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Ankota: Ushering in the Next Generation of Homecare Blog

Compliance and the Business Associate Agreement under HITECH

Posted by Will Hicklen on Feb 28, 2013 1:40:00 PM

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I'm amazed at the number of healthcare organizations that are completely unaware of the Business Associate Agreement under HITECH. Of those that are aware of the document, further confusion exists as to whether they are required to execute one. Here are some resources to help you determine quickly whether this requirement applies, but you should err on the side of putting one in place with your business partners. They are simple and easy to use and there is nothing objectionable about the terms so long as you and your partners intend to do business the right way.

Here is a brief description of the BAA from from TechTarget and a video from legal experts on the matter below: Under the U.S. Health Insurance Portability and Accountability Act of 1996, a HIPAA business associate agreement (BAA) is a contract between a HIPAA covered entity and a HIPAA business associate (BA). The contract protects personal health information (PHI) in accordance with HIPAA guidelines.


Effective Feb. 18, 2010 in accordance with the HITECH Act of 2009, a BA's disclosure, handling and use of PHI must comply with HIPAA Security Rule and HIPAA Privacy Rule mandates. Under the HITECH Act, any HIPAA business associate that serves a health care provider or institution is now subject to audits by the Office for Civil Rights (OCR) within theDepartment of Health and Human Services and can be held accountable for a data breachand penalized for noncompliance.

With these new regulations in mind, a HIPAA business associate agreement should explicitly spell out how a BA will report and respond to a data breach, including data breaches that are caused by a business associate's subcontractors. In addition, HIPAA business associate agreements should require a BA to demonstrate how it will respond to an OCR investigation.

Attorneys Carlos Leyva and Mayra Scheuermann have developed a HIPAA/HITECH Survival Giude, which includes educational resources, model contracts, and a sample Business Associate agreement. Ankota does not endorse this package, but this is a good resource to learn from and the package looks to solve the problems that many of Ankota's readers face.

Topics: HIPAA compliance, Business Associate Agreement, Will Hicklen, Video

5 Things I Didn't Learn in Physical Therapy School

Posted by Will Hicklen on Feb 27, 2013 8:30:00 AM

This piece was suggested to Ankota by a therapy customer and we thought our other therapy customers might appreciate seeing it. We've run other pieces from PutMeBackTogether.com and recommend the site for our therapy customers.

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As always, click on any of the blue buttons to learn more about Ankota's TherapEZ solution for Therapy agenices. TherapEZ is an affordable solution that make agency operations entirely electronic, allowing the use of tablets at the point of care, handling complex scheduling requirements, automating billing and payroll, and even integrating your agency with referral sources and Accountable Care models in your area.

Learn How Ankota Helps Therapy Agencies

By: Erson Religioso III

Not anything and everything is taught in school. It is only when we are exposed to the outside world when we realize a lot of things. There are many facets of being a health care provider that they do not cover in physical therapy school or even when taking up the best courses.

Here are five important things I did not learn in school or courses:

  1. Provocation Tests Actually "Provoke"
    We are taught to use tests like Neer's, Patellar Grind, etc. It's sad that physical therapy students are still required to know a battery of tests that even the texts say have little sensitivity and/or specificity. They have to know them for the licensure exam and to communicate with clinical instructors and other clinicians who insist on getting information from something like cervical compression.

    With what we know about modern pain science, we should try our best not to provoke our patient's complaints as much as possible. These patients are already anxious and possibly close to being centrally sensitized. I saw a young black belt who had excellent outcomes with his shoulder. He returned a year later for acute lumbar pain with a lateral shift. Upon explaining possible causes, being as vague as possible, his eyes widened, he became anxious and asked to be referred to all kinds of specialists. He even volunteered at our clinic for several months and knew how we emphasized conservative Tx, HEP, etc. These cases are specific to individuals and different areas on the same individual. Our choice of words may provoke, much less sensitizing movements or tests.

    One of the biggest parts of MDT, the repeated motion exam can do this. If a patient tells me that bending, sitting, and squatting hurts them, it's probably not a great idea to test flexion in standing and lying repeatedly. I try and just check the motions that more than likely are going to be their directional preference.

