Posted by Ken Accardi on Mon, Aug 30, 2010 @ 12:39 PM
When people "follow" me on Twitter, I'm always interested to learn 
what they do and how it connects to our mission at Ankota. Last week, I was "followed" by Dr. Mary E. Jackson, whose twitter name is DrCares4Seniors. Dr. Jackson is a geriatric clinical pharmacist with 28 years of medical experience. Dr. Jackson just released a new book entitled Lower Prescription Costs: An Easier Pill To Swallow. The book is available on Amazon by clicking here or on the book cover.
A synopsis that Dr. Jackson shared with me is as follows:
- Exclusively focuses on medication costs
- Compares medications within a drug class including those available in $4 generic discount programs
- Includes a savings tips section for each drug class
- Designed for easy use (Dr. Jackson tried to make it as simple as possible since it is primarily for the elderly who may have cognitive impairment)
- Uses system similar to hotel & dining guides (e.g. $ = 0 to $25, $$ = $25 to $50, etc)
- Provides an example of a medication regimen, offering an alternative regimen that saves nearly 90% - $4,370 vs $470/year (and that's with Medicare D coverage).
Savings on medication costs is a huge opportunity for seniors, and with the help of Dr. Jackson's book, your home care nurses can provide a great service to your patients.
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 Fri, Aug 27, 2010 @ 10:15 AM
Today's post is reprinted with permission from Home Health Care Today. Copyright 2010 Stephen C. Tweed. To receive a FREE subscription to this newsletter, log on to www.leadinghomecare.com.
Well, it's official. After five months of discussion, questions, 
debate, seminars, workshops and webinars, the bottom line is that Health Care Reform is here, it's huge, and it will have a major impact on all of health care in America. We've continued to study the law and monitor the development of regulations needed to implement the law. Here are a few things that have happened that may affect your home health agency, hospice, or private duty home care business.
The 1099 Rule
A little-noticed provision in the Patient Protection and Affordable Care Act is suddenly generating a lot of attention. The new rule requires all businesses to file 1099 forms if they purchase $600 or more in goods or services from another business during a year. While the rule was largely overlooked in the early analysis of the health-care law, a recent uproar has put it in the spotlight, and efforts are now under way in Congress to repeal the measure.
Formerly, only unincorporated businesses that purchased services greater than $600 in a year were required to file a 1099 with the Internal Revenue Service and with the provider. The new rule extends the requirement to all companies, charities, and state and local governments. It also expands the provision to include purchases of goods or products.
For example, if a business buys more than $600 in office supplies from Staples over the course of a year, it will now have to send a 1099 to Staples and file another one with the IRS. Or, if you buy an airplane ticket to fly to the NAHC convention and it costs more than $600, you'll need to get the taxpayer ID number for your airline, figure out where to send the 1099, and file a copy with the IRS.
We suspect that this provision of the law will be revised, as neither the Congress or the IRS fully understood the unintended consequences of this tiny provision in the law. I'm sure we'll find other provisions like this that have major unintended consequences.
American confidence in ability to pay for Healthcare declines.
Americans' confidence in their ability to pay for and access health care has fallen by 5 percent since December 2009, according to a Thomson Reuters poll of consumer confidence released Monday, (8/23/10).
The monthly survey questions 3,000 consumers about their ability to pay for health care. According to Reuters, "On every survey question, responses were more pessimistic in July than they were in December."
New York state now has an active Pre-existing Condition Insurance Plan (PCIP), the NY Bridge Plan.
In July, New York officials said they were hoping the New York PCIP program premiums would be less than $600 per month. The actual premiums will be just $362 per month in upstate counties and $421 per month in downstate counties, including counties in New York City, officials say.
The initial plan design includes a $20 office visit co-payment, a $500 co-payment per inpatient stay and a $100 emergency room co-payment, officials say. The package also includes pharmacy benefits and vision care benefits.
The NY Bridge Plan administrators will process applications on a first-come, first-service basis, officials say. The earliest coverage can take effect is October 1. Once the NY Bridge Plan reaches capacity, administrators will set up a waiting list.
The federal Affordable Care Act (ACA) - the legislative package that includes the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act - allocated $5 billion to the PCIP to fill in coverage gaps that will exist before a ban on medical underwriting takes effect in 2014.
