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Ankota: Ushering in the Next Generation of Homecare Blog

Care Coordination: Medical Home Model Delivers Results

Posted by Will Hicklen on Sep 28, 2012 9:13:00 AM

N.J. Medical Home Collaboration Pays Off for Patients, Physicians, and Insurer


Hospitals, ACOs, Primary Care practices, Home Health and Therapy agencies, and other post acute providers are sharing evidence that care, well coordinated and delivered proactively, reduces hospitalizations, lower costs and improve patients lives. This recent article pubslished by the Healthcare Financial Management Association (HFMA) documents the Medical Home model led by Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) that is delivering results today. With 154,00 patients in the program and plans to expand to 200,000+ patients, the BCBSNJ Medical Home Model demonstrates key successes of these programs: Hospitalizations have been reduced 26% and total cost of care reduced by 10%. These types of results are not uncommon in PCMH pilots and suggest that even better results are achievable with scale and Care Coordination technology such as that provided by Ankota

Medical Home Results
In the BCBSNJ model, Horizon BCBSNJ provides participating PCMH practices upfront funding to hire Care Coordinators. "Care Coordinator nurses work directly with physicians and office teams to improve the coordination of treatment for patients and help engage and empower patients to take control of their health. Once established, participating PCMH practices have an opportunity to receive additional outcome-based payments provided they meet specified goals for quality care, increased patient satisfaction, and lower costs." Read the full article here.

Readers of Ankota's blog should realize that many large insurers across the country either have pilots under way or are designing Medical Home pilots, based largely on the well documented Patient Centered Medical Home model (PCMH). These early programs engage Primary Care practices, leverage dedicated Care Coordination nurses, and look to rapidly expand to engage many more post acute services into the Patient Centered Medical Home, or PCMH, model. Home Health, Therapy, Infusion nursing agencies and even Non-medical Home Care businesses should engage in projects with payers, hospitals, ACOs and other post acute providers NOW if you aren't already. Don't wait for the model to come to you, get involved now and be aleader in your respective area of service. That will position your business for growth in those programs and others will seek you out for new programs as they emerge. 

One of the great challenges that providers and payers all face is exactly how to coordinate services. It's not enough to say, "Let's do it," and simply throwing more bodies at the problem (more nurse care coordinators) has limited benefit and scale. Providers must come together to operate as a single, integrate service model where the parts and the whole are both accountable and rewarded for performance. Payment models can help with this, but technology must enable the model and provide the platform from which to scale. For that, Ankota's PCMH technology is ideally suited. Learn more about Ankota's solutions for PCMH by contacting us using the really cool orange button below.


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Related articles:

HealthAffairs.org Horizon’s Patient-Centered Medical Home Program Shows Practices Need Much More Than Payment Changes To Transform

BCBSNJ: Horizon Blue Cross Blue Shield of New Jersey Expands Its Successful Medical Home Program To Benefit More New Jersey Residents

HFMA Article N.J. Medical Home Collaboration Pays Off for Patients, Physicians, and Insurer

Topics: Care Coordination, Will Hicklen, Care Transitions, Accountable Care Organizations, ACO

Accountable Care Organizations, Explained

Posted by Will Hicklen on Sep 27, 2012 12:39:00 PM

Significant confusion remains about Accountable Care. This overview from Kaiser Health News is a good primer for Hospitals, ACOs, and post acute providers.

ACOsWhile existing ACOs and Hospitals are generally better aware, post acute providers who ignore the changing business landscape do so with certain peril. Either plan your business strategy to be a valued partner in the ACO model, or wait for Accountable Care to happen to you. Those who plan and make it easy to do business with them under ACO the model will thrive. Those who wait for it to happen and do things the way they've always done them will be eliminated from the highest paying, fastest growing services. The latter group will fail at alarming rates.  

Providers that are more directly in the line of fire and face reimbursement penalties for high readmission rates tend to be more aware. These include providers like large hospitals, large physician practices, and few very large home health agencies. Hospital leadership tends to be more keyed in on Accountable Care as an opportunity to reduce costs and improve quality, and appreciates the financial implications. An overwhelming majority of post acute providers are surprisingly unclear on the emergence of ACOs and what it means to them. The more advanced groups are already considering what infraststructure, technology and management skills they require to thrive in the new era of Accountable Care. 

KHN Kaiser Health News

ACO is the hottest three-letter word in health care

By Jenny GoldKHN Staff Writer

OCT 21, 2011

Jenny Gold KHN bio

Accountable care organizations take up only seven pages of the massive new health lawyet have become one of the most talked about provisions. This latest model for delivering services offers doctors and hospitals financial incentives to provide good quality care to Medicare beneficiaries while keeping down costs. A cottage industry of consultants has sprung up to help even ordinary hospitals become the first ACOs on the block.

ACOs were compared to the elusive unicorn: everyone seemed to know what it looks like, but no one had actually seen one. Nonetheless, the health care industry embarked on a frenzied quest to create them as quickly as possible. But when the Obama administration released its proposed rule on ACOs, industry excitement fizzled. Hospital and doctor groups complained that the program created more financial risks than rewards and imposed onerous reporting requirements.

Thursday, after many delays and false starts, the administration at last released its final rule on how ACOs should work, including several concessions likely to assuage the concerns of skittish providers.

What is an accountable care organization?

An ACO is a network of doctors and hospitals that shares responsibility for providing care to patients. In the new law, an ACO would agree to manage all of the health care needs of a minimum of 5,000 Medicare beneficiaries for at least three years.

Think of it as buying a television, says Harold Miller, president and CEO of the Network for Regional Healthcare Improvement and executive director of the Center for Healthcare Quality & Payment Reform in Pittsburgh. A TV manufacturer like Sony may contract with many suppliers to build sets. Like Sony does for TVs, Miller says, an ACO would bring together the different component parts of care for the patient – primary care, specialists, hospitals, home health care, etc. – and ensure that all of the "parts work well together."

