by Michael McGowan, former OASIS coordinator for CMS Region IX, and currently president and founder of OperaCare, a healthcare at home software company

It was a true story. “The Perfect Storm,” a book by Sebastian Junger, made into a 2000 film by Wolfgang Petersen and starring George Clooney, chronicled the tragic story of the Andrea Gail, a fishing boat that encountered a rare confluence of three meteorological events, all hitting at once, destroying the ship and its entire crew.

Though these events occurred in New England, home health agencies in Florida are about to find out exactly what the Andrea Gail crew experienced during their final day on Earth. A perfect regulatory storm is approaching Florida from the north, from Security Boulevard in Baltimore, to be precise:

  • Unless last-ditch efforts to delay are successful, the CMS Pre-Claim Review Demonstration (PCRD) will be introduced on April 1.
  • In January 2018, revenues for 50% of the agencies in the state will either rise up to 3% or be cut up to 3% with the Home Health Value Based Purchasing payment system.
  • HHAs that failed the first round of probe and educate, and then fail round two, will be headed toward increasing ADRs, according to CMS contractors.
  • ZPIC probes, audits, and investigations will increase in frequency and intensity in Florida and nationwide throughout.
  • Do not forget the annual March Madness from MedPAC, who for the fifth year in a row continues to advocate for the removal of therapy visits as a payment driver, with an additional 5% reduction in the base rate.

Florida is used to its storms, but nothing like this.

So, what does this mean to the HHA striving to meet compliance standards and hoping to still be in business next year? [McGowan provides advice and instructions to Florida healthcare at home agencies regarding appropriate face-to-face documentation, preparing appropriately for pre-claim reviews, submitting appropriate OASIS documentation, advice on submitting HHVBP and undertaking a 2-person OASIS system]

1 – If you are using a form to capture the Face-to-Face requirement, you are missing the point.

Many agencies believe the F2F “form” is the actual F2F encounter note. This is a mistake. Contract auditor review teams require the actual F2F note or discharge summary note from the physician, the one that includes the date of the encounter by the NPP or Physician.

The note must include the date of the encounter and the documentation in it must be related to the primary reason home health services are necessary. There is no requirement the note contain a declaration of “homebound status,” however, if the physician does incorporate such a statement, it can only help. In short, no note = no referral.

2 – Pre-Claim Reviews
Pre-Claim Review is no more and no less than the evaluation of compliance with long standing requirements established in regulatory statutes. There is nothing new about what is required other than the form to fill out and submit to Palmetto and the date  it has to be submitted.

The early submission date moves your referral intake process and your OASIS processes to a status where they become the key factors to your success. Agencies starting a case before assuring compliance with these requirements are frequently being presented with pre-claim denials.

Even worse, in some Florida areas, ZPIC investigations have discovered “altered” physicians’ documents being utilized in home health episodes to authorize care. Consequently, more and more physicians in these areas are growing extremely reluctant to share their notes with agencies, for fear that something nefarious may happen with the documents, resulting in their own ZPIC visits.

In our consulting practice, we teach a proprietary process through which QA staff in the office engage with the nurse in the home during the OASIS visit, producing a RAP-ready, compliant claim shortly after the clinician is done.

The implementation of OASIS C-2 and the changes in the grouper and case mix compilation make it much more difficult to obtain accurate acuity scores reflective of the patient’s actual abilities and deficits. Many agencies make the mistake of submitting “light acuities” with heavy service utilization, a practice that always triggers ZPIC radar. The result is further problems in the form of probe edits, prepayment review, and occasionally millions of dollars in extrapolation.

Our consulting practice acknowledges that clinicians have an inherent understanding of what their patients need, yet they often struggle to translate those needs into OASIS data supportive of the care they want to provide. In light of that, we teach a unique, two-person, live QA process. This technique aligns the clinical expectations of the clinician, detailed in the plan of care, with the transmitted assessment data. The result across our client base is substantial increases in case-mix accompanied by near zero ADR risks.

The inability to and effectively score OASIS assessments, meaning accurately and consistently across all clinical staff, virtually dooms an agency to failure under an HHVBP payment system as currently envisioned by CMS. If no room is left for improvement between start of care and discharge, it is impossible to demonstrate positive outcomes.

The difficulty lies primarily in the limitations inherent in the practice of sending a single clinician into the home without any accountability, until much later, of how an assessment is to be performed. Lack of consistency among assessing clinicians in the same agency creates a haphazard data pattern, which is all MAC, ZPIC and Pre-Claim reviewers have to go by to determine if an agency is compliant. What you submit to CMS, you own.

A growing number of HHAs in Florida and other states have begun to use the two-person OASIS system we teach. Generally, they find they can accurately complete four or more OASIS events per clinician per day. They routinely submit each day’s RAPs and Plan of Care documents prior to the close of business that same day. In Illinois, they have PCR submission ready as well.

We have found this to be a practical, cost-effective business practice, possible for most agencies to achieve. It enhances compliance, increases case-mix revenue, and accelerates cash flow. To help with the impending perfect storm, we will be making this system known to Florida agencies through a number of means this month and next, including live sessions and webinars through HCAF and Curaport.


Upcoming Webinar Sponsored by Curaport

Thursday, April 6
Noon EDT
Click to register or for more information


Michael McGowan is the former OASIS coordinator for CMS Region IX. He is currently president and founder of OperaCare, a software system to streamline clinical process, improve compliance, and protect home health agencies against the appearance of fraud, waste and abuse. He can be reached at




By Tim Rowan, Editor & Publisher of Home Care Technology Report

If the Republicans pass their adaptations to the Affordable Care Act, a bill they are calling American Health Care Act, Medicaid could be cut by $880 billion over 10 years, according to the Congressional Budget Office. This alarms one Colorado advocate for people with disabilities, who fears her state stands to lose $14 billion of that total.

