The Ankota Healthcare Delivery Management Blog

Home Health Care Paradigm Change: A New Dream (by Ginny Kenyon)

Posted by Ken Accardi on Apr 27, 2011 9:59:00 AM

One of the industry experts I learn from every time we speak is Ginny Kenyon, principal at Kenyon Home Care Consulting.  Ginny helps open home care agencies and has given Ankota great inputs on our software.  Plus she's helped influence our new offerings for Therapy Management, Private Pay Home Health, and Geritric Care Management combined with Private Care.  As I blogged in my last post, Home Care will be at the heart of Health Care Reform,we at Ankota strongly believe that keeping elderly people health and comfortable in their homes (and out of the hospital) will be the secret to success.   Ginny is one of the pioneers driving moves in home health delivery.  Enjoy her post (below).

Kenyon Home Care Consulting

A Paradigm Shift for Home Health Care: A New Dream

For years I have dreamed of a day when home health care nurses and therapists would be in charge of their own services, with doctors as integral members of the team – not the “directors” of the plan. It never made sense to me that a physician, who knows little about home health care services, would be required to sign off on our orders. I agree that physicians or nurse practitioners should confirm the working diagnosis and the medications. From that point, it is the professional clinician in home health care that does their assessments, defines the problems in terms of their discipline, and sets the plan of action – not the physician. Having a physician sign our orders and “direct the care” of the home health care makes as much sense as asking the plumber installing the kitchen sink to sign off on, and be in charge of, the electrician, sheet rockers, framers and roofers, and their work. Physicians repeatedly object to the requirement that they sign orders and now, with the new face-to-face documentation, the objections are even stronger.

How did we get here? When – and why – has there been a paradigm where the physician directs the care of other providers? Think of the money spent supporting this false paradigm! Think ofGinny Kenyon all the hours spent by home health care staff gathering a physician signature on the 485. Think of the patients denied services because their physician did not want to deal with the added burden of the paperwork required to obtain the care needed by their patients through the home health agency. Frankly, I do not blame physicians for not wanting the added burden of paperwork that is imposed on them by this requirement.

Therapists are able to establish individual practices that do not require physician oversight. Not so for nurses. Physician control over nursing practice started in the early part of the last century when it was determined that the independent practice of nurses was the single biggest threat to future physician financial growth. (See my article, “Nurse Power: The New Voice in Home Health). Nurses were considered a financial threat to physician financial futures. As a result, the American Medical Association got Congress to pass legislation requiring that nurses work under the direction of a physician. The current state of affairs is testimony to the success of that effort. Unfortunately, for nurses, consumers, and those who pay, it has not been the best practice.

Many physicians who sign the plans of care developed by nurses and therapists will be the first to tell us that the plans make little sense to them. They sign the plans of care so their patients get the care they need. It’s no surprise the plans make little sense to the physicians. They are not medical plans of care. They are nursing and therapy plans written in the language of each discipline. It is time that home health care plans are recognized for what they are: discipline-specific plans that should be signed by the individual disciplines. Let’s leave the medical components, diagnosis and medication lists to the physicians to sign.

What could the future look like? I dream of a future for home health care where the physician is part of the team and works with the other disciplines to achieve the desired goals identified by our patients. I dream of a future for home health care where each discipline is responsible for their role. I dream of a future for home health care where nursing is responsible for coordinating the overall plan. Just as Medicare recognized long ago, nurses would serve as the coordinator or case manager of patient care in home health care. In that respect, little would change from the current practice.

The physician would confirm the working diagnosis and medications electronically. Each discipline would sign and date their plans. Compliance with the home health care conditions of participation would continue to be the responsibility of the clinical staff at the home health care agency. The requirement that the physician certify the patient as home-bound would virtually disappear.

The focus of the system would change from rule enforcement to that of outcome-focus. With these few changes, costs would decrease and outcomes would improve, as would physician, home health care staff, and patient satisfaction.

A return to individualized plans of care structured in care plan format would help others on the team do better planning. It would help new staff understand the care planning process.