The problem today, Miller says, is that patients are getting each part of their health care separately. "People want to buy individual circuit boards, not a whole TV,” he says. “If we can show them that the TV works better, maybe they'll buy it," rather than assembling a patchwork of services themselves. "But ACOs will need to prove that the overall health care product they’re creating does work better and costs less in order to encourage patients and payers to buy it."

When will ACOs begin operating?

The government will begin receiving its initial round of applications for the ACO Shared Savings Program in January 2012, and the first ACOs are expected to launch in April.  But the race to form ACOs has already begun. Hospitals, physician practices and insurers across the country, from New Hampshire to Arizona, are announcing their plans to form ACOs, not only for Medicare beneficiaries but for patients with private insurance as well. Some groups have already created what they call ACOs.

In addition, CMS created a second strategy, called the Pioneer Program, for high-performing health systems to pocket more of the expected savings in exchange for taking on greater financial risk.

Why did Congress include ACOs in the law?

As lawmakers search for ways to reduce the national deficit, Medicare is a prime target. With baby boomers entering retirement age, the costs of the program for elderly and disabled Americans are expected to soar.

ACOs make providers jointly accountable for the health of their patients, giving them financial incentives to cooperate and save money by avoiding unnecessary tests and procedures. For ACOs to work they have to seamlessly share information. Those that save money while also meeting quality targets would keep a portion of the savings. Providers can choose to be at risk of losing money if they want to aim for a bigger reward, or they can enter the program with no risk at all.

HHS estimates that ACOs could save Medicare up to $940 million in the first four years. That’s far less than one percent of Medicare spending during that period. If the program is successful, it can be expanded by the Secretary of Health and Human Services.

How would ACOs be paid?

In Medicare’s traditional fee-for-service payment system, doctors and hospitals generally are paid more when they give patients more tests and do more procedures. That drives up costs, experts say. ACOs wouldn’t do away with fee for service but would create savings incentives by offering bonuses when providers keep costs down. Doctors and hospitals would have to meet specific quality benchmarks, focusing on prevention and carefully managing patients with chronic diseases. In other words, providers would get paid more for keeping their patients healthy and out of the hospital.

If an ACO is not able to save money, it could be stuck with the costs of investments made to improve care, such as adding new nurse care managers, and also may have to pay a penalty if they don't meet performance and savings benchmarks. ACOs sponsored by physicians or rural providers, however, can apply to receive payments in advance to help them build the infrastructure necessary for coordinated care – a concession the Obama administration made after complaints from rural hospitals.  

How would an ACO be different for patients?

Providers who are part of an ACO are required to alert their patients, who can choose to go to another doctor if they are uncomfortable participating. The patient can decline to have his data shared within the ACO. But although physicians will likely want to refer patients to hospitals and specialists within the ACO network, patients would still be free to see doctors of their choice outside the network without paying more. ACOs also will be under pressure to provide high quality care because if they don't meet standards, they won’t get to share in any savings – and could lose their contracts.

Who's in charge — hospitals, doctors or insurers?

Hospitals, primary care providers and other physicians are in charge of an ACO, but insurers can also play a role.

Some regions of the country, including parts of California, already have large multispecialty physician groups that may become an ACO on their own, likely by networking with neighboring hospitals. "A lot of health care organizations are going to dust off the existing structures they had in place" in the past, says Kelly Devers, a senior fellow at the nonprofit Urban Institute.

In other regions, large hospital systems are scrambling to buy up physician practices with the goal of becoming ACOs that directly employ the majority of their providers. Because hospitals usually have access to capital, they may have an easier time than doctors in financing the initial investment required by an ACO.

Some of the largest health insurers in the country, including Humana, United Healthcare and Cigna, already have announced plans to form their own ACOs for the private market. Insurers say they are essential to the success of an ACO because they track and collect the data on patients that allow systems to track patient care and report on the results.

If I don't like HMOs, why should I consider an ACO?

ACOs may sound a lot like health maintenance organizations. "Some people say ACOs are HMOs in drag," says Devers. But there are some critical differences – notably, an ACO patient is not required to stay in the network.

Steve Lieberman, Deputy Director for Policy and Analysis at the National Governors Association, explains that ACOs aim to replicate "the performance of an HMO" in holding down the cost of care while avoiding "the structural features that give the HMO control over [patient] referral patterns," which limited patient options and created a consumer backlash in the 1990s.

What can go wrong?

Lieberman cautions that ACOs are not a panacea. "ACO has become the three-letter health acronym of the year, if not the decade," he says. The health industry tends to operate with "kind of a herd behavior," rushing to implement an idea "without working through the detailed business questions of how they'll work."

Many health care economists fear that the race to form ACOs could have a significant downside: hospital mergers and provider consolidation. As hospitals position themselves to become integrated systems, many are joining forces and purchasing physician practices, leaving fewer independent hospitals and doctors. Greater market share gives these health systems more leverage in negotiations with insurers, which can drive up health costs.

But Lieberman says while ACOs could accelerate consolidations, it’s already "such a powerful and pervasive trend that it's a little like worrying about the calories I get when I eat the maraschino cherry on top of my hot fudge sundae. It's a serious public policy issue with or without ACOs."

Are there any possible legal concerns?

Doctors, hospitals and others in the health care industry have raised concerns that ACOs could run afoul of antitrust and anti-fraud laws, which try to limit market power that drives up prices and stifles competition. One concern is that ACOs, particularly those in rural markets, could grow so large that they would employ the majority of providers in a region.

To help providers avoid legal problems, the U.S. Justice Department's antitrust division promises to provide an expedited, non-mandatory, antitrust review process for these new doctor-hospital partnerships.