The PCIP program is supposed to provide "uninsurable" individuals access to coverage at rates comparable to individual rates in the commercial market. The program is open to individuals with serious pre-existing conditions who have been uninsured for at least 6 months. Some states are letting the new federal Office of Consumer Information and Insurance Oversight run their PCIP programs, but a majority will be running their own risk plans. New York is expecting to use $297 million in PCIP funding to provide temporary coverage for about.
Only two people enroll in New Jersey Plan.
New health plans for the sick and uninsured that became available as a result of federal health care reform have been slow to enroll patients: just two people in New Jersey will begin receiving coverage today, the first day the plans take effect.
Called NJ Protect, the health plans are available to people who have been without insurance for at least six months and submit evidence of pre-existing health conditions, such as diabetes, hypertension or cancer. New Jersey is to receive $141 million in federal subsidies to cover claims that exceed the premiums paid by the beneficiaries.
Most small businesses in California qualify for Tax Credit.
Garnering little to no press attention when released in July, a report undertaken by Families USA and the Small Business Majority found that 80 percent of California's small businesses with 25 or fewer employees will qualify for federal tax credits under the Patient Protection and Affordable Care Act starting this year.
This means that of the state's 571,200 small businesses, 465,500 are eligible for the tax credits in 2010. Of those, 30 percent - or 135,900 - qualify for the maximum tax credit amount.
Stay tuned to Home Health Care Today and Private Duty Today for more new developments in the implementation of the Patient Protection and Affordable Care Act.
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, Aug 05, 2010 @ 07:25 AM
The conversation on telehealth has shifted quickly... Just one year ago the question was "does Telehealth deliver value?" Over a very short period of time and backed by many studies showing positive results, the question of the value of telehealth seems to have been answered with a resounding yes... Now the question is "Who should 'do' telehealth?" What I mean by who should 'do' it, is the following:
- Who should make the case to an individual patient/client about the value of telehealth for their situation?
- Who should buy and own the Telehealth unit?
- Who should perform the monitoring and follow up?
It would seem that home care agencies would be very well equiped to do telehealth, but there are other contenders - most notably hospitals/doctors and families.
One of my favorite bloggers, Tim Rowan from HCTR (Home Care 
Technology Report at www.homecaretechreport.com) wants homecare to do telehealth. He has been evangelizing telehealth as a primary focus in his writing for over a year. But more recently, Tim has been cautioning and lamenting that market forces (specifically telehealth device manufacturers) aren't bothering to target home care. They're having more success with hospitals and families. See specifically this weeks feature article entitled "With or Without Home Care Agency Involvement, Remote Patient Monitoring Moves Into Consumers' Consciousness" at this link.
We've been trying to do our part to educate the home care market 
on telehealth as well and I'd direct your attention to Will Hicklen's article "Telehealth, Home Monitoring and Home Care Business" and my follow up "Telehealth, Home Monitoring and Home Care Business - Part II".
The core issue here comes down not to who will "do" telehealth, but rather who will pay for it. For an interesting take on this, I'd highly encourage you to look at the post "Healthcare Reform without Permission - A Recipe" inspired by a presentation by Dr. Randall S. Moore who is president of American Telecare - a maker of telehealth devices. Dr. Moore compells us to focus on the 
value (savings) delivered by Telehealth and to collaborate with the effected players to find the money (e.g., if care for a CHF patient will cost $15K less per year with Telehealth than without, then the insurance company would be silly not to pay for the telehealth).
So presuming that you want your home health or private duty agency to do telehealth, what should you do about it? Here are a couple of thoughts:
- If you're in home health, you can go to the hospitals, doctors and insurance companies and make the case that you can do it better and cheaper.
- If you're in private care, you might grow your business significantly by helping families get started with telehealth early (this way, as care needs increase you'll be the obvious choice to fill the gap)
- In either case, waiting for CMS to come forth with "we'll pay you if you do this" isn't going to put you in a leadership position
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 Marc Ottinger on Thu, Jul 15, 2010 @ 08:51 PM
Question -
When all is said and done what is the impact of Operational Excellence?