It’s time to dream a new dream for the home health care industry. A dream of true patient-centered care that allows each team member to fully use their particular set of skills and expertise to assist patients in their goal achievement. Time to dream. What are your dreams for the future of home health? Let me know. Together, let’s make those dreams a reality.

Home Physical Therapy Software

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 or contact Ankota 

Topics: Home Care Entrepreneurship, Health Care Reform, thought leadership, Home Therapy, Home Health Therapy Software

Home Care plus TeleCaregiving can be Winning Combination

Posted by Ken Accardi on Apr 25, 2011 9:24:00 AM

My friend and colleague Laurie Orlov posted another gem on her blog entitled “Tech-enabled home care is betwixt and between”Laurie Orlov which you can read here.  For those unfamiliar with Laurie, her website and blog is called the Aging in Place Technology Watch and can be viewed at  As the title implies she focuses on technology for aging in place.  From a style perspective, she has a snarky way of pointing out iniquities in understanding the way that technology and aging are being used and should be used.  This makes her posts very entertaining.  She’s also a great researcher which makes her posts well-informed and educational.

Aging in Place Technology Watch

In a nutshell, Laurie looks at the high costs of elderly care in assisted living facilities (ALFs) and Home Care and then looks at how the Kentucky-based company ResCare has 50,000 employees helping 1 million clients by checking in on them using home monitoring technology combined with web-cam and chat capabilities.  The caregiver checks in on the individual or couple remotely in their home, and has the ability to get them help only when needed.  In the case of ResCare, most of their cases are reimbursed through Medicaid.

Laurie then points out that so far as she knows there aren’t a lot of private pay home care organizations using this type of technology to lower their costs or differentiate their service.  In our home care entrepreneurship series on the Ankota blog, we suggested a blueprint for this several months ago that you can read here, but in a nutshell, here’s the idea:

  • Offer a service to install TeleCaregiving technology such as the products offered by Ankota's partner BeClose.  For this you can charge a site-survey and installation service fee
  • Next offer a bundled service where you check-in on the client on a regular basis (weekly, monthly, etc. based on their need)
  • Couple it with Ankota’s FamilyConnect which gives you a way to report back to the loved ones of the person under your care
    Ankota FamilyConnect
  • Also offer the ability to deploy a caregiver when needed (at a higher than normal price because of the on-demand nature of the service)

What does this give you:

  1. A low-priced yet high margin entry-level caregiving service that you can offer in your community
  2. A way of building a relationship with prospective clients long before you currently do
  3. A great shot at being able to provide in home care as the client’s needs escalate


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 or contact Ankota 

Topics: Home Care Entrepreneurship, Elderly Care, Care Coordination, Aging in Place Technology, Home Care Technology, BeClose, telehealth

Veterans Administration Awards $1.38B in Telehealth Contracts

Posted by Will Hicklen on Apr 19, 2011 12:46:00 PM

Veterans Administration Telehealth

In an effort to reduce healthcare costs and improve quality of life for veterans everywhere, The Department of Veterans Affairs awarded $1.38BILLION in contracts to companies to accelerate its Care Coordination / Telehealth Program. The aawards represent a doubling of VA expenditures on telehealth in the first year alone.

"The Department of Veterans Affairs this week awarded contracts to six IT vendors to run its massive (and growing) telehealth program for the next five years," says Sara Jackson in this FierceMobile report. Selected companies include Authentidate (Nasdaq: ADAT), American Telecare , Cardiocom (TSXV: EKG.V), HealthHero Network, Visual Telecommunications Network/ViTelCare and Viterion Telehealthcare (Div. of Bayer Healthcare).

For more information about The Veterans Administration Care Coordination / Telehealth Program, visit these links:

Care Coordination / Telehealth Program

Care Coordination / Home Telehealth – a program specifically for telehealth enabled home care

FierceMobile logo



Related articles:

VA Cuts ER Visits, Admissions with Remote Care Coordination

Wireless Home Monitoring Likely to Become Mainstream

Wireless Home Health Said to Grow nearly 15-Fold by 2013

Topics: Care Coordination, Home Care Technology, Home Care Mobile Solutions, Home Care, telehealth

Update on Mediware's Announced Acquisition of CareCentric

Posted by Will Hicklen on Apr 8, 2011 8:59:00 AM

We do not ordinarily post announcements on the Healthcare Delivery Management blog, but this is relevant to many HME companies, Home Healthcare agencies, Infusion and Private Duty providers who are among our readers.