Topics: Care Coordination, thought leadership, Will Hicklen, Care Transitions, Accountable Care Organizations, ACO, Managing Post Acute Care, ACO Technology

Penalties for Avoidable Readmissions Loom in October 2012

Posted by Will Hicklen on Sep 24, 2012 2:23:00 PM

October 2012 marks the beginning of CMS penalties for high readmission rates, but it's clear that great confusion over these penalties continues. Just how substantial are they and how much will it cost providers?
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 Hospitals, ACOs, and providers of post acute services of all types should be both aware and concerned. Either you're a target of these readmission penalties and at risk financially, or you're part of the solution because you provide care in homes and communities that helps reduce readmissions and costs by keeping patients healthier and in their homes. Either way, you're not immune.

Hospitals put 7-figure price tag on readmission penalties
  Kaiser Health News



Ignore these penalties at your own peril, and know that they will only get worse. Many providers remain confused about the size and scope of these penalties, but are faced with penalties of .42 to 1% starting immediately in October.  

According to KHN, 2,211 hospitals will be penalized for readmissions for certain conditions in October, amounting to $280 MILLION dollars in penalties in the next 12 months alone. The average penalty will be 0.42 percent of revenue, but 278 facilities will receive the maximum penalty of 1 percent. The costs associated with such readmissions could run well into the high six and low seven figures a year for single, large facilities, reported Kaiser Health News. And that's just in the first year. Penalty rates are scheduled to increase to as much as 3% of revenue.

"And who are those pesky people who have been re-admitted?" asks Lori Orlov in the Aging in Place technology Watch? "Surprise, they are disproportionately comprised of seniors, initially with diseases like pneumonia, heart attack and heart failure, with more diagnoses added each year."

Looming readmission penalties force hospitals to improve transitions

Fierce Healthcare logo


Consider this the new era of financial incentives that force alignment in services provided to reach the common goals of reduced readmissions and lower overall costs. As financial incentives align, the formation of new collaboratives, ie "Care Coordination Models," will only accelerate.  Technology will help enable and drive change, and the focus will be on better managing care transisions and better utilizing resources. Hospitals and ACOs will cooperate with post acute providers of all types to achieve this double-aim and Ankota's is leading the wat with technology to connect and manage these ecosystems or providers. 

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Topics: Care Coordination, Will Hicklen, Care Transitions, Accountable Care Organizations, Avoidable Readmissions, ACO, Patient Centered Medical Home

Home Care Inspirational Quotes from Boyd and Nicholas

Posted by Ken Accardi on Sep 21, 2012 12:27:00 PM

When Ankota first started out, we went to several trade shows to meet people and to learn more about the home care industry.  One of the first few people I remember meeting at the NAHC Financial Managers Conference in Boston in 2009 were Tom Boyd andtom boyd Tom Nicholas from the creatively named company Boyd & Nicholas.  They're pictured here in this blog article, but the couple of times that I met them they weren't dressed in jackets and ties as they're depicted here.  Instead they were wearing shorts and Birkenstock's and walking around inviting people to come to their booth to get into their drawing for a couple of nice bottles of wine.  

They call themselves "the Cost Report People" and their main business is to do the accounting and cost reporting for Medicare Certified Home Health Agencies.  Here at Ankota, we mostly focus on Private Duty Care, Home Health Therapy and Care Coordination, so I don't know a real lot about cost reports, but I do receive Tom and Tom's emails.  They usually share financially-oriented and compliance-related newstom nicholas in Home Health and they also share a lot of inspirational quotes.  In this week's edition, and in celebration of their 19th anniversary, they shared a whole bunch of quotes and I liked a lot of them.  So here you go...  Home Care Inspirational Quotes:

  • "Great quotes make the light bulb go off in my mind. If you're like me, you'll jump at the chance to bypass all the churning and scoop the cream right off the top–that is what quotes are...the cream of our learning!" Zig Ziglar
  • "You can do anything, but not everything." David Allen
  • "Perfection is achieved, not when there is nothing more to add, but when there is nothing left to take away."Antoine de Saint-Exupéry
  • "The richest man is not he who has the most, but he who needs the least." Unknown Author
  • "You miss 100 percent of the shots you never take." Wayne Gretzky
  • "Courage is not the absence of fear, but rather the judgment that something else is more important than fear." Ambrose Redmoon
  • "You must be the change you wish to see in the world." Gandhi
  • "When hungry, eat your rice; when tired, close your eyes. Fools may laugh at me, but wise men will know what I mean." Lin-Chi
  • "The third-rate mind is only happy when it is thinking with the majority. The second-rate mind is only happy when it is thinking with the minority. The first-rate mind is only happy when it is thinking." A.A. Milne
  • "To the man who only has a hammer, everything he encounters begins to look like a nail."Abraham Maslow
  • "We are what we repeatedly do; excellence, then, is not an act but a habit." Aristotle
  • "A wise man gets more use from his enemies than a fool from his friends." Baltasar Gracien
  • "Do not seek to follow in the footsteps of the men of old; see what they sought." Basho
  • "Everyone is a genius at least once a year. The real geniuses simply have their bright ideas closer together." Georg Christoph Lichtenberg
  • "What we think, or what we know, or what we believe is, in the end, of little consequence. The only consequence is what we do." John Ruskin
  • "The real voyage of discovery consists not in seeking new lands but seeing with new eyes."Marcel Proust
  • "Every successful man I have heard of has done the best he could with conditions as he found them, and not waited until the next year for better." Edgar Howe
  • "Only those who will risk going too far can possibly find out how far one can go." T.S. Eliot
  • "Imagination is the highest kite that one can fly." Lauren Bacall
  • "To get the full value of joy, you must have someone to divide it with." Mark Twain
  • "Your imagination is your preview of life's coming attractions."Albert Einstein
  • "Set higher standards for your own performance than anyone around you, and it won't matter whether you have a tough boss or an easy one. It won't matter whether the competition is pushing you hard, because you'll be competing with yourself." Rick Pitino
  • "Extraordinary accomplishments only happen when your passion produces extraordinary effort. If it doesn't consume you, be ready to except mediocre results." John Rennie
  • "On a good team there are no superstars. There are great players who show they are great players by being able to play with the others as a team. They have the ability to be superstars, but if they fit into a good team, they make sacrifices, they do the things necessary to help the team win. What the numbers are in salaries or statistics don't matter; how they play together does." Red Holzman
  • "A leader has the vision and conviction that a dream can be achieved. He inspires the power and energy to get it done." Ralph Lauren
  • "For myself, losing is not coming in second. It's getting out of the water knowing you could have done better. For myself, I have won every race I've been in." Ian Thorpe
  • "Happiness is found along the way, not at the end of the road. People will soon forget the record. What they remember is the way you hustled, the poise you had, and the class you showed." Sheryl Johnson
  • "It is not the events in our life that define our character, but how we deal with them." Eric Heiden
  • "You are never too old to set another goal or to dream a new dream." C.S. Lewis
  • "When you're prepared, there's no reason to sweat." Jim Caldwell
  • "Anger makes you smaller, while forgiveness forces you to grow beyond what you were."Cherie Carter-Scott