Summary
Today we operate in unsettled times. What will the impact of the Healthcare Bill be? History tells us in period of instability positive change results. The high-performance businesses, those that have put a premium on operational excellence, will excel and gain customers and as a result market share. For those companies that are stumbling during these difficult times, it is an opportunity to look at business processes and put in place operational excellence initiatives. Either way to achieve it takes management vision, commitment, and investment.
The focus of this series has been that high performance businesses put a premium on operational excellence. Below graphically depicts the average Return on Invested Capital (ROIC) between companies using operational excellence to excel and that of the Followers. Investing in operational excellence has great rewards.
The installments have been the five characteristic of operational excellence. These characteristics are –
1st – Identifying the “Dominant Vector.”
Revisit this characteristic by scrolling down to the July 9th blog post.
2nd – Establishing a structure to that creates an advantage.
Revisit this characteristic by scrolling down to the July 11th blog post.
3rd – Out-Executing other Home Care Providers.
Revisit this characteristic by scrolling down to the July 12th blog post.
4th – Maintaining the Balancing Act for success.
Revisit this characteristic by scrolling down to the July 13th blog post.
5th – Addressing the Journey to ensure success.
Revisit this characteristic by scrolling down to the July 14th blog post.
It is time to put in place Operational Excellence Initiatives and take advantage of instability.
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, Jun 23, 2010 @ 07:31 AM
The Home Care Software Geek posts in this blog don't talk about Home Care Nursing Software, Private Duty Telephony, DME Delivery Software, Home Infusion Care Management or the other topics we focus on regularly at Ankota. Instead, these posts are intended to keep our readers up to date with technology trends that might be useful to your agencies, such as social media technologies, mobile devices, and what's happening from the big-boys like Microsoft, Google and Apple.
The home care software geek generally attempts to inform you about technology topics that you've heard of but might not understand. The cell phone doesn't fall into that category, but that's because most of us are still thinking of it as a phone and not yet as a health care device, but that's changing. My friend and colleague Dr. Eliot Heller MD was speaking to a group of health care entrepreneurs from France last week and made a point of mentioning that the one constant across his patient base in the Bronx was that they all have a cell phone. Many of these low-income patients from Bronx-Lebanon hospital don't have home phones, but they all have cell phones. In fact, Dr. Heller indicated that the cell phone number is more important and consistent for the hospital to track patients than their address.
Health care delivery efforts have taken notice and are starting to take advantage. Here are some examples:
- In the article Cellphone + EHR = Diabetis Management, two programs are designed which help inner city residents of Washington DC manage diabetis. The applications allow people to record their weight, blood glucose and blood pressure and they are given alerts on their phone screen if the values are out-of-range. This initiative is expected to easily pay for itself by reducing hospitalization, and participants are given the cell phone.
- My friend Jacqueline Thong started a company called UBIQIHEALTH to help migraine sufferers. UBIQIHEALTH chose to implement their technology on a cell phone, because everybody has one and because the nature of migraines is that you can get them under control better if you track when they happen and what triggered them. Below is the content from their "How We Can Help" section of their website
So why is this relevant for home care? Perhaps the cell phone becomes an entry level TeleHealth unit that you can use to monitor your patients or clients at a very affordable price. Remember Ankota's book of the year for 2009 was The Innovator's Prescription, by Clayton Christensen, and that one of his key messages is that that simple applications on devices available to more people often displace the more expensive devices. You can see this explained by Clayton Christensen in a video, here.
Also, here at Ankota we've recognized the potential of the cell phone for home health aides to report their arrivals and departures. As more and more cell phones are replaced with smart phones that can support simple applications and track GPS location, we expect that this will become a preferred option over telephony. But, of course, we offer both and offer them interchangably (you can have some workers use telephoiny and others use their cell phone, and in fact you can even have a worker report their arrival on their phone and their departure on telephony (and vice versa). Read more about Ankota's paperless work tracking solutions here.
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 Tue, May 25, 2010 @ 08:05 AM
Last week I attended a seminar on the subject of Patient-Centered Design, which included a key note address by Jim Champy, the author of the new book Reengineering Health Care: A Manifesto for Radically Rethinking Health Care Delivery (available on Amazon June 17th). His co-author is Harry Greenspun, M.D., the Chief Medical Officer at Dell Inc. Jim is also the best selling auther of the New York Times Best Seller Reengineering the Corporation, which has sold over 3 million copies.