Dr. Patricia Yeager, PhD, is the CEO of The Independence Center, which provides services for the disabled, including home healthcare services, under a number of state waiver programs in 16 Southern Colorado counties. She spoke to the local press this week, with a stern warning that the overall cost of healthcare would skyrocket if Medicaid is cut this deeply.

“The Colorado Health Institute estimates that this will likely cause nearly 600,000 Coloradans to lose their eligibility for Medicaid by 2030,” she said. “These people would be left with little to no health care options. Those who cannot afford to pay out of pocket for medical services would be forced to go without care, increasing their risk of injury, illness, and mental health crisis.” [Details about these expected cuts to the Medicaid population’s varied health-related funding are described in this article. the populations living with disabilities being singled out as the most negatively affected by the Medicaid cuts. Types of much-needed services that will be lost with the cuts are delineated in multiple tables.]

In its current form, she continued, the bill converts federal funding for Medicaid to block grants and per capita caps, which will likely result in cutting funds from critical programs (see tables below). While reducing Medicaid, the AHCA would give states more power to minimize health care coverage for vulnerable people. Proposals in the AHCA would also result in an enormous transfer of wealth from low income to high income populations, according to “Disability Rights Maryland.”

She fears that funding cuts could mean the loss of Medicaid services and supports for close to 100,000 children, adults and seniors in Colorado who live with disabilities.

“More than others, people with disabilities are likely to have serious health issues and rely on long-term services in order to work and live in the community,” Yeager explained. “Without long-term services and support, people with disabilities would have no choice but to move into nursing homes, each person costing the state and federal government an average of $6,900 per month. In addition, many who are caregivers today would have to choose between going to work and caring for their loved one who has a disability.

“For all the risk cutting Medicaid will pose to human lives, this will not solve problems; it will create new ones. People with disabilities will continue to need financial support. Any net savings in federal spending will have to be reallocated to fund additional hospital charges, and the extreme costs of institutionalization.”

According to Dr. Yeager, until an alternative solution to Medicaid exists, cutting funding will create drastic consequences in the daily lives of people with disabilities, including those who are able to hold down a job if a home health aide helps them get ready in the morning:

  • Loss of the basic right to live in the community
  • Loss of safety net
  • Loss of access to resources
  • Loss of hearing aids and other assistive technologies
  • Worsening health or disabilities
  • Loss of ability to work
  • Loss of housing
  • Loss of life


TABLES: Endangered Home and Community Based Services for Adults and Children with Disabilities:

Adults with Major Mental Illness could lose some or all of these services:

  • Adult day services
  • Alternative care facilities
  • Consumer directed attendant support services
  • Home Modifications
  • Homemaker services
  • Non-Medical Transportation
  • Personal care
  • Personal emergency response system
  • Respite care

Adults with Spinal Cord Injury could lose some or all of these services:

  • Alternative therapies (acupuncture, chiropractic care, massage therapy)
  • Transportation
  • Home modifications
  • Homemaker services
  • Personal injury response system
  • Consumer directed attendant support services
  • Adult Day Services
  • Respite Care
  • Personal Care
  • Personal Emergency Response System

Adults with Developmental Disabilities could lose some or all of these services:

  • Behavioral services
  • Specialized habilitation, supported community connections
  • Dental service
  • Prevocational services
  • Residential habilitation (24 hour individual or group)
  • Specialized medical equipment/supplies support employment
  • Transportation
  • Vision services

Children with Disabilities at risk of hospital or nursing facility placement could lose one or both of these services:

  • Case management
  • In Home Support Service

Children with Autism that have intensive behavioral needs could lose this service

  • Behavioral therapies

Children in the Care of Social Services could lose some or all of these services: 

  • Cognitive Services
  • Community Connections
  • Communication Services
  • Emergency Services
  • Personal Assistance
  • Self-Advocacy
  • Supervision Services
  • Travel Services

Children with Life Limiting Illness at risk of hospital placement could lose some or all of these services: 

  • Therapeutic Services (Counseling/Bereavement Services)
  • Expressing Therapy (art, play, music therapies)
  • Palliative/Supportive Care
  • Support (Individual/Family/Group)

Adults with Brain Injuries could lose some or all of these services:

  • Adult Day Services
  • Behavioral Management
  • Day Treatment
  • Home modifications
  • Non-medical Transportation
  • Respite care
  • Personal care
  • Personal emergency response system
  • Counseling
  • Specialized Medical Equipment/Supplies
  • Consumer directed attendant support services
  • Support Living Program
  • Transitional Living
  • Respite Care

Adults who are Elderly, Blind and Physically Disabled could lose some or all of these services:

  • Community transition service
  • Alternative Care Facilities
  • Adult day services
  • Consumer directed attendant support services
  • Personal care
  • Personal emergency response system
  • Non-Medical Transportation
  • Homemaker services
  • In Home Support Services
  • Respite Care

Adults who Need Supported Living Services could lose some or all of these services: 

  • Assistive technology
  • Behavioral services
  • Day habilitation services
  • Dental service
  • Home modifications
  • Homemaker services
  • Mentorship
  • Personal care services
  • Professional services (Hippo, massage, and/or movement therapies)
  • Respite services
  • Specialized medical equipment/supplies
  • Supported employment
  • Transportation
  • Vehicle modifications
  • Vision services
  • Personal emergency response system

Children with Intensive Behavioral or Medical Needs could lose some or all of these services: 

  • Adapted Therapeutic Recreation and Fees
  • Assistive Technology
  • Behavioral Services
  • Community Connector
  • Home Accessibility Adaptations
  • Homemaker Services
  • Parent Education
  • Personal Care
  • Professional Services
  • Respite Care
  • Specialized Medical Equipment/Supplies
  • Vehicle Modification
  • Vision Services
  • Youth Day Services


For more information, visit:


National Council on Independent Living

Colorado Cross Disability Coalition

Colorado Health Institute

Disability Rights Maryland


©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. One copy may be printed for personal use; further reproduction by permission only.


by  Roger McManus, MBA (who has held several positions as Director of Strategic Relationships)

US businesses spend $360 million on advertising every day. And every day, 80 percent of people who are not familiar with an advertised business will check it out online before spending a dime.