What are your favorite quotes?

Boyd and Nicholas

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.

Topics: Home Care Best Practices, NAHC

Home Care Aide shortage coming back

Posted by Ken Accardi on Sep 19, 2012 10:48:00 AM

Today's article is from Stephen Tweed who leads Leading Home Care.  We've featured Stephen on the Ankota blog numerous times in the past, including this piece sharing Stephen's tips for selling home health to physicians, and this moreStephen Tweed - Leading Home Care recent and somewhat controversial piece where Stephen shares the insight that social media doesn't seem to work for home health - in the piece his points are contrasted with a piece by Merrily Orsini about how to make social media work in home care.  Today's post indicates that the shortage of Home Health Aides is an issue we need to be cognizant of.

Home Care Aide shortage coming back

by Stephen Tweed

A recent article from the Associated Press and reported on Minnesota Public Radio describes the coming crisis in finding and keeping enough caregivers to meet the home care needs of aging baby boomers.

"Demand for home health care workers is soaring as baby boomers -- the 78 million Americans born between 1946 and 1964 -- get older and states try to save money by moving people out of more costly nursing homes. But filling more than 1 million new home care positions over the next decade will be a challenge.

The U.S. Labor Department projects that home health and personal care aides will be among the fastest-growing jobs over the next decade, adding 1.3 million positions and increasing at a rate higher than any other occupation. If those jobs can't be filled, many older Americans are likely to face living with relatives or in nursing homes, which will only cost families and taxpayers more money.  

Nearly half of all home care workers live at or below the poverty level, and many receive government benefits such as food stamps, unions and advocacy groups say. The median pay a year ago was $9.70 per hour -- 4 cents less than fast-food workers and short-order cooks, according to the most recent statistics from the Labor Department." 

Prior to the collapse of the economy in the 4th quarter of 2008, the biggest challenge to growing a private duty home care business was the difficulty in finding enough caregivers.  Leading Home Care and Private Duty Today responded to that issue by conducting research into recruiting and selection methods to help home care business owners find the people they need to grow their businesses.  When the economy turned down, the staff shortage become less of a crisis.

As the economy picks up, we project that owners will see that same type of staff shortage. We're already getting reports from clients and customers about the challenges they face. 

If you do not have in place a process for effectively recruiting and selecting caregivers now, then you will have a real challenge growing your business next year when the economy rebounds.  We encourage you to begin right now to review your people and processes for recruiting, selection, and retention.  If you need assistance, visit Caregiver Quality Assurance (TM) for resources to help you grow your business. 

To learn more about Stephen Tweed and Leading Home Care, or to sign up for publications like Private Duty Today or Caregiver Quality Today, please visit the Leading Home Care website, or click on the banner below:

Leading Home Care

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.

Topics: Starting a Home Care Business, Home Care Industry, Elderly Care, Home Care Best Practices, Care Coordination, Home Care, Home Care Blogs

Will You Survive All The Home Health Changes?

Posted by Will Hicklen on Sep 18, 2012 8:00:00 AM

As readers of Ankota's blog will attest, we're not above borrowing a good article from someone else when we see it. We'll share it with the world if we like it. This post is an refreshing reminder about dealing with change, and who fares well through change. 

Dr John Baker Baker Rehab Group

"The Mind of John Baker" is a blog published by Dr. John Baker, of Baker Rehab Group. It is just coincidence that Baker Rehab is based in Frederick, Maryland, which is only about an hour west of Ankota's Baltimore headquarters. Maybe one day our paths will cross, but for now I'll share Dr. Baker's observation about the pace of change in home health health therapy, knowing that it applies to most Ankota customers, including the many home health therapy agencies and other providers of post-acute care, hospitals and ACOs that use Ankota's software. 

Baker Rehab logo

From The Mind of John Baker, "Will We Survive the Home Health Changes?" :

I recently had a conversation with a therapist who was frustrated and worn out from all the changes that occur in home health and was thinking about switching to an outpatient clinic-based or skilled nursing facility environment for “consistency and ease of mind.”

We discussed the recent reassessment requirement, cuts in reimbursement, and increased documentation requirements that are occurring in home health. I tried to help her see this is just one component of a universal “sea change” that is in the early phases and is by no way unique to home health. It is occurring throughout the industry. How we deliver and “do healthcare now” will be very different from how we will deliver it in 5-7 years from now. Change is inevitable.

Theologians and psychologists alike will all tell us that “how we approach change” will often determine how successful we will be in adapting to the new healthcare system beginning to emerge.

