankota develops technology to help companies like these to coordinate care and operate more efficiently. Please let us know if we can help you make the transition to a better coordinated, more efficient business.
Posted by Ken Accardi on Tue, Jan 03, 2012 @ 06:41 AM
In my previous blog article, I covered Home Care Predictions for 2012 based on some thoughts from Laurie Orlov. One of Laurie's points was that caregiver jobs are being created, but they're not paying well enough for the caregivers to be off of food stamps and Medicaid. I believe, however, that there is hope for caregiving to be the start of a career...
As we've discussed numerous times on this blog, we believe that home should become the location for much more of the care delivery provided by the US healthcare system. This is especially true as it relates to the elderly for whom travel is difficult and who are more susceptible to get a cold or infection in a clinic or hospital. So the future of care as we see it requires more care delivery in the home and the community. This creates jobs and also creates cost, but the key is to more than offset those costs by reducing the cost of care. We've seen that this is possible when focused inexpensive care is applied to expensive populations. For more proof of this, read this article inspired by the research and writing of Atul Gawande.
Extrapolating from here, you can see how caregiving can become a first step towards a move to a comfortable middle class living. Take a look at the diagram below:
In this rendering, a home care caregiving job becomes a first step in a progression and a big one, moving an individual from unemployed to having a job as a non-medical caregiver, providing companion, cleaning and assistance with activities of daily living. This is not a high paying job but a caregiver can earn over $20K per year and possibly much more.
For caregivers with good reading and writing skills (or the ambition to develop them) and a good work ethic, they can move up to a higher skilled and higher paying job. The diagram depicts a phlebotomist (a person trained at taking blood samples), but there are other potential roles as well, such as becoming a certified nurses assistant (CNA), a home care scheduler/supervisor, or a job monitoring telehealth results or working as a health coach in a call center. These are the types of jobs that will be created as part of health care reform that will reduce overall health care costs.
Further progression can include a step up to a social worker role or a nursing role that requires a degree or specialized training.
All of this will require a better ability to coordinate the delivery of care, and this is what Ankota is focused on delivering. If your organization has the ambition to improve care, create jobs and lower costs, but the technology to manage care coordination is a challenge, we'd love to help.
Ankota provides software to improve the delivery of care outside the hospital. Today Ankota services home health, private duty care, DME Delivery, RT, Physical Therapy and Home Infusion organizations, and is interested in helping to efficiently manage other forms of care. To learn more, please visit www.ankota.com or contact Ankota
Posted by Ken Accardi on Thu, Dec 29, 2011 @ 08:50 AM
Around three years ago, Laurie Orlov pitched a large and prominent industry analyst firm with the idea that they should cover and focus on technologies for aging in place. They said no,
but she thought it was a good enough idea to go it on her own. She created the Aging in Place Technology Watch blog and began offering consulting services in the space. Since then, I've served in two panel events with Laurie and have enjoyed her coverage of the industry, and her inimitable snarky style. You can visit Laurie's website to view her interesting content and sign-up for her email newsletter.
Laurie covers a lot of topics, and over the past year she's began focusing more on home care with the realization that caregivers, who are comprised of family members and outside home care workers, are a large part of the aging in place user base. Below are Laurie's predications for home care in 2012:
HOME CARE -- gets the attention, not yet the tech deployment, it deserves. May you live in interesting times – this past year saw the boom of jobs in home health and home companion care -- to the point where they comprise the fastest growing job so-called opportunities in the US. But given their low wages and mostly missing benefits, federal efforts are underway to apply wage and overtime protection to these 2 million or more workers -- 40% of them on Medicaid and/or food stamps. Beyond the controversy over who works, who pays and how much, there is still no talk of requiring any type of monitoring technology in the job – and in one survey from Magnolia Prime recently, at least 50% of the home care agencies surveyed reported that they had "no plans to purchase, replace, or upgrade their technology in any way." So they say
Let's dissect Laurie's prediction:
- HOME CARE -- gets the attention... it deserves: It's great that home care is getting attention, as it should! It's up to our industry to turn that attention towards the positive value that home care can bring (and to weed out the bad apples who bring negative attention)
- Home Care is one of the fastest growing job "so-called" job opportunities: Laurie points out that jobs are being created but that many home care workers are on food stamps or Medicaid. My more optimistic view is that it's better having people working and providing a valuable service at a low wage than the alternative of being unemployed. Also, we're seeing that health care reform will create a large number of opportunities for higher paying jobs in the arena of caregiving and that home care workers who excel and who have or develop their reading and writing skills will have a chance to move up.