Listening to Jim talk, it was clear that he knows a lot about reengineering. He knows and conveys well that we need to stop thinking in silos, and instead that we need to think about end-to-end processes from the patient's perspective. He also brings a clear agenda for reforming health care, and talks about how it's necessary to find ways that delivery better care at lower cost, and that by doing so that access to care can be increased. While these were the strengths in his presentation, his health care knowledge and the examples that he used were a little bit "light" so that was the negative. But I'm sure that as he works on his presentation, he'll be able to beef this up (maybe by reading some of the other great books profiled in this blog - click for links).
Although I was underwhelmed by Jim's command of how healthcare is actually delivered, I realize that the healthcare industry is really at its infancy when it comes to re-engineering, and there's a lot we can learn from Jim. So if you'd like a good primer on how to improve the quality and efficiency of your home health care or private duty organization, you might give this book a gander.
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, May 19, 2010 @ 05:48 AM
One of my favorite authors and professors is Clayton Christensen from the Harvard Business School. He has written numerous books about disruptive innovation - the kind of innovations that often go on to replace the way something is done. More recently he wrote The Innovator's Prescription, which was named as Ankota's Book of the Year for 2009. Here, thanks to BigThink.com is a 10 minutes video of Dr. Christensen explaining these key concepts. Home Care and Private Duty Care organizations should realize our opportunity to be a major part of the most needed innovation in healthcare today. Enjoy the video.
Some leading candidates for Ankota's book of the year in 2010 are The Checklist Manifesto, by Atul Gawande, and Healthcare Won't Transform Itself, by George Halverson. Check out our blog posts on these books by clicking their links.
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, Apr 28, 2010 @ 11:34 AM
Monday's Wall Street Journal featured a prominent article about home care, but it wasn't the story we would have hoped for. Instead of focusing on the opportunity for home care to increase patient satisfaction, lower costs as compared to hospital and nursing home stays, reduce the risk of infection, free up hospital beds, and create jobs, the Journal instead shared a story about how reimbursement incentives have influenced the delivery of care.
You can see the article, entitled Home Care Yields Medicare Bounty (by Barbara Martinez in the April 26th edition, by clicking on the image below:
The synopsis of the article is that Medicare reimbursement for Home Care Services was structured so that an episode of care with 10 or more visits paid the agency $2,200 more than an episode with up to 9 visits, and that research showed that when this provision was in place, that a lot more episodes had 10 visits than 9. Most of the data for the article came from Amedisys, but it was clear that the practice of "more 10 than 9" occurred industry-wide (sadly for Amedisys, their leadership in the industry made them easy to pick on).
As a taxpayer, of course I'm not happy that the industry opted for the reimbursement option that paid them more, but can you really blame them, or should we instead be looking at the reimbursement policy. To draw an analogy, movie theaters offer different sizes of popcorn where the small bag costs some crazy amount like $6.00 and the big bucket with twice as much popcorn costs $6.50. Are the buyers of the big bucket wrong to get more value by shelling out the extra 50 cents?
But there are several differences between the popcorn analogy and the Medicare example, as follows:
- With popcorn, the buyer got 100% more product for just over 8% more money, whereas with Medicare, the patient got 11% more service for 67% more money - the opposite of a volume discount
- With popcorn, the buyer made the decision and the buyer paid for it, whereas with Medicare the seller made the decision and the taxpayers paid for it
- If the buyer who set the policy of "We'll pay a lot more money for a little bit more product" had worked somewhere like at GE, they'd likely be fired
So shame on everyone... Yes it's likely that 10 visit episodes didn't deliver better care than 9 visit ones, so shame on home care. But shame on the policy makers who crafted the reimbursement, too.
As we've shared in previous posts, the definition of health care reform needs to be "Better Care at Lower Cost". And when this policy is applied, home care will deliver a win/win and the Journal will be able to tell a much more positive story.
Ankota provides software to improve the delivery of care outside the hospital. Today Ankota services home health, private duty care, DME Delivery 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, Apr 28, 2010 @ 05:47 AM
One of the key successes in home care is following checklists. Home Health Aide Software Telephony software puts the checklist of care activities right on the phone so that care givers know just what to do to care for a client. But can simple checklists save lives? A new book, The Checklist Manifesto - How to Get Things Right, by Dr. Atul Gawande gives us a clear answer that YES, checklists can make a significant difference in patient outcomes and the quality of care.