I was reading a Parkinson’s study that correlated the clinical outcomes with attitude and willingness to accept change. As one might expect, those patients who approached change with a positive attitude had better clinical outcomes and lower stress levels.

What a great reminder for the importance of being willing to adapt to change in our own profession.


About John Baker 

John Baker is the CEO of Baker Rehab Group, formerly HomeCare Rehab and Nursing as well as the chairman of the Maryland Physical Therapy Board of Examiners. In addition to owning Baker Rehab Group, he has been a physical therapist for more than 20 years and holds professional degrees including a doctorate of science in physical therapy. Read John's blog The Mind of John Baker  

Topics: Home Care Best Practices, Health Care Reform, Will Hicklen, Care Transitions, Physical Therapy software, ACO

Hospitals Look to Home Care In Cutting Patient Readmissions

Posted by Ken Accardi on Sep 17, 2012 8:21:00 AM

The following article appeared in Home Health Care News at this link.  We're reproducing it in its entirety for our readers, because it perfectly exemplifies the opportunity for Home Care to make a difference in lowering the cost of care in America and increasing the profits of hospitals in your communities.  It's a win win and we hope that you're taking advantage of it.

Hospitals Look to Home Care In Cutting Patient Readmissions

by  on AUGUST 23, 2012 in MEDICARENEWS


Medicare will begin penalizing 2,211 hospitals in October for having too many counts of patient readmissions, and some hospitals are looking to home health care as a solution to the readmission problem. 

Severity of the Medicare penalties is based on the number of the readmissions for Medicare heart failure, heart attack and pneumonia patients between July 2008 and June 2011. While the maximum penalty  a hospital can receive is 1% per submitted claim, 1,933  hospitals will experience sub-maximum penalties, according to analysis of Medicare data conducted by Kaiser Health News. 

Medicare plans to continue penalizing hospitals for unacceptable numbers of readmissions by increasing the maximum percentage of claims reimbursements it will penalize to 3% by 2014, according to the rule

Home Health Care News

In published comments by hospitals across the country, some believe Medicare is enforcing too much oversight in the penalties. Other hospitals, however, are taking the opportunity to smooth the transition between hospital and home care.

“We are looking at better handoffs to home care, skilled nursing facilities, better discharge preparation of patient families and using home care as an avenue to really track them. Because it’s the right thing to do, truly,” Coy Smith, vice president for patient-care services and chief nursing officer of Delaware’s St Francis Hospital told WHHY News

Home care agencies can help in preventing hospital readmissions, told Kelly Court, chief quality officer at the Wisconsin Hospital Association to Wisconsin Public Radio’s Shamane Mills. 

“Hospitals can only do so much to prevent the readmission, like [making] sure patients understand their discharge instructions, understand their medications, make a good transition to a physician after the patient leaves the hospital,” Court told Mills. 

One of the ways that Ankota differentiates ourselves from other home care software companies is through our ability to enable care coordination.  To learn more, please contact us via this button.

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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.

Topics: Home Care Entrepreneurship, Home Care Best Practices, Health Care Reform, Care Coordination, transitional care, Avoidable Readmissions

Will HMEs Survive Competitive Bidding?

Posted by Will Hicklen on Sep 13, 2012 3:02:00 PM

Are HMEs surviving competitive bidding? Funny you'd ask...As Theresa Flaherty's September 7th piece in HME News shows, more than 450 HME providers have closed locations, sold their businesses or gone out of business due to the program. Further, VGM estimates that more than 100,000 jobs will be lost. Download the VGM report here

Subcommittee Scrutinzes Competitive Bidding Program 

HME News Competitive Bidding

from HME News, September 7, 2012

Theresa Flaherty Photo

WASHINGTON – When industry stakeholders give testimony during a congressional hearing tomorrow, one of the things they plan to do is paint the competitive bidding program as a job killer.

Stakeholders are scheduled to testify at a hearing titled "Medicare's Durable Medical Equipment Competitive Bidding Program: How are Small Suppliers Faring?" before the House Small Business Subcommittee on Healthcare and Technology.

"Lawmakers want to know what the impact is on small businesses," said John Gallagher, vice president of government relations for The VGM Group.

VGM has commissioned several studies on the economic impact of competitive bidding, and AAHomecare in July provided the House Ways and Means Committee with a list of more than 450 HME providers who have closed locations, sold their businesses or gone out of business due to the program.

Boosting the industry's message: a weak jobs report, released last week by the Labor Department, that showed U.S. employers added only 96,000 jobs last month—far less then anticipated. That means preserving the jobs of providers and their employees—rather then forcing them out of business—will be front of mind for lawmakers at the hearing.

"We are trying to make sure they've got our reports on jobs," said Gallagher. "And we want them to ask CMS, 'What is the impact of this and what are the jobs that are going to be impacted?'"

With lawmakers returning to the Hill this week, stakeholders say the hearing will provide momentum to move the market-pricing program (MPP) forward. In August, Rep. Tom Price, R-Ga., agreed to introduce a bill for MPP.

"Everybody understands the issue, now it's just a matter of keeping it in the forefront," said Joel Marx, chairman of AAHomecare chairman and Cleveland-based Medical Service Co.

Scheduled to testify at the hearing: Laurence Wilson, director of the Chronic Care Policy Group for CMS; Peter Cramton, an economics professor and critic of the bidding program as currently designed; Tammy Zelenko, president/CEO of Bridgeville, Pa.-based Advacare Home Services, who will testify on behalf of AAHomecare; and Randy Mire, owner of Reserve, La.-based Gem Drugs, who will testify on behalf of the National Community Pharmacists Association.

click here for the full article on HME News


Related article Home Care Magazine "Bidding Will Cost Jobs"

Home Care Competitive Bidding 




Topics: Competitive Bidding, Health Care Reform, transitional care, HME, DME, Will Hicklen

Home Care Alert! Surviving An Audit

Posted by Will Hicklen on Sep 12, 2012 2:59:00 PM

When faced with an audit, documentation and technology can save the day

Health care providers of all types face increasing scrutiny from public and private payers alike to operate in a totally above-board, compliant fashion. Simply doing things the right way is no longer enough, you have to prove that you are compliant, and have systems and processes in place to assure that you will continue to operate that way with every patient, every day.   