- There is still no talk of requiring any type of monitoring technology in the job: We're seeing a higher adoption rate for telephony now that companies like ours have made it affordable. We also believe that when smart phones with data plans become universally affordable, that monitoring will improve.
- At least 50% of the home care agencies surveyed reported that they had "no plans to purchase, replace, or upgrade their technology in any way": We're excited about the remaining 50% who are considering upgrades. Also we know that those who adopt technology will sustain a competitive advantage and at the most basic level will be able to add clients and caregivers without needing to increase back-office staff.
Laurie is considering an independent research study of the home care industry in 2012. If you know companies or other organizations who might sponsor Laurie's work, please let her know.
Let us know your predictions for home care in 2012. You can post comments below, or if you've published home care predictions for 2012, let us know where and we'll read and share them.
Ankota provides software to improve the delivery of care outside the hospital. Today Ankota services home health, private duty care, DME Delivery, RT, Physical Therapy and Home Infusion organizations, and is interested in helping to efficiently manage other forms of care. To learn more, please visit www.ankota.com or contact Ankota
Posted by Ken Accardi on Thu, Dec 22, 2011 @ 12:03 PM
Ginny Kenyon has weaved another gem with her recent posting entitled "New Strategies for Competition in Home Health." I'll keep this post short to encourage you to read the original post on Ginny's site. This article is specifically focused on older agencies who started when there wasn't a lot of competition in their area. Now competition is fierce...
The main message is that you shouldn't put all of your eggs in one basket and opportunities to diversify. You should listen carefully to your local community for the ways that you can better meet their needs and win more referrals. Some examples are elaborated:
- Can you offer a "Home Modification" service?
- Can you negotiate medication discounts for your patients (e.g., from a mail-order pharmacy)?
- Can you offer the ability to get your patients connected with Personal Emergency Response Systems?
- How about med dispensers?
- How can you win referrals for chronic care management?
All agencies, and especially older and more established agencies, need to think like "start-up entrepreneurs" to expand your business model. If you're on top of it - great! If not, maybe Ginny can help!
Ankota provides software to improve the delivery of care outside the hospital. Today Ankota services home health, private duty care, DME Delivery, RT, Physical Therapy and Home Infusion organizations, and is interested in helping to efficiently manage other forms of care. To learn more, please visit www.ankota.com or contact Ankota
Posted by Will Hicklen on Wed, Dec 21, 2011 @ 09:59 AM
In "How to Improve Delivery Operations Management," Dave Kopf, Editor of HME Business writes, "One of the major elements of HME business overhead is running delivery and repair fleets and their supporting operations. It is a staff-intensive, and involves continuing regular capital expenditure for fuel and repairs, as well as depreciating assets — the vehicles — that need to be regularly replaced."
It's on every HME's mind: How Can I Cut Costs Now?
Kopf points out that the practice of managing deliveries and planning routes consumes a good amount of staff time, which also means more overhead. The HME industry has been grossly underserved with technology until recently, and most HMEs are still in the dark ages when it comes to leveraging technology.
Managing deliveries is both complex and expensive. Kopf and other experts note primary costs to consider, below. Ankota offers additional guidance on how technology can address and reduce these costs directly. I cannot speak for other software companies, but in our experience with Ankota's HME Optimization technology, these results can be achieved in less than one quarter, even making the system self-funding.
It's a matter of survival. With reimbursement cuts, many HMEs are certain to fail. Technology MUST be leveraged immediately to improve profitability and allow providers to survive and grow with fewer staff. It's all about productivity improvement and that is best achieved through automation.