    Learn How Ankota Helps Therapy Agencies
  2. Patients are Consumers

    therapy practiceYou may be the expert but you're also a salesperson for you, your therapy practice, your profession, and the approach you are using. The interaction from the first phone call, to the website, and with everyone in the clinic will make a difference on a patient’s outcomes and whether or not they are likely to refer you their family and friends.

    We have an unwritten rule in our practice: say hello to everyone, especially if they are not your patients, and it's the same thing with good bye. When a patient tells me “thank you” at the end of the visit, I tell them "Thank you!" not "You're welcome."

  3. Patient Positive Expectation of a Treatment is Important
    One of my favorite recent research articles to be published recently is the Cervical Thrust CPR by @aussielouie. It is very simple and takes into account patient's positive expectation of a treatment. As an MDT practitioner, I do try to talk patients out of repeated passive treatments like maintenance adjustments. However, if they are hell-bent on getting a manipulation, and think they're going to benefit from it, I do a thrust manip. I then teach them cause and effect, loading and unloading strategies based on their DP and make them responsible for their symptoms.

  4. The HEP is Everything
    You think of the home exercise programs in physical therapy school as simple stretches or strengthening exercises. In reality, because of the transient nature of the treatment we perform in the clinic, the HEP is what helps lock in part of those changes. Making cortical changes in movement tolerance, pain thresholds, decreasing perceived threat, and redefining smudged virtual somatic representations takes both time and repetition. The time we spend in the clinic with our patients is so little compared to them being on their own. Even seeing a patient daily would not be enough. This message is one of the most important you can tell a patient from day one and shortly into evaluation and treatment.

    Learn How Ankota Helps Therapy Agencies
  5. The Only Rule is That There are No Rules!
    Bonus points for those who can identify that cheesy quote from one of my favorite 90s martial arts movies without Googling it!

    What works for one patient may not work for another with exactly the same subjective complaints and objective measures. My most personal example is not being able to treat myself or respond to treatment by my business partner for my own DeQuervain's-like issues. What worked on most thumb and radial neurodynamic dysfunction only worsened my complaints. I ended up coming up with a novel and easy strategy of repeated wrist flexion with radial deviation since that has also helped a patient I thought only had radiating cervical issues into her wrist.

What are some of the things you wish they had taught in physical therapy school? Share them with us!

Visit Dr. Religioso at www.themanualtherapist.com.

Click here for more information on Dr. Erson Religioso III.

Topics: Care Coordination, Will Hicklen, Home Therapy, Physical Therapy software

Care Transitions Program Reduces Costs and Hospital Stays

Posted by Will Hicklen on Feb 26, 2013 1:01:00 PM

How changes in Washington University's Medicare coordinated care demonstration pilot ultimately achieved savings. 

by J. Hunter Young, MD, MHS 

Dr. Young is Ankota's Chief Medical Officer, and serves jointly as Assistant Professor of Medicine at the Welch Center for Prevention, Epidemiology, and Clinical Research, and Core Faculty of Johns Hopkins Bloomberg School of Public Health. In these roles, Dr. Young is involved in population health programs and community based initiatives that are aimed at decreasing readmissions and lowering the overall cost of care. Managing Care Transitions has emerged as a critical element in reducing avoidable readmissions and lowering overall costs, and health care providers are looking for information to guide them in the creation of these programs. 

 Learn How Ankota Technology Reduces Readmissions

Health Affairs Cover

Last week, we reviewed the lessons learned from Medicare’s Coordinated Care Demonstration Programs. Those programs that were most effective in controlling costs emphasized face-to-face interactions between the patient and care coordinator and between the care coordinator and the physician, focused on medication management, included behavior change interventions, and facilitated communication among all the providers. 

This week, we will focus on one of the 15 programs, Washington University’s pilot care management program, as reviewed by Peikes and colleagues in a Health Affairs article published in 2012. The importance of effective program design could not be any more clear in this example. The opportunity for post acute providers like home health, therapy, and DME companies is tremendous in these rapidly emerging models. 

Key lessons from the Washington University program include

WashU program design

The health care expenditures in the Washington University program actually increased by 12% during the program’s first 4 years.1 This result is not unlike those experienced by many care management programs underlying the point that it’s hard to save money by spending money. it requires efficient program design to accomplish the desired savings.