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This helpful piece, written by Wayne van Halem, CFE, AHFI, President of The van Halem Group, LLC, originally ran in Home Care Magazine and is intended to help HME providers to better prepare for and respond to Medicare audits. The lessons are applicable to many of Ankota's customers and are definitely not limited to just HME companies (or CMS), so we decided to share it here on the Ankota blog. Whether you are an HME, a home health agency, a physical therapy providerer, infusion nursing, or even non-medical private duty home care -- read on!

If you are a hospital or Accountable Care Organization (ACO), or involved in Care Transitions Initiatives, then you should also read on. You should anticipate that your organization will become increasingly responsible for the care and services that take place outside of the hospital--whether by your organization or one to which you refer or subcontract services. As more care is delivered outside of hospital settings, hospitals and ACOs need to take steps to assure that 3rd party providers follow the rules. 

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From Surviving an Audit, Home Care Magazine
Insufficient Documentation

The biggest problem concerning audits, without question, is physician documentation being deemed insufficient. Recent changes to the Medicare Program Integrity Manual, which guides audit contractors, have reflected what we are noticing in these audits. The Centers for Medicare & Medicaid Services (CMS) wants to see that the physician documentation specifically addresses the criteria listed in the Indications and Limitations of Coverage section of the Local Coverage Determinations, and that it is documented in their notes as well as in the normal format that they document their own services. This seems reasonable, in theory, except for the fact that CMS does not fund the DME MACs to educate physicians and the Part B MACs are not funded to educate physicians on DME policies. So physicians do not know what they are supposed to document—it’s up to you to educate them.

While it may not be feasible to request documentation up front in all instances, CMS and its contractors seem to believe it is. I’m not sure what to do to resolve that issue, but what I can recommend are some ways to encourage cooperation from physicians by touting the term “compliance.” It’s not an option for physicians to comply, it’s the law. Unfortunately, CMS has put the responsibility on you to educate the physicians, and there has been little—if any—liability placed on physicians who do not comply.

Recently, however, we have seen an increase in additional documentation requests (ADRs) because contractors are auditing the physicians, so perhaps they will be more aware and willing to cooperate. We must come together and hold physicians accountable, so begin educating your physicians of their legal obligation. It’s not your requirement that you provide documentation, it’s Medicare’s requirement, and in order for you to be in compliance with federal regulations you need the documentation. As a result, the physicians may become the target of an audit because their documentation is not being deemed sufficient, so why not work with a company that is taking the extra effort to be compliant? It’s a great marketing tool in an environment of intense regulatory oversight that is now affecting other health-care providers, including physicians.

Patient Accountability

Another important topic to address is holding your patients more accountable. If you get the patients involved in their treatment and care, and educate them under what circumstances Medicare will cover the equipment that was ordered for them, it helps them understand what is needed to get their claim reimbursed accordingly so they are not liable. If you explain to patients that their physician has failed to comply with the request for documentation, and as a result they may be responsible for payment of the services, they will naturally be motivated to contact their physician.

While most physicians may not be concerned over your claims getting paid, they would likely be concerned if the patients call to complain. A successful practice must keep their patients content. While I advocate for the use of Advance Beneficiary Notices (ABNs), I also think it is extremely important that you fully explain the document to the patients so they understand what they are signing. The form should be specific and unique to that patient’s situation. It’s a fine line the provider must walk between alienating referral sources and patients, but both of these groups must take an active role in the care you provide. 

In my opinion, I think suppliers should develop a process to request documentation for each patient knowing that you won’t always get a response. However, it’s an opportunity to educate your physicians on what the coverage policies are. We recommend drafting cover letters to use when faxing orders to be signed by physicians that explain under what circumstances the items are reimbursed by Medicare, as well as the documentation requirements. Explain that the patients’ progress notes must support that the criteria are met or coverage can be denied and the patient may be held liable for payment. Ask them to review, sign and date the attached order and return it with the most recent progress note which supports that your patient meets the criteria for coverage. While they may not send the progress note in return, they may take notice of what needs to be documented. By asking for the most recent progress note, you are alerting them to the fact that you’re not asking for hundreds of pages of records and they may be more willing to comply. The more often they get the letter, the more quickly it may sink in. It certainly increases your chances above not requesting anything at all, and it’s worth the minor extra effort if they do comply. Of course, following up if they don’t respond is highly recommended, as well.

Quality, Not Quantity

Many providers think that the more records they send in, the higher the likelihood the claim will be approved. There is just no truth to that, and it’s really quite the contrary. Patients’ conditions may worsen, but the physician may not adequately document it in their records. Therefore, sending in additional records may raise concerns with the reviewer that the patient does not qualify for coverage, when they do indeed.

Additionally, the reviewers at Medicare have strict timelines and performance standards related to their workload that must be met. They could be reviewing thousands of pages of records each day. The more records that you send in, the harder it is for the reviewer to find the necessary elements in order to approve the claims. Be precise and simple in your documentation requests, and try to automate the process as much as possible to manage the workload associated with doing so. If your system allows you to export intake data to Excel, it could be as simple as performing a mail merge to complete cover letters.