Here's a picture of the book cover (click on it for a link to the book at Amazon.com).
The book uses compelling examples to show how "the lowly checklist" can be a powerful tool to improve outcomes in health care and in other industries as well, and then goes on to teach us how to make a good checklist - a lesson we can all apply. Plus, Dr. Gawande has used the book to lauch a World Health Organization (WHO) initiative to improve care globally.
For those of you who don't know Dr. Gawande, you should! His first breaktrhough book, Complications, provides a compelling view into medical decision making and medical rounts (and frightening but true, it emphasizes the importance of trial-and-error and making mistakes in improving care). He also wrote a piece in the New Yorker called The Cost Conundrum that explores the disparity between Medicare costs in different geographies of the US. This was the subject of one of our very first blog posts (click here).
The book is easy to read and uses memorable examples throughout. We highly recommend it and will give it strong consideration for the Ankota Book of the Year (which was last one by Clayton Christensen's, The Innovator's Prescription).
Ankota provides software to improve the delivery of care outside the hospital. Today Ankota services home health, private duty care, DME Delivery 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 Thu, Apr 15, 2010 @ 04:49 PM
Or: The double edged sword of health care reform
Or: What should YOU-the Home Care Provider (HHC, PD, DME, RT, Infusion ...)-do RIGHT NOW to improve your business.
There are a number of companies, like Ankota, that make their business in various healthcare markets. For many, healthcare reform presents both opportunity and risk. I recently did an interview on this topic with Elain Pofeldt of the Atlantic Monthly, which you can read here: http://bit.ly/cNFomN
To be sure, the constant escalation of health insurance premiums affects Ankota like any other business. It consumes financial resources that could otherwise be directed to product development, hiring and fueling the company's growth. Recent legislation adds to that uncertainty, but we were in an uncertain market before, as well.
So why are we so excited? Because our customers' businesses are in crisis. "Seriously?" you say. I don't mean to celebrate any misfortune, but consider what this means for a company like yours as well as Ankota.
Markets in crisis tend to exhibit certain behaviors. Businesses in crisis tend to innovate. They find new and more productive ways to manage their business. They are less likely to stick to old, inefficient ways. Or they die. They find ways to cut spending and reduce operating expenses. They leverage technology to improve efficiencies, to utilize staff better, and to get rid of old, tedious (and often paper-based) methods. In short, they look to do more with less. And markets in crisis are motivated to act immediately.
Companies making decisions to spend money in this type of environment do it for one reason: to become more profitable. Often times, they do it just to survive. They hold would be vendors to a very high standard, saying,
"Don't waste my time: Show me exactly how you are going to save me money, help me bill faster, or increase my revenues."
They want immediate, quantifiable results and they want to pay for enabling technology as they use it (like current subscription based models). They won't spend a lot of money today to see nebulous returns a year or two down the road.
The exciting news for Ankota and other Health IT companies is that companies in the home care ecosystem are under extreme pressure to improve productivity immediately. A business in crisis is motivated to act. Winning technologies will help them cut operating costs by better planning and delivering home health care. The providers who adapt and innovate will ultimately thrive.
The exciting news for those that provide home health care (Certified or Private Duty) and related services (such as RT and Infusion), and those companies that deliver home medical equipment (HME/DME), pharmaceuticals and supplies, is that there are a number of ways you can immediately improve your business:
- Get rid of paper-based processes such as scheduling and reporting. Use technology to plan schedules and routes for your mobile staff and vehicles more efficiently.
- Coordinate Care Plans with the staff and resources needed for execution. Good intentions are not enough. Efficient follow through and execution are critical.
- Keep track of work performed in real time via technology such as "telephony" that anyone with a cell phone can use. This is inexpensive and requires no additional investment in equipment. Whatever telephony solution you choose, make sure that it is integrated with the care plan and schedules.
- Measure your performance. Much of the technology mentioned above will begin to help collect the data such as time and cost information that you need to measure performance. This will lay the foundation for continuous improvement.