Certainly it used to be different, and not that long ago. A few years ago, you could run a clever radio or television ad and people would call you (on a landline phone) or drop by to check out your business in person. Not anymore!

21 Century marketing is different
Companies that provide healthcare services at home have always had to carefully spend advertising dollars but the definition of “carefully” has changed. To put it another way, the objective is still to get new clients but the tactic is now to move people to go to their computers and smart phones, not to knock on your door. [A chain of reactions to learning more about one’s products/services spurred by customers is described by McManus, who also provides this advice about advertising/marketing in today’s new world:

  1. Deliver a top quality product
  2. Capture the reactions of customers who are pleased with the effort.
  3. Invest in traditional advertising.

He also covers the realm of “reputation marketing”–which ” has the effect of ‘insuring’ advertising dollars” and multiplying one’s positive reviews online.]


This is the best you can hope for today. People do not call you first anymore. Calling you will be their third move, if they call at all. What causes them to pick up the phone? What they find out your current customers say about you online. Google star ratings and Yelp reviews and other online rating systems, such as Facebook reviews on your own Facebook business page, are king today. After they see what other people — yes, perfect strangers — have said about you, they may then go to your web site. If they like what they see there, they may call.

Good, bad, or indifferent, this is the way people shop today. At its best, advertising only gets people to go online, where they will believe the opinions of people they do not know before they decide to spend money with a business. In home care, this means before they decide to entrust their elderly mother to you.

In this new world, today’s reasoning goes, you spend your attention and your resources in this order:

  1. Deliver a top quality product
  2. Capture the reactions of customers who are pleased with the effort.
  3. Invest in traditional advertising.

He also covers the realm of “reputation marketing” which has the effect of “insuring” advertising dollars and multiplying one’s positive reviews online.

Reputation Marketing

Reputation Marketing has the effect of “insuring” advertising dollars. When your ads evoke a response, 80% of people first go to online reviews. If what they find there is a realistic, generally positive, view of your business, your advertising investment has paid off. If it is mostly negative, your budget has been wasted.

This is what people are calling “Reputation Marketing.” It has nothing to do with covering up negative reviews. (See “Why Yelp Doesn’t Lose in Court” in a recent report, where we discussed the futility of trying to delete negative online comments.) It has everything to do with multiplying the number of positive reviews by identifying happy customers and getting them to repeat their positive comments online. If you cannot remove negative reviews, you have to bury them with positive ones.

The unfortunate fact is that happy customers expect to be happy. While perhaps appreciated, good service is not so exceptional that it inspires people to rush home and comment about it online. A bad experience, however, is entirely different. It is always exceptional. People will go to the extra effort to warn others — yes, perfect strangers — by vilifying a business that has not served them well.

Logic would suggest that a business that has survived for a while must be pleasing more customers than it displeases. This does not matter if those happy customers are less vocal than the few unhappy ones. The whole system of online reviews skews toward a negative bias. It is simply human nature to use the anonymity of online review tools to criticize rather than praise.

In with the good, out with the bad
This is no time to kick yourself if you have not yet modernized your marketing efforts. It is not your fault that the world changed around you. However, now that you know, it is imperative that you make use of the information before your competitors do. Reputation Marketing is a two-pronged tool. Savvy businesses use it to promote positive reviews and to find, and dialog with, the writers of negative reviews. Preventing a small situation from becoming a big broadcast is another form of “insurance,” protecting future advertising spending. Making it easy for happy customers to express their experience with you in a public forum turns the insurance into an annuity.

Roger McManus is an online marketing consultant. He teaches businesses how to automate the solicitation of online reviews. He can be reached at

©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. One copy may be printed for personal use; further reproduction by permission only.



By Tim Rowan, Editor & Publisher of Home Care Technology Report

Seattle, WA – March 16, 2017 – NetMotion® Software, a leading provider of Mobile Performance Management (MPM) software solutions, today announced the release of Diagnostics 4.0, the world’s first mobile intelligence and analytics solution that captures robust network and security data across any wireless network. Diagnostics 4.0 gives IT organizations key security and operational data — from public and private networks, Wi-Fi and carrier, inside and outside the firewall — to plan for, deploy and manage their mobile employees. Diagnostics collects real-time, location-based data from mobile devices enabling in-field support and troubleshooting.

As an integral component of an MPM solution, states a company news release, Diagnostics allows decision makers in security, IT, and other roles to leverage live data about the security and productivity of a mobile organization. This empirical data gives IT staff a clear view of every employee’s mobile experience, including optimization level, security risks, utilization rates and more.

We spoke with VP of Product Management John Knopf, who described the new product for us and explained the problems it is designed to solve.[Details provided by Knopf, about productivity and security of healthcare at home service providers’  work are presented for much of this article, followed by details on key features of Diagnostics 4.0.]

“The genesis of the idea for Diagnostics 4.0 came from lessons learned in the field,” he told us. “Today’s mobile employees spend more time working outside the firewall than they do behind it, making it exceptionally difficult for IT staff to monitor and manage connection security and reliability. Diagnostics 4.0 allows IT staff to proactively shore up security, troubleshoot problems and continually enhance their mobile users’ experience. On its own or used in conjunction with other Security Information and Event Management (SIEM) and Business Intelligence (BI) tools like Splunk, IBM QRadar and open stack solutions, Diagnostics helps enterprises maximize the performance and operational effectiveness of their mobile workforce.”

Productivity and security
In the case of home health and home care workers, he added, this can mean keeping people more productive. For example, when connectivity is lost, there can be any number of reasons. The cause might be in the wireless carrier’s system, in the agency’s firewall or in the remote device itself, and there it could be either a hardware or a software problem.