Mediware Acquisition of CareCentric logo

On March 31, Mediware Information Systems, Inc. (Nasdaq: MEDW) announced that it had signed a definitive purchase agreement to acquire assets of CareCentric, Inc.’s, home medical equipment, home health and home infusion businesses. According to a press release issued by Mediware, the company plans to close the acquisition within 30 days.

We wanted to inform customers of CareCentric's Caretinuum and Mediware's HomecareNet that they will continue to be able to use Ankota HDM to optimize business operations, coordinate with other providers and lines of business, and reduce home healthcare delivery costs. Ankota will continue support for both product integrations, helping Home Health Care, Home Medical Equipment (HME/DME), Infusion and other companies to operate more efficiently. 

For any questions regarding Ankota's relationship with CareCentric or Mediware, please contact Will Hicklen at


Topics: Private Duty Agency Software, Home Healthcare Delivery Management, HME, DME, Announcements, Home Care Mobile Solutions, Home Care Scheduling Software

Ankota Shares HME News Most Read Stories

Posted by Will Hicklen on Apr 7, 2011 10:58:00 AM

HME News most read logo


Ankota would like to share this from HME News:

Each month, the editors of HME News compile the top 5 most read stories from and send them to you in an email alert, keeping you up-to-date on what's most important in the industry. The links to the top 5 stories for March are below.

Competitive bidding hearing draws crowd

WASHINGTON — It was standing room only at a congressional staff briefing held March 2 on competitive bidding, a sign, HME industry stakeholders say, that there might be support for another bill to repeal the program.

Competitive bidding: A bill for the Hill
WASHINGTON — When industry stakeholders convene here for AAHomecare's Washington Legislative Conference this week, they will be carrying an important piece of paper with them.

Legislative conference: 'Senator, we're here to talk to you about competitive bidding'

WASHINGTON — Looks like providers had the luck of the Irish March 17 during AAHomecare's Washington Legislative Conference. H.R. 1041, the new bill to repeal competitive bidding, picked up 18 new co-sponsors in that one day.

Competitive bidding update: Bill, auction and PAOC
WASHINGTON — With members of Congress on recess last week, there are no new official co-sponsors for H.R. 1041, the bill to repeal competitive bidding, but commitments are trickling in, according to AAHomecare.

CMS admits RAC got it wrong
FARGO, N.D. — CMS plans to halt automated CPAP audits in Jurisdiction D after learning that its contractor has misinterpreted Medicare policy, AAHomecare reported last week.

HME News Business Summit

Topics: Home Healthcare Delivery Management, HME, DME, Home Care Scheduling Software

Home Care will be at the heart of Health Care Reform

Posted by Ken Accardi on Apr 6, 2011 2:03:00 PM

Many of my blog posts share great information and analysis from others (except for the home care software geek stuff, which is all me).  But today's bold title "Home Care will be at the Heart ofHealth Care Reform Health Care Reform" is my story and I'm sticking to it...  Let me explain why I believe this...

Things we've all heard and know:

  • 5% of the people consume 50% of the US healthcare budget
  • Most of those 5% are elderly people with multiple chronic conditions
  • The reason they're so expensive is because of the pay-per-service model that puts them in the hospital when they're in trouble (at a cost of $3,000 to $12,000 per day) and when they get out of the woods they send them home with an "episode's worth" of care from a home health agency.  And sometime along the way the whole cycle starts over...

So what's the solution?

The solution is a different approach, which is to engage a care manager to oversee the care for this patient focused on a few goals, as follows:

  • Give them the best quality of life and comfor that is possible?
  • Monitor them proactively and on an ongoing basis (through a combination of people and telehealth) to keep them out of the hospital
  • In the process, keep the costs as low as possible

So the bottom line is that putting care management and homeHealth Care Reform Signature care at the center of health care reform makes a lot of sense.  You might think that this is a nice idea but inconsistent with the health care reform bill, but that's not really true.  Here's why:

  • Health care reform focused mostly on payment reform, but by insuring many more people through Medicaid (with much lower budgets) this will drive the prices down
  • There is evidence that health care reform believes in this, as evidenced by the introduction of reimbursed home health for chronic care and the concept of the ACO (accountable care organization).