Some providers have created forms to document medical necessity, or have added this information to their orders. However, if you have this information on your order, Medicare is clear that the order is not part of the “clinical record” for purposes of an audit. Therefore, under no circumstances would a claim in which this is the only supporting documentation get approved upon initial review. There is a similar issue with forms. Unless it is a CMS-approved form required by policy—such as a Certificate of Medical Necessity or a Statement of Certifying Physician—an auditor would not consider it as part of their review. The supporting documentation must be present in the clinical record and in the normal format that the practitioner uses in documenting their notes. If you are relying solely on forms, then the physician completes the form and assumes that their work is done. This actually makes it less likely that the physician will document the need for the equipment in the notes.

The Meaning of Modifiers

The last—but probably most important—item that I want to discuss is the KX modifier. I believe the government is building this up as a tool to implement false claim violations. Recently, and often, the “meaning” of these modifiers has been revised and changed in various policies. In some instances the KX modifier added to a claim indicates that the supplier has clinical notes in their possession supporting that criteria for coverage has been met. Yes, some policies now have a mandatory documentation requirement. If you add the modifier indicating this and you get audited, and if they determine you don’t have it, you’ve potentially submitted a false claim, which carries significant monetary penalties. I cannot stress enough the importance of knowing and understanding the specific meaning of this modifier for all the products you bill that require it.

Too many times I’ve asked billing staff why they added the KX modifier when conducting our compliance assessments, and the response was that it will not be paid without it. While this is true, that is not why it is added to the claim, and there is a significant amount of risk associated with this modifier for our industry. I’m afraid that in the future, auditors and investigators will target suppliers using this modifier. In fact, for the second year in a row the improper use of modifiers has been identified as an issue in the Office of Inspector General Workplan. Suppliers should take heed of this advice in order to avoid future issues. 

Good Business

As I’ve previously stated, documentation is your only defense in an audit. You must come up with innovative and streamlined processes to obtain as much documentation as possible, and review it before putting it in your files. Conduct risk assessments with your referral sources to determine which physicians are not cooperating, which need more education, and which ones seem to understand. You can then decide which ones you no longer want to do business with, and which you may feel comfortable can provide you with the necessary documentation if you choose to not request it every time for every claim.

Don’t accept liability without holding those other interested parties more accountable. Stated simply, it’s just a sound business decision.

Physician, Heal Thyself!

Lack of physician documentation complicates audits. Here are some points you should make to the physicians in your referral network:

  • CMS doesn’t fund physician education, so it’s up to you to educate them. Help physicians understand the challenges you face and ask for their help.
  • Encourage cooperation from physicians by touting the term “compliance.” It’s not an option for physicians to comply, it’s the law.
  • Emphasize that it’s not your requirement to provide documentation, but Medicare’s, and in order for you to be in compliance you need the documentation.
  • Physicians may become the target of an audit when their documentation isn’t deemed sufficient, so market yourself as a company that will help them to comply.
  • Point out that the current environment of intense regulatory oversight is affecting a wide variety of health-care providers, including physicians.
About the author:

Wayne H. van Halem, CFE, AHFI, is president of The van Halem Group, LLC, which is based in Atlanta. He can be reached at 404-343-1815 or wayne@vanhalemgroup.com. Visit online at www.vanhalemgroup.com.

Topics: HME, DME, Will Hicklen, Home Care, Accountable Care Organizations, ACO, ACO Technology

Best Practices for Managing Dementia/Alzheimer's in Home Care

Posted by Ken Accardi on Sep 11, 2012 4:00:00 PM

I read a piece this morning by a pastor named Anthony Robinson about his experienceAnthony B Robinson with his mom's dementia, and it reminded me that home care workers visit daily with people dealing with memory issues.  Here's the anecdote:

My wife and I were nervous about my 94-year-old mother's impending visit to the family cabin this summer. We had spent the weeks before she came remodeling, adding a new bathroom to the nearly 100-year-old structure built by my own grandparents. When my parents were the stewards of the cabin their policy had been to maintain the place as a kind of living museum. No changes.

The first time we steered her to the new bathroom, we held our breath. Pushing her walker across the threshold, she stopped, looked around, then said, "This is nice. This is really very nice." (Because she has short-term memory loss, each subsequent time she used the new bathroom was also the 'first' time, and every time she said, "This is very nice.")

On my mother's last day, we again steered her to the "new bathroom." "We have a new bathroom?" she asked. My wife said, "Well, next year it won't be the 'new' bathroom any longer." My mother stopped, looked up, and with sudden full clarity - and a wry smile - said, "Oh yes, it will be the 'new' bathroom for a very long time."

I learned a lot about Alzheimer's care in a lecture by Dr. Verna Benner Carson whoDr. Verna Benner Carson teaches people how to become an Alzheimer's Whisperer.  Here are five tips that your caregivers can use to better deal with Alzheimer's and other forms of dementia:

  1. Don't Quiz, Argue or Reason
  2. If at first you don't succeed, wait five minutes*
  3. To combat repetition, find a "job" for the person you're caring for (such as folding towels or building with Legos(r))
  4. If a loved one complains "My mom didn't have breakfast", or "Nobody has been in to see my dad today", calmly explain that that "Your mom/dad can't remember, and fill them in"*
  5. Old photo albums and songs from the past are likely to connect with the patient because long-term memory lasts the longest.

*Note: Alzheimer's sufferers generally have less than 5 minutes of short-term memory, so if for example you propose a shower and get a negative response, rather than forcing the issue, you might instead wait 5 minutes and try an approach like "let's go for a nice walk but get cleaned up first."

Do you have any other tips you can share for managing Alzheimer's and other forms of dementia in the home care setting?

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.

Topics: Alzheimer's, dementia, Elderly Care, Home Care

What Home Care Employees Need the Most

Posted by Ken Accardi on Sep 5, 2012 1:31:00 PM

Veteran employers will tell you that no matter what industry you work in, pay is a strong motivator. It is the reason most people work in the first place, but is it the only rationale behind building a career? No, as critical as fair wage is in the world of home care, there are other considerations, as well. Jeff Haden explains some of the responsibilities employers have to their workforce in this piece for Inc. titled “8 Things Your Employees Need Most.”