Diagnostics 4.0 collects connectivity data and stores it on the mobile device. Field users see a root-cause analysis, presented on a non-technical level, in plain English, explaining why they cannot connect. If that recommendation does not solve the problem, they can click on it and see a more technical version that they can read to the IT support person when they call for assistance.

“Over time, IT staff can start to identify trends,” Knopf continued. “If there is a recurring issue, they may be able to make an adjustment that fixes it for all users. Or they may see that the issue is with another vendor, such as a wireless provider, in which case they submit a trouble ticket with that vendor.”

He laughed and added that often the problem is nothing more than that the field user bumped the hardware switch that turns the device’s Wi-Fi radio on and off. Sometimes the issue is performance rather than loss of connectivity; the system can diagnose the source of that problem as well.

Backward compatible
Diagnostics 4.0 is symbiotic with NetMotion’s mobile VPN product, Mobility XE 8.0™, a database protection system that suspends a session when a remote connection is lost and restores it automatically without damaging either the remote or server-based database. We introduced that product back in 2008 in an article about how the VNS of New York used it to overcome the challenges of maintaining connections in a skyscraper jungle.

Deploying Diagnostics does not necessitate additional IT staff, Knopf assured us. In fact, because support interactions are much briefer, it may lighten their load as well as free up time for field staff. “Think about it,” Knopf said. “How often do your in-home caregivers get frustrated with a bad connection, throw up their hands, and choose the wrong response? Maybe they spend another hour in Starbucks, waiting for the connection to come back. Maybe they waste time driving to another hot spot where the connection will be better, only to find the problem is in their device.”

One anecdote from a user tells just how high the product’s ROI can be. “One of our clients was trying to roll out thousands of new devices and having nothing but trouble connecting them to the company network. As soon as they installed Diagnostics, it told them most of the new devices had an outdated wireless card driver. After the driver update, problem solved.”

The product, he added, is available in both SaaS and server versions. It typically runs over wireless networks but works on Ethernet connections as well, making it useful for clinicians working from home.
“Inevitably, mobile business workers will connect to a network other than their own organization’s secure corporate network,” said Bryan Bassett, Research Analyst for IDC, a tech market research firm. “Examples abound from public Wi-Fi to home networks or connecting to a cellular providers’ broadband network. These unknown or unsecured networks can potentially expose the user or the user’s data to malicious attacks, increasing the chance of a security breach.”

Key Features of Diagnostics 4.0:

  • Big Data, SIEM, Business Intelligence Integrations:New and improved reporting brings faster Big Data analytics and reporting capabilities. Since mobile workers usually work outside the firewall where traditional management tools lack visibility, this expands the level of actionable intelligence for IT and other stake holders. Also, with real-time updates and reports, in-field troubleshooting is also improved. There is a NetMotion Mobile Deployment app for Splunk that allows users to better explore the benefits of NetMotion Diagnostics 4.0. It is available for free download at:
  • Wi-Fi Support: Diagnostics tracks and troubleshoots all types of networks – WWAN (carrier networks), Ethernet, GPS, and now Wi-Fi. Know when mobile users are connecting to unsecured Wi-Fi networks and get information on network and access point usage/roaming, network security and rogue access points.
  • Full support for iOS Devices: In addition to collecting inventory data, Diagnostics for iOS can now detect and track WWAN/Wi-Fi connections and disconnections, data counts on received and transmitted bytes, device location, and report on a device’s Mobility mVPN status.
  • Multiple Adapter Support for Windows: Windows laptops typically have multiple connection options – WWAN, Wi-Fi and Ethernet – now Diagnostics can concurrently monitor multiple adapters in the same Windows device.

NetMotion is headquartered in Seattle, Washington.
NetMotion and NetMotion Mobility are registered trademarks of NetMotion Software, Inc. All other trade names, trademarks and registered trademarks are the property of their respective owners.

 ©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. One copy may be printed for personal use; further reproduction by permission only.


Advanced TeleHealth Solutions (Springfield MO) , a telehealth services provider, conducted a study that looked at how improving the post-discharge care of chronic heart failure patients could be a strategy for reducing hospital readmissions. Full details about the study of 83 heart failure patients followed between Feb. and Oct 2011 are provided in this article. The results of the study are summarized as follows: The Results: Better Patients, Fewer Hospitalizations, Lower Costs.]


Problem and Background
Chronic heart failure patients are at the center of the national effort to reduce hospital readmissions. Nearly one in four patients is readmitted for events that likely were preventable, and more than one in 10 patients is readmitted within 15 days of being released, according to the Medicare Payment Advisory Commission (MedPAC). The leading cause of death in the U.S., heart failure is the most common hospital discharge diagnosis for Medicare patients, and treatment of them is among the most expensive. As the Affordable Care Act requires hospitals to take more responsibility for patient outcomes, health care officials are determined to reduce the number of heart patient readmissions.

In October 2012, Medicare began refusing to pay for unnecessary readmissions of patients with heart failure, heart attacks and pneumonia, and in August 2013, Medicare fined 2,225 hospitals $227 million for excessive readmissions in those categories. [To address this problem for the healthcare at home industry (which was seriously affected  by Medicare’s refusal to pay for readmitted patients with heart conditions and pneumonia, Advanced TeleHealth Solutions  developed a telemonitoring program  for heart patients

Solution: Monitoring Heart Patients Reduces Readmissions
The study evaluated 83 heart failure patients, who also had four to five other co-morbidities and had been released from an integrated health system in Southwest Missouri between February and August in 2011. The patients were divided into two groups: one received telemonitoring services for six months, and the other, a control group, did not. The results were analyzed by a Missouri State University researcher who found that patients who received telemonitoring services were less likely to be readmitted and more likely to take their medications than patients in the control group. Heart failure patients often suffer from depression because their illness can seriously limit their activities, sleep and social relationships. Compared to the control group, the patients in the telemonitoring group indicated a greater quality of life, as measured by the scores on the Minnesota Living with Heart Failure (MLWHF) scale, a commonly used Likert-scale patient self-assessment of how heart failure affects patients’ daily lives.