I'm certainly bullish on the future of home care.  I'd love to hear your feedback.

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 or contact Ankota 

Topics: Home Care Entrepreneurship, Home Care Industry, Health Care Reform

Don't Let Being a Home Care Exec Melt You Down

Posted by Will Hicklen on Apr 4, 2011 5:27:00 PM

entrepreneur logo

entrepreneur Dont melt down title

I recently conducted an informal and wholly unscientific survey of homecare CEOs, including CEOs of home medical equipment and a physical therapy businesses, and found some major overriding stresses that keep them awake in a cold sweat at night, including:

Stress at night

We all know it intuitively, but most of us don't do anything about the stress.  The Japanese have a word for it when it reaches extremes: Karoshi. It's the corporate equivalent of Hari-Kari and literally means "death by overwork." The Japanese government recognizes it as a cause of death and has campaigns to reduce Karoshi. Families of the deceased can and do successfuly sue employers when a family member dies from overwork. Officially, the Japanese work 20 hours less per year than Americans, although some argue that they work more off the books than their American counterparts.


So what's the point of this blog post? I don't presume that we have a prevalence of home healthcare workers about to fall victim to Karoshi. We do, however, widely recognize caregiver fatigue, whether it be family or professional caregivers. We have a responsibility to better undertstand it and help mitigate the risk of caregivers, who are already stressed, becoming even more so. Entrepreneurs rarely acknowledge the exhaustion that often develops among their ranks. I speak with hundreds of home healthcare executives and their counterparts at Home Medical Equipment (HME/DME), Therapy and Private Duty home care businesses who seem to be determined to make Karoshi a common word in US households. They have the best of intentions and, like the caregivers they employ, are fully committed to their professions and their clients.

Today's post is an effort to encourage our current and future customers--Home Health Care agencies, Therapy, HME and Private Duty companies--to AVOID KAROSHI!

"This is not good for my mental and physical well-being," says Douglas Heddings of New York City in a recent article in Entrepreneur entitled "Don't Melt Down."

The article continues, "Researchers agree. Frequent long hours can increase stress and touch off a host of health hazards, including insomnia and high blood pressure. Poor decision-making starts to creep in. And unlike your laptop, your system doesn't have an internal fan to cool it down.

"Entrepreneurs are, of course, an action-oriented bunch by definition. That's usually a good thing. But a bias toward action can get in the way of the thinking needed to set limits and work smart. Too many entrepreneurs default to reactive behavior, reflexively jumping to the chime of a new e-mail, the pressure of a ticking clock and other external pressures and interruptions. They let technology and time manage them. This leads to the burnout model of work--they just keep going until the paramedics arrive."

What can you do? Well, we don't have all the answers, but there are several that fit within our area of expertise and that have been proven to reduce some of these stresses and dramatically improve business performance at the same time. 

A few helpful hints from Ankota on avoiding Karoshi by better preparing your business to run well and run consistently:


For more on improving business performance and making life in charge a bit easier, click here or on the Ankota logo and ask Ankota to help.

ankota logo color[5]

For more on avoiding Karoshi, click on the Geekpreneur logo here:

Geekpreneur logo

Topics: Home Care Entrepreneurship, Healthy Caregivers, Private Duty Agency Software, Home Health Aide Software, Home Care Best Practices, thought leadership, Home Healthcare Delivery Management, HME, DME, Home Care Technology, Will Hicklen, Home Therapy, Home Care Scheduling Software, Leadership, Learning

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About Ankota

Ankota provides software to improve the delivery of care outside the hospital, focusing on efficiency and care coordination. Ankota's primary focus is on Care Transitions for Reeadmisison avoidance and on management of Private Duty non-medical home care. To learn more, please visit or contact Ankota.

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