Everyone needs a reason. When it comes to home care, the mission is in the service. It is an industry like no other, distinctive in its requirements. Remind them they are a piece of a larger purpose.

All industries benefit from adding a mission statement to define the reason for the job. Working in home care means others rely on the service, so the mission is a unique one. Part of the development process is letting the employees choose what the mission means to them. After all, it is about motivation, so it is their thought process that matters. You might takeCaregiving in Home Care suggestions and let them vote on one statement, for example. After selecting a mission, use it as a mantra.


Give them clear guidance and the tools to succeed in the job. Training is a critical part of expectation. Home care has standards and regulations meant to protect both the employee and client. Education for employees should be vigorous. With proper training, home care employees go into the workplace understanding exactly what is required of them. They will have a toolbox of skills that helps them meet those goals. When you set criterion and provide concise training, everyone wins. Use continuing education to improve the quality and adjust to changes.


Job security and the possibility of moving up is a promise you can give employees. Reward good service through internal promotions and pay increases to bolster morale. When the time comes to select a new field supervisor or another management position, give the employees the first bite at the apple.

Keep work reviews productive. You can find something good to say about each employee. Take the opportunity to point out what they do right in the job. This is the time to make suggestions on ways to improve, as well. Balancing the evaluation with positive reinforcement will promote a sense of job security. When they see you appreciate good skills and service, they will work harder to earn your favor.

Home care is about giving. Your employees give to their clients every day. You need to give them appreciation for that effort. Respecting them as part of a team will grow your business and lead to a long-lasting partnership. Find out more about giving back in business by reading the full article here. We look forward to hearing your comments.

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.

Topics: Home Care Best Practices, Home Care, Leadership

Storm Watch: Managing Care Transitions & Home Care In A Storm

Posted by Will Hicklen on Sep 4, 2012 1:24:00 PM

Storms threaten the delivery of healthcare services, but a little planning and some good technology can help hospitals, ACOs and post acute providers of all types.

In the mid Atlantic, we've just entered hurricane season and many of Ankota's customers are still cleaning up the mess from Isaac in the Gulf region. Tropical Storm Leslie is gaining momentum in the Atlantic as we speak, and the next storm, Michael, has also just formed behind her. Once we emerge from hurricane season in November, much of the country will face the snowy winter months and the risk to care continuity that presents. Then, tornadoes of spring and the extreme heat of summer... and so on. Storm Happens.

Managing Home Care in a Storm

Click here to see 15 cool images of Hurricane Isaac

One of the most read articles ever on Ankota's blog discussed ways to better manage home care when catastrophes hit. "Managing Home Care in a Strom," was originally written by Ankota's CTO, Ken Accardi, and the same lessons apply to hospitals, ACOs and post-acute providers that provide services including DME delivery, Physical Therapy, Infusion Nursing, and more. 

What is your strategy

The challenges of delivering care outside of hospitals on any kind of mobile basis are exacerbated when weather disrupts operations, as we just witnessed again with Hurricane Isaac. How are patients prioritized and rescheduled? Which ones require critical care regardless of the weather? Which ones can wait? Which care plans are affected? How do you communicate changes in schedules and care plans with staff, patients, family, and support networks? Hospitals, ACOs, and post acute care providers of all types must implement strategies to deal with weather-related emergencies and utilize technology that enables care, rather than inhibits it. Dangerous and life threatening conditions can be avoided with some simple planning. 

From Managing Home Care in a Storm: 

Here are some best practices that we've observed home care organizations follow to manage their operations in the midst of a snow emergency (and some things that Ankota's software does to help):

  • Move Appointments to Avoid the Times when travel is most inhibited: Ankota's scheduling board (screenshot below) shows you all of the planned jobs for the week on a drag and drop interface. so moving jobs forward or back is simple.

  • Make Sure that the jobs with critical timing are dealt with at the appropriate time:  Visits such as "chemo finish" visits for a 48-hour chemo infusion have a very specific time frame for completion.  Ankota's scheduling board let's you know if you've by attempting to move a visit you've violated a scheduling constraint. 

  • Communicate the Changes to the Care-Givers:  Ankota's software changes the visits to a different color when you manually reschedule, allowing you to tell your care workers what changed and what stayed the same.

  • Plan for Two people per car (in the event that it will be impossible to park and one person will need to hover): Although the Ankota software doesn't specifically have a feature for scheduling two people in the same vehicle, we have the ability to change the work shifts easily for the emergency workers and mark the others as unavailable (and to make sure that all of the time sheets come out right).

  • Keep non-essential personnel at home: Ankota's web-based software allows your office staff to operate from their home via their internet connection.

  • Communicate to the Loved-Ones of Your Patients: Ankota's FamilyConnect allows you to send a message out to family members of the people you care for.  By proactively sending a message to all of the families, you can save time for your critical staff.  Also, you can send messages to the families of individual patients/clients using the quick connect feature.  FamilyConnect messages are received by email and/or text message (as selected by the family member)

Below is a screen shot of the Ankota Drag and Drop Schedule Board that allows you to see status and resolve issues at a glance.

Home Care Scheduling Software

We thank you for all you do to provide outstanding home care, even during the thoughest conditions!  If rescheduling was tougher for you than what's described above, please contact us so we can try to help.

Ankota provides software to improve the delivery of care outside the hospital.  Today Ankota services hospitals, ACOs, 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 contact Ankota by clicking on this cool orange button!

How do you mamage risk during storms? We'd love to hear from you in the comments section below.

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Topics: Geriatric Care Management, HME Delivery Operations, Home Health Aide Software, Home Care Best Practices, Care Coordination, transitional care, Home Care Technology, Will Hicklen, Care Transitions, Home Care Scheduling Software, ACO Technology

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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 www.ankota.com or contact Ankota.

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