How Telemonitoring Works
The 83 patients in the control group and the telemonitoring group were sent home from the hospital with medications and instructions provided by their discharge nurse. Patients in both groups may have also received home health services paid for by their insurance companies. For the purposes of the study, the patients in the telemonitoring group received an additional layer of care: remote patient monitoring that included daily measurements of their biometric readings and questions regarding their symptoms along with daily phone conversations with an Advanced TeleHealth Solutions nurse, who was certified in chronic care and trained to coach patients through their recovery.

Every day the patients used peripherals such as a pulse oximeter to measure oxygen levels and heart rate, weight scales and a blood pressure cuff to record vital sign changes. With a touch of a button, these measurements and answers to questions regarding the patients’ symptoms were transmitted to the Advanced TeleHealth Solution nurses.

The patients had established parameters for their vital signs. Anytime the patients’ vital signs were outside the acceptable parameters or the patients replied to the questions regarding their symptoms in a negative way, the patients received a call from their Advanced TeleHealth Solutions nurse. The information provided a framework for the daily conversation between the patient and caregiver about the specific health issues the patient was having that day.

The nurse also provided proven clinical interventions and coordinated with the patients’ other care providers. After ongoing coaching, patients and their families were able to determine on their own when a vital sign had changed enough to be a cause for concern. When problems occurred, patients were instructed to call Advanced TeleHealth Solutions’ telehealth department, which provided nursing help around the clock.

The amount of time the nurse and the patient spent on the phone calls depended on the condition of the patient, education provided and care coordination. If a physician needed to be contacted, the Advanced TeleHealth Solutions nurse made the call and coordinated any changes to the plan of treatment with the patient.

“The work was intensive for everyone involved. Heart patients are among the most difficult to care for because there are so many vitals and symptoms—e.g. shortness of breath, fatigue and swelling in their legs, ankles and feet—to monitor,” said Tresa Marlow, Advanced TeleHealth Solutions’ Director of TeleHealth. “Adding to the anxiety is the knowledge that heart patients can deteriorate quickly and a patient’s condition can change dramatically overnight. Successful telemonitoring nurses have good communication and relationship-building skills, and the nurse responsible for the study was no exception,” Marlow said. “She had a very close-knit relationship with everyone involved.”

The Results: Better Patients, Fewer Hospitalizations, Lower Costs
A study of discharged heart failure patients who were monitored remotely shows that telemonitoring is a promising strategy for reducing hospital readmissions. Telemonitoring can keep even the most fragile heart failure patients connected to health care providers after they are sent home from the hospital. In addition to preventing costly readmissions, telemonitoring has the added benefit of helping patients comply with their medication instructions and improving their quality of life.

While patients have the comfort of knowing their vital signs and symptoms are evaluated daily, hospital administrators are learning that telemonitoring can help them reduce health care costs and keep hospital rooms free for patients with the most urgent needs.


©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. One copy may be printed for personal use; further reproduction by permission only.


Mountain View, CALivongo Health, the consumer digital health company focused on chronic conditions, announced a $52.5 million growth round. The new funding round is co-led by existing investor General Catalyst and international investment company Kinnevik and joined by Singapore-based EDBI, American Investment Holdings LLC, and Microsoft Ventures. All previous investors participated in the current round as well. This round positions Livongo to accelerate growth in diabetes management, expand to other chronic conditions, and move to international markets in 2017. [Details are provided by CEO Glen Tullman on his views of key role of technology, particularly smart technology, to drive much-needed healthcare services.  The company’s success to date with connecting people living with diabetes and improving their care is noted.  Its plans to expand its solutions to support current members who have other chronic conditions such as high blood pressure and high cholesterol is also noted.]

Glen TullmanGlen Tullman

We heard from CEO Glen Tullman, who formed Livongo after 15 years as CEO of Allscripts. “I truly believe that we’re at the beginning of a revolution in healthcare. We hear so much about healthcare policy debates today and, while those are very important, the most important impact we will see on our long-term health as a country, and around the world, is how we blend smart technology, mobile communications, findings from data science, and healthcare services to make it easier to stay healthy and get the care you need, often before you know that you need it! I believe Livongo’s success to date is the beginning of a wave of innovative healthcare changes like we’ve seen in so many other industries, driven by smart technology, and I’m proud to be a part of a Company that is leading the way.”

“Livongo is one of the fastest growing companies in our portfolio and we are happy to double down to help the team expand their market leadership,” said Hemant Taneja, Managing Director at General Catalyst. “Additionally, we are excited to see Livongo expand their service to offer comprehensive support for their members’ chronic needs beyond diabetes.”

Livongo’s program is demonstrating significant improvements in health outcomes for its members and cost savings for its clients. Livongo members spend more time-in-range in the first month of use and show a reduction in HbA1c within the first 90 days sustained to at least 180 days.1 A recent third-party study found that Livongo optimizes utilization and decreases diabetes-related medical costs across the covered population.2

“Livongo has really connected with our people who have diabetes,” said Scott Kirschner, Director of Benefits Strategy at Iron Mountain. “Our people are using the product and love it. We’re also seeing improved clinical results and cost savings, which have been documented by independent consultants. Livongo means healthier, happier, more productive employees and families, with reduced costs for their care. Pretty impressive.”

Livongo DeviceLivongo Connected Meter

Livongo is working to expand its solutions to support current members who have other chronic conditions. For example, 71% of people with diabetes have high blood pressure and 65% have high cholesterol.3 Managing multiple chronic conditions is complicated and most people with diabetes deal with this reality every day, something which Livongo intends to address.

To date, Livongo’s growth has been driven by rapid adoption of its diabetes management solution among leading Fortune 500 companies as well as 4 of the 7 largest health plans in the U.S., the most innovative health systems, and 2 of the 3 largest pharmacy benefits managers.