Fortunately for Washington University, and for us, the story did not end at 4 years. When Washington University’s program was extended in 2006, their telephonic care management vendor stopped participating to focus on other programs. In response, Washington University expanded and modified the component of their program employing local case managers. In addition, they added ancillary staff including a licensed clinical social worker and care manager assistants. The care coordinators focused on the sickest patients, strengthened their transitional care and medication reconciliation processes, and supplemented frequent phone contacts with occasional in-person visits. They also redesigned their care plans to more closely focus on key conditions and to more clearly guide clinical interventions. Finally, they standardized the assessment process to eliminate assessment gaps and increased supervision to ensure periodic patient contact per established protocols.

Learn How Ankota Technology Reduces Readmissions

The results were remarkable given the program’s previous increase in costs. The redesign resulted in a 12% reduction in hospitalizations and a decrease in monthly Medicare expenditures of $217 per member. This success emphasizes the importance of several characteristics to effective care management programs. First, all health care is local and depends on building trusting relationships with patients. Second, care transitions and a focus on sick patients provide the opportunity to lower costs. Third, standardization, clearly defined goals, and close operational supervision are essential for an effective and efficient care management process. Finally, medication reconciliation is an essential element of effective care management programs.

The program's abstract provides a good summary, "The results underscore findings from the overall Medicare Coordinated Care Demonstration that suggest that programs with more in-person contacts were more likely than others to build trusting relationships with patients and providers, improve patient adherence to care plans, and address additional needs and barriers that entirely telephonic contacts had been unable to identify. The results also indicate that programs can be more effective by focusing on the highest-risk patients, for whom the largest savings resulted."

This presents numerous opportunities for post acute providers, which are playing increasing roles in such programs. Hospitals and ACOs do not have sufficient staff or expertise to manage these outbound and highly mobile care delivery models, nor do they have the systems to manage them. Many are already expanding case management functions to lead care for patients following discharge, but will increasingly need to leverage existing channels such as home health, physical therapy and DME providers to be effective. New software systems are required to coordinate roles and dependencies, manage complex schedules and track services while assuring that protocols are followed consistently. Ankota's Healthcare Delivery Management platform manages these models effectively today and assures that programs deliver on the promise of better care at lower overal costs, and can scale approppriately. Contact Ankota using any of the blue buttons to learn more.

Ankota Technology to Manage Transitions of Care


1.         Peikes D, Peterson G, Brown RS, Graff S, Lynch JP. How changes in Washington University's Medicare coordinated care demonstration pilot ultimately achieved savings. Health Aff (Millwood). Jun 2012;31(6):1216-1226.



Topics: Care Coordination, transitional care, Dr. J. Hunter Young, Care Transitions, Avoidable Readmissions, ACO

Pharmacists and Hospitals Partner to Reduce Readmissions

Posted by Will Hicklen on Feb 20, 2013 9:18:00 AM

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The following NPR story hits right at the heart of the avoidable readmissions problem our country faces, which is widely accepted as a cost and quality problem. As this broadcast discusses, hospitals are partnering with Pharmacists to suppport patients and reduce readmissions after discharge, a problem that amounts to a $17 BILLION cost for CMS, the largest payor of health care services in the country. Ankota's technology is used to connect providers and allow them to coordinate care to reduce readmissions and lower overall health care costs. Readmissions has emerged as a central issue in the era of healthcare reform and accountable care, and Ankota is leading the way with technology to enable care delivery models to solve these problems. 

The complete broadcast is available for download or to listen to by clicking below

NPR listenAbout 1 in 5 Medicare patients who leave the hospital come back within 30 days. Those return trips cost U.S. taxpayers a lot of money — more than $17 billion a year.

In October, the federal government started cracking down on hospitals, penalizing them if too many of their patients bounce back.

Learn How Ankota Technology Reduces Readmissions

That has some hospitals going to the corner drugstore for help managing the care of patients like Dorothy Irene Tucker. She is a cheerful 73-year-old who's about to be discharged fromWashington Adventist Hospital just outside of Washington, D.C.