A few more things to consider when choosing a system:
- Get rid of paper now. Does the system provide a "closed loop" electronic process? You can initiate orders, plan and track staff, vehicles and deliveries (including signature capture), generate invoices and payroll -- all electronically. Your billing and payroll should be done instantly as a result, further reducing staff needed to support operations. It is not unusual for an HME to consume .5-.75 FTE filing delivery sheets, or scanning and attaching them in another system. That process can be fully automated, saving a single office several tens of thousands of dollars in direct labor costs per year.
- Scheduling & Route Planning: does the system simply create routes and maps based on the schedule? Or does it utilize optimization technology to schedule deliveries in such a way that the appointments and sequence in which deliveries are made are optimized, resulting in fewer miles traveled and lower fuel expense? You want the latter, for sure. It can reduce your cost per service order by 25-50%.
- Integration with existing systems: Does the system connect with your order entry system so that your staff can avoid time wasting efforts like entering data multiple times? Same should go for integration with your billing and payroll systems (or services you use for these).
- Finally, only use web-based technology that you can pay for on a monthly or quarterly basis. The technology will serve you far longer, will provide greater innovation, and you can always hold the vendor's feet to the fire when issues come up. Good web based products will also support offline use and syrchronize when you have a connection.
Delivery of Home Medical Equipment (HME/DME) is critical to the overall success of the healthcare system. HME Providers must utilize technology to maintain viabillity and survive resimbursement cuts. Technology can be used to improve profitability quickly and put HME providers in position to participate in Coordinated Care and Accountable Care models. Without Care Coordination technology that ties delivery operations to those who plan and authorize care, HMEs will be left out.
Posted by Ken Accardi on Tue, Dec 20, 2011 @ 10:03 AM
President Obama temporarily appointed Dr. Donald M. Berwick to lead the Centers for
Medicare and Medicaid Services (CMS). When Dr. Berwick stepped down he had a few things to say:
There's an extremely high level of waste in federal health spending, ranging between 20%-30%, said Donald Berwick, the freshly departed head of the CMS. He listed five reasons for the waste: overtreatment of patients, the failure to coordinate care, the administrative complexity of the health care system, burdensome rules and fraud. The Office of Inspector General (OIG) has urged CMS to improve its oversight of hospitals and other health care providers, as well as to increase enforcement of rules and cut overpayments.
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For our industry, the key questions are 1) What are some of the remedies? and 2) How can home care help? Here are my thoughts:
- Overtreatment of patients: Overtreatments occur because 1) the doctor is afraid of missing something so they order too many tests, 2) the tests were done already but results are not readily available so they test again, or 3) the health community is taking advantage of the pay-per-service plan that focuses on what is paid for tests and not on what tests are required. The answer here requires payment reform that makes it more advantageous for the health system to spend less.
- Failure to Coordinate Care: Some of the best care professionals I respect have said "we try to coordinate care because it's the right thing to do, but it's hard because we don't get paid for it". The answer, also in the form of payment reform, will be to pay less if you don't do it. (Editor's note - this is why Ankota's main focus is to make it easier to coordinate care, and to do it with greater efficiency)
- Administrative Complexity and Burdensome Rules: Today's health care software is mostly designed for billing, whereas it should be designed around the care delivery process (and billing should happen automatically in the background). This is a big shift...
- Fraud: Unfortunately there has been a history of fraudulent claims in home care and this has gotten the attention of lawmakers more than the potential benefits that home care can bring. As an industry, home care needs to blow the whistle on fraud and make it go away. In your own agencies, make sure to be "Squeaky clean" and invest in technologies like telephony and electronic note systems that create an unquestioned audit trail. Then once the "bad apples" are thrown out, the focus will shift.
Many of the people in home care have been around for a while and now is the time to take the long term perspective. Ultimately, home care can and will take center stage in fixing America's health care issues, and legislation like the "Independence at Home Act" will help. In the mean time, provide great care, and invest to make care coordination central and to stamp-out fraud. Good times are ahead!
Ankota provides software to improve the delivery of care outside the hospital. Today Ankota services home health, private duty care, DME Delivery, RT, Physical Therapy and Home Infusion organizations, and is interested in helping to efficiently manage other forms of care. To learn more, please visit www.ankota.com or contact Ankota