About Livongo
Livongo is a consumer digital health company that empowers people with chronic conditions to live a better life. Livongo has developed a completely new approach for diabetes management that combines the latest technology with coaching. On a personal level, many of us have loved ones with diabetes and many of us have it ourselves, which helps us better understand our members.

1 Based on Livongo’s 2016 Clinical and Financial Outcomes Report and business reporting.

2 Third-party study based on comparison of two years medical and prescription claims data for active Livongo members compared to people with diabetes who did not participate in Livongo Program.

3 Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. Atlanta, GA: U.S. Department of Health and Human Services; 2014


©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. One copy may be printed for personal use; further reproduction by permission only.


Seema Verma

By Tim Rowan, Editor & Publisher, Home Care Technology Report

On March 13, the Senate confirmed Seema Verma to be the Administrator for the Centers for Medicare and Medicaid Services on a 55-43 vote, with four Democrats joining 51 Republican Senators voting for confirmation.

Who is Seema Verma and what healthcare philosophy does she bring to the office that affects the businesses of nearly 12,000 home health agencies, not to mention thousands of hospitals, physicians and insurance companies? We took a tour through her history to try to get a feel for what we can all expect.

A first-generation American whose parents emigrated from India, Ms. Verma earned a Masters in Public Health, Health Policy and Administration from Johns Hopkins in 1996 and a Bachelor’s degree in Life Sciences from the University of Maryland in 1993. In 2001, she founded and served for 16 years as President and CEO of SVC, Inc., a national health policy consulting company. In that capacity, she worked with Governor’s offices, State Medicaid agencies, State Health Departments, State Departments of Insurance, as well as the federal government, private companies and foundations to redesign policy and strategic projects involving Medicaid, insurance, and public health.[Extensive  details about Verma’s involvement in Medicaid funding issues, particularly her work in the “Healthy Indiana Plan,” described as the first consumer-directed Medicaid program.  Other work of hers in other states’ Medicaid programs is noted as are her views on the federal government’s supporting the Medicare population through a voucher system, as promulgated by the new HHS Secretary Tom Price.]

Her passion for Medicaid surfaced in her first official action, minutes after her swearing-in ceremony. With Health and Human Services Secretary Tom Price, M.D., Verma co-signed a letter to the nation’s governors affirming the Department’s intent to “work with states to improve the Medicaid program and the lives of those it serves.”

Highlights: Price/Verma
Letter to Governors

“Today, we commit to ushering in a new era for the federal and state Medicaid partnership where states have more freedom to design programs that meet the spectrum of diverse needs of their Medicaid population. We wish to empower all states to advance the next wave of innovative solutions to Medicaid’s challenges—solutions that focus on improving quality, accessibility, and outcomes in the most cost-effective manner. States, as administrators of the program, are in the best position to assess the unique needs of their respective Medicaid-eligible populations and to drive reforms that result in better health outcomes.

“We intend for this to be the beginning of a discussion on how we can revamp the federal and state Medicaid partnership to effectively and efficiently improve health outcomes. We look forward to partnering with you in the years ahead to deliver on our shared goals of providing high quality, sustainable, health care to those that need it most.”

Experience tilts toward Medicaid
Ms. Verma’s claim to fame is the “Healthy Indiana Plan,” described as the first consumer-directed Medicaid program. She was the architect of the program under Governor Mitch Daniels of Indiana and continued it into the administration of his successor, now VP Mike Pence, who has been called her mentor.

Referred to by SVC as a historic program, Indiana Medicaid under HIP includes premiums, health savings accounts, deductibles and a work requirement for able-bodied adults. Each qualifying participant in HIP receives a $2,500 grant toward the deductible. SVC describes it this way:

“In line with commercial market consumer-driven plans, HIP members receive a $2,500 deductible health plan (HDHP) paired with a $2,500 “POWER” account, similar to a health savings account (HSA). The POWER account is HIP’s paramount feature. It acts as both a payment mechanism and a terminal through which HIP’s incentive structure flows. Members use the POWER account to pay for health care services until the deductible amount is met, at which point the HDHP becomes solely responsible for paying any further claims. Preventive services are provided outside the deductible and members do not face any barriers to seeking these services.”

SVC managed every aspect of designing and winning approval for HIP since its inception in 2007, from development of the enabling legislation, negotiating the financing plan with the State’s hospital association, developing the federal waiver, supporting federal negotiations and leading the implementation of the program, including the operational design. One of Verma’s final victories before leaving Indiana for Washington was to win approval of HIP under the Affordable Care Act’s Medicaid expansion provision.

Criticized by some as confusing for beneficiaries, some of whom have incurred penalties through no fault of their own, Verma defended her approach during her Senate confirmation hearing by saying that low-income people are fully capable of making health care decisions based on rational incentives.

Verma and Mitch Roob, then the head of the Indiana agency that administers Medicaid, touted the philosophy behind the program in a 2008 blog post, outlining a vision for health policy that “melds two themes of American society that typically collide in our health care system, rugged individualism, and the Judeo-Christian ethic.”

Former Indiana Governor Mitch Daniels proclaimed that results [of HIP] were clear. Participants in the plan, he said, were much more likely to use generic drugs and seek second opinions. They were also less likely to go to the emergency rooms, probably because of the $25 charge for non-emergency use of the emergency room. “By introducing consumerism,” Daniels said, “they demonstrated that low-income people are very good consumers, too. The fatal mistake is to make everything completely free.”

In addition to her work in Indiana, Ms. Verma and her SVC team developed many of the recent Medicaid reform programs including waivers for Iowa, Ohio and Kentucky. She helped design Tennessee’s coverage expansion proposal and also provided technical assistance to Michigan as that state implemented its 1115 Medicaid waiver. Ms. Verma and SVC also supported Iowa’s Medicaid transition to managed care, as well as Maine’s Medicaid strategy efforts.