She says they don't let you sleep much in the hospital. "To draw the blood, they would come in, like, twice before morning," Tucker says.

It's pretty common for patients to leave the hospital sleep-deprived. Many haven't been eating regularly, and lots of them are still coming to terms with whatever event landed them in the hospital in the first place.

It's also common for people in this bewildered state to be handed a bunch of prescriptions upon discharge. Tucker takes pride in being able to manage all the different drugs she takes. But it's a long list, and even she isn't sure exactly what she's supposed to be taking once she gets home.

"I was on a lot of medications — it was, I think, all together 23 bottles. Twenty-three bottles! So they might cut me back when I go home," she says.

Patients like Tucker could use some help keeping all those drugs coordinated, and so could the hospital. So Washington Adventist is matching her up with a local pharmacist from Walgreens, the drugstore chain.

That's a new service run by Walgreens to connect patients with pharmacists who act as coaches.

Dr. Jeffrey Kang, a vice president at Walgreens, describes the new role as "our grandfather's Walgreens on steroids." Walgreens is now contracting with hospitals to eliminate conflicting prescriptions on discharge, and then the pharmacy will check back with patients to make sure they understand all their medications and take them properly when they get home.

It's a new expense for hospitals, but it can make sense. If too many patients return to the hospital within 30 days of being discharged, Medicare cuts their payments. Health care researcher Dr. Jane Brock, of the Colorado Foundation for Medical Care in Englewood, says medication errors can be a big factor in whether a patient lands back in the hospital.

Learn How Ankota Technology Reduces Readmissions

"We know that people who have medication discrepancies, or are not adhering to what the health care team thought they were adhering to, have at least double the risk of becoming a readmission," she says.

Washington Adventist Hospital's Dr. Randall Wagner says his hospital was one of the first to contract with Walgreens this way.

Wagner says he's happy with the results so far. It's harder for hospitals to monitor discharged patient medications on their own than it might sound, and a lot easier to just plug in to an experienced pharmacy.

"The infrastructure of doing these callback programs is not merely that there's a telephone and someone who can dial it," Wagner explains. "It involves creating a database, creating a group of people who can call, and if the patient doesn't answer the phone, there's someone else who can call back. There's a handoff of information between the inpatient side and the outpatient side."

Research shows that having a pharmacist follow up with recently discharged patients reduces the likelihood that they'll get worse at home and have to come back.

Dorothy Tucker returned home with three fewer medications to keep track of than when she was admitted. She says she looks forward to working with the pharmacy so she can learn her new regimen.

This story is part of a partnership between NPR, Colorado Public Radio and Kaiser Health News.


Learn How Ankota Technology Reduces Readmissions

Topics: Readmissions, Health Care Reform, Care Coordination, transitional care, Avoidable Readmissions

6 Steps to Reducing Readmissions with Care Coordination

Posted by Will Hicklen on Feb 18, 2013 11:44:00 AM

 Johns Hopkins Medicine logo

JH Shool of Public Health logo

by J. Hunter Young, MD, MHS

Dr. Young is Ankota's Chief Medical Officer, and serves jointly as Assistant Professor of Medicine at the Welch Center for Prevention, Epidemiology, and Clinical Research, and Core Faculty of Johns Hopkins Bloomberg School of Public Health. In these roles, Dr. Young is involved in population health programs and community based initiatives that are aimed at decreasing readmissions and lowering the overall cost of care. As managing Care Transitions has emerged as a critical element in reducing avoidable readmissions, health care providers are looking for information to guide them in the creation of these programs. A recent paper noted below studied some early programs to both assess their success and identify the common elements that make them successful. 

Learn How Ankota Technology Reduces Readmissions

The Medicare Coordinated Care Demonstration program tested the effectiveness of 15 care coordination programs with regards to their ability to decrease Medicare expenditures, improve quality of care, and improve patient satisfaction. During the program’s first 4 years, only 2 of the 15 programs reduced hospitalizations.1 In a recent analysis published in Health Affairs in 2012, Randall Brown and colleagues reexamined the impact of the 11 programs that were extended beyond 4 years.2 Four programs significantly reduced the number of admissions by 8 – 33% among the high-risk subset of their enrollees. These high risk Medicare beneficiaries represented 18% of the Medicare population and 37% of Medicare fee-for-service expenditures.

The authors were able to identify 6 distinguishing features of the successful interventions, which may guide providers in developing their own programs to better coordinate care, improve patient outcomes, and reduce avoidable readmissions:

  • Approximately one face-to-face interaction between the patient and care coordinator per month
  • Promotion of a good working relationship between the care coordinator and the patient’s physician by embedding the care coordinator in the clinic or assigning a physician’s patients to 1 care coordinator
  • The care coordinator served as a “communication hub” ensuring that all providers had key information about their shared patients
  • The care coordinators supplemented patient education with motivational interviewing and other behavior-change techniques
  • The care coordinators provided robust medication management with access to a pharmacist or the physician as needed
  • The care coordinators contacted patients during hospitalizations and assisted with their care transitions

Therefore, in effective care coordination programs, the care coordinator facilitates transitions, takes a lead with medication management, and facilitates behavior change through education and support. In addition, the care coordinator serves as a hub for interactions among providers. Programs incorporating these features were effective in both urban and rural contexts and in a variety of organizational settings demonstrating broad applicability of care coordination.

Common themes among these 6 elements is coordination of activities and communications among provider care teams, and between caregivers and patients. Early programs such as these, while producing encouraging results, have been criticized for being limited in scale and are typically not automated. The lack of automation could suggest that the success of these programs is very limited, but that's not a valid conclusion. With the emergence of Care Coordination technology from Ankota, highly efficient and large scale coordination among providers is possible immediately. This facilitates better provider-to-provider communications, as well as provider-to-patient & family communications. Care plans are evidence based, easily shared among all providers, and interventions are well timed and coordinated in addition to being very efficient. This technology applies well to Avoidable Readmissions programs, Community Based Care Initiatives, Care Transitions, and post discharge planning and follow up. Contact Ankota using the button below to learn more 

Learn How Ankota Technology Reduces Readmissions

1.         Peikes D, Chen A, Schore J, Brown R. Effects of care coordination on hospitalization, quality of care, and health care expenditures among Medicare beneficiaries: 15 randomized trials. JAMA. Feb 11 2009;301(6):603-618.

2.         Brown RS, Peikes D, Peterson G, Schore J, Razafindrakoto CM. Six features of Medicare coordinated care demonstration programs that cut hospital admissions of high-risk patients. Health Aff (Millwood). Jun 2012;31(6):1156-1166.


Topics: Care Coordination, transitional care, Dr. J. Hunter Young, Care Transitions, Accountable Care Organizations, Avoidable Readmissions, ACO Technology

Health Care's Trillion Dollar Disruption and Why You Should Care

Posted by Will Hicklen on Feb 12, 2013 12:51:00 PM

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"...new patient-centered population health models will cause more than $1 trillion of value to rotate from the old models to the new and create more than a dozen new $10 billion high-growth markets."

It's already happening: why should you, as a provider, care?

Why should Hospitals, Accountable Care Organizations and post acute providers care about this dramatic shift? After all, you're still going to get paid for delivering services, right? THINK AGAIN! This shift will have a PROFOUND impact on every provider. You will either benefit from participating in new models of care, or you will suffer a painful death by being disintermediated.

Disintermediated? Cut out. Left behind. Irrelevant. Out of business.

As reported in FORBES last month, and detailed in the Oliver Wyman paper you can download here, "Healthcare innovators are already redefining healthcare value, putting patients first and inventing with little regard for current constraints. They have ignited a powerful, self-funding upward spiral by focusing first on healthcare’s big opportunities, transforming the value equation, generating large savings, and fueling smart reinvestment in the next wave of innovation." 

Ask yourself this: Am I among the trillion dollars worth of healthcare business that goes away?

Read the FORBES article in its entirety here and link to the Oliver Wyman white paper.

Learn how Ankota is helping Hospitals, ACOs and post acute provders to operate efficiently and be a valued partner in the new healthcare Ecosystem - click the blue button below.


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Topics: PCMH, Care Coordination, transitional care, Care Transitions, Avoidable Readmissions, ACO, Patient Centered Medical Home

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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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