Internal Medicare battle looming?
Though there is little to be found in the record for Medicaid expert Verma’s thoughts on Medicare, she has stated that she does not support turning the public insurance program for seniors into a voucher plan under which beneficiaries would get a fixed federal contribution to purchase private coverage from government-regulated private insurance plans. On this policy she is 180 degrees from her new boss, HHS Secretary Tom Price, who is a prominent advocate of such an approach. Stay tuned.


©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. One copy may be printed for personal use; further reproduction by permission only.


Briggs Healthcare has announced a partnership with MatrixCare to provide joint clients with its electronic documentation system. Users of the Boca Raton-based software company’s post-acute EMR system, formerly known as Soneto, will be able to choose electronic instead of paper forms and data will be integrated with their Electronic Medical Record.

The leading paper forms provider has created a software system known as “eBriggs.” It is described as a digital plug-and-play content solution for EMR systems that offers full integration between HTML and advanced PDF technology to provide users with digital versions of the same Briggs forms they know and have trusted to be regulatory compliant. eBriggs forms possess workflow triggers, structured drop downs and required mandatory field entry to ensure accurate reporting. [Various senior representatives at Briggs Healthcare outline the history and value of the eBriggs system,

We spoke with Sherry Anderson, Briggs’ Director of eSolutions.”This has been talked about within Briggs for a long time,” she told us. “We have wanted to offer customers the ability to fill out PDF forms and file them electronically. But it had to be more feature-full than a typical PDF form filled out on a screen. It had to support and work with the EMR’s workflow, otherwise vendors might as well do it themselves.”

Ms. Anderson walked us through the eBriggs system and we found that the appearance of the forms on the screen is identical to the Briggs forms that have been a staple for Healthcare at Home providers for decades.

For the MatrixCare integration, Ms. Anderson said, eBriggs has built a product with intuitive attributes that allow an EMR provider to deploy it within their workflow. “PDF and HTML are aligned identically in field names,” she explained. “This allows clinicians to enter data in their format and output to PDF.” Organizing document production in this way, she added, avoids the problem that HTML printing is less than ideal.

“This partnership brings together a superior post-acute EMR system with a long-time trusted source of documentation. Using eBriggs integrated with MatrixCare, users will experience a smoother transition to documenting in an EMR,” said Dustin Epstein, Briggs Healthcare’s Chief Digital Officer.

“By partnering with Briggs to embed industry approved and tested forms, we can offer a much broader suite of assessments and notes to our clients in all lines of home care and home health. Rather than descend into a black hole of forms design and constant change requests, standardizing on the Briggs form set allows us to focus our efforts on workflow, usability, business intelligence and clinical decision support, leading to better outcomes and a happier, more productive care team,” added Joe Kraus, SVP & President of Home Care Solutions at MatrixCare.

The advantage to EMR vendors like MatrixCare, Ms. Anderson concluded, is that they no longer need to devote resources to forms development and OASIS regulatory changes. “They can rely on us as their content provider. When OASIS is ready, we ship it off to them. We will make sure their customers remain compliant.” The EMR vendor, she said, receives eBriggs HTML code, integrates it into its point-of-care software, and clinicians are presented with PDF documents and the data they enter on the screen updates the patient record.

eBriggs electronic forms are currently available in MatrixCare’s home care EMR.

About Briggs
Briggs Healthcare has provided a variety of products and services to the long-term care, assisted living, home care, hospice, hospital, physician and clinics and other health care markets for more than 70 years. Briggs serves more than 50,000 customers with professional documentation systems and forms, compliance services, medical supplies and rehabilitation aids, charting equipment and supplies, training materials, education and operational resources.

About MatrixCare
MatrixCare solutions have powered the long term care continuum for over 30 years. MatrixCare is the largest LTPAC technology provider in the US and the first to offer a true full-spectrum solution. Used in more than 12,000 facility-based care settings and 2,000 home care and home health agency locations, MatrixCare’s solutions help skilled nursing and senior living providers, life plan communities (CCRCs), home health and home care organizations prosper as we migrate to a fee-for-value healthcare system.

©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. One copy may be printed for personal use; further reproduction by permission only.

Two Tech Companies Appoint Veteran Executives, Board Members

Ankota Introduces Three New Leaders

Boston, MA — Responding to increased growth, innovative home care management software vendor Ankota has announced an expanded management team.

  • David S. Cole joins as Chief Operating Officer. He will be responsible for company operations, product development and customer satisfaction.
  • Burgess A. Harrison will serve as Vice President for Marketing and Sales.
  • Hamilton G. Temple joins as Regional Sales Director.

A 25-year veteran of the healthcare at home industry, David Cole brings an extensive management, healthcare, telehealth, business development and customer support background to Ankota. He is a certified Chronic Care Professional and one of the original pioneers in the use of telephony by home care providers. Cole co-founded StatChek, Inc., one of the industry’s first telehealth companies and now a part of Wi-Pro (NYSE:WIT), in 1993. His credentials include a role on the startup team at AccentCare, Inc., which has grown to over 150 offices in 11 states. He has founded and managed healthcare at home provider agencies and served as the Medicare administrator for Interim Healthcare of Atlanta, Georgia.

Cole bring to Ankota a novel model he helped develop for post-discharge patient management that has proven to achieve the Triple Aim of lowering costs while improving outcomes and patient satisfaction.

Burgess Harrison is a seasoned marketing, advertising and sales executive with extensive experience in telehealth, communications, technology marketing and sales. A pioneer in electronic visit verification (EVV) and telephony, Burgess has spoken at National Association for Home Care. Most recently he co-founded Triple Aim Technologies, an innovation in remote patient monitoring with its Multi-Morbidity Engine™ technology for the post-acute care market. Previously Harrison led marketing efforts at American TeleCare and StatChek and the healthcare division of InfoCrossing (now WiPro).  He also is a member of the board of directors of the 109 retail store chain, Tradehome Shoes.

Hamilton Temple, most recently with Savii Care, brings 20+ years of sales and marketing experience in high tech and enterprise software with the last 9 years being exclusive to the post-acute technology space. He has worked with providers of home health, home care, DME and Infusion.

“The addition of these three experienced leaders will accelerate the growth of Ankota exponentially in the coming months,” asserted Ken Accardi, CEO. “We promise ‘next generation’ home care software and I cannot think of any other people that embody that mission more than David, Burgess and Hamilton.”

About Ankota 
Ankota™ offers the post-acute care industry a customizable home care management system on a Software as a Service (SaaS) platform. The software offers telephony, GPS, fixed number generator fobs, biometric authentication and verification schema. It manages people, payers and programs via configurable business rule sets and supports optimized delivery of care in homes, readmission reduction, individualized plans of care and cost controls. Sophisticated scheduling algorithms support managing non-skilled and professional workers in post-acute markets that include AAA’s, Medicaid, DME, therapy staffing, infusion and phlebotomy.  Foresight Care™, an innovative remote patient monitoring service and patient engagement platform, helps avoid hospital readmissions at the lowest possible cost.


Atlanta, GAExcel Health Group, a market intelligence data analytics company, announced the appointment of Tom Maxwell to its Board of Directors. Mr. Maxwell, CEO of Maxwell Health Care Associates, is widely recognized as a leader in home health and hospice technology and operations. He will play a key role in the development of the Excel Health paradigm-shifting market intelligence products and services.

Excel Health’s Home Healthcare and Hospice Market Intelligence Portals support post-acute care agencies that want to gain a competitive edge. “Outdated, two-year old data and decile rankings do not meet the needs of the market in today’s era of value-based care,” a company news release states. “We provide a view into post-acute, acute and ambulatory care networks to offer a complete picture of an agency’s entire care network.”

Portals accomplish this through Excel’s direct access to the CMS Chronic Conditions Warehouse, including 100% of the Medicare Part A and B data (1.25 Billion claims annually). Company materials also refer to a multitude of exclusive data sources, such as the mortality index, just 90 days after CMS closes each quarter.

“For many years, Tom has been a highly respected leader in the post-acute industry, and his guidance will be invaluable to Excel,” said CEO Ian Juliano. “We are absolutely thrilled to have Tom on our Board.”

Most recently, Maxwell launched Maxwell Health Care Associates (see HCTR, February 15, “Former HCHB Exec Launches Post-Acute Consulting Firm). Prior to that, he was COO and Chief Strategy Officer for Homecare Homebase.

“I chose to work with Excel Health Group after seeing data and analytics that I had never seen before. The Excel Health market intelligence solution is beyond powerful and desperately needed for this industry,” said Tom Maxwell. “Their metrics, from post-acute hospitalization rates to hospital discharge compliance rates, answer the most pressing questions for all key stakeholders of an organization, from the C-suite to the sales, marketing and clinical teams. While most healthcare analytics is focused on population management, their suite of B2B solutions is focused on managing the entire care network. I believe in the Excel solution so much that I have also financially committed to the business.”

About Excel 
Atlanta-based Excel Health Group was founded by John Lees, PhD (physics), Kevin Gunter, and Ian Juliano, MBA, in 2015. It released its first product, a market intelligence portal for hospice, in February, 2016. Related products for home health, hospitals and post-acute care facilities are in the works.

This is Dr. Lees’ first foray into post-acute care after serving as President of Revenue Cycle Services for MedAssets, a hospital analytics services company. Gunter had led business development for Curo Health Services, a national hospice, and directed home health and hospice sales for Amedisys. Juliano briefly held titles of EVP of Corporate Development of Brightree, CFO of CRE Secure and CEO of HomecareCRM during the times each company was being presented by its respective VC investors for acquisition.

Company materials explain that its Market Intelligence Portals give access to timely — 90-days old — factual analysis of Medicare Part A and Part B data, amounting to over 1.25 billion claims annually. Access to timely analysis of patient flows, market trend and key performance indicators for networks, facilities and individual providers meets the goal to construct care networks and select providers based on care efficacy (superior outcomes) and care efficiency (reduced utilization), offering the potential to impact healthcare and patient lives.

©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. One copy may be printed for personal use; further reproduction by permission only.

The Centers for Medicare and Medicaid Services awarded five contracts to three new collection agencies on October 31 [2016] and they are just about ready to begin to examine your claims and documents, looking for overpayments and underpayments.

The contractors are (full contact details below):

Region 1 – Performant Recovery, Inc.

Region 2 – Cotiviti, LLC

Region 3 – Cotiviti, LLC

Region 4 – HMS Federal Solutions

Region 5 – Performant Recovery, Inc.

If you are still wrestling with overpayment accusations from a previous RAC investigation, you will continue to deal with that legacy collection agency. CMS stated that their original Medicare FFS RACs will be under contract with CMS until 2018 for administrative purposes. Providers may still receive correspondence related to claims adjusted under the original RAC contracts. [A thorough overview of the Medicare Fee for Service (FFS) Recovery Audit Program’s mission is provided in this article; and new RACs as of Oct. 31, 2016 are identified by region and purposes. The goal of RACs, it’s noted, is to “identify and correct Medicare improper payments through the efficient detection and collection of overpayments made on claims of health care services provided to Medicare beneficiaries, and the identification of underpayments to providers so that the CMS can implement actions that will prevent future improper payments in all 50 states.”]

From the CMS announcement

Mission – The Medicare Fee for Service (FFS) Recovery Audit Program’s mission is to identify and correct Medicare improper payments through the efficient detection and collection of overpayments made on claims of health care services provided to Medicare beneficiaries, and the identification of underpayments to providers so that the CMS can implement actions that will prevent future improper payments in all 50 states.

Background – The Medicare FFS Recovery Audit Program began as a demonstration required in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. The demonstration was conducted from March 2005 to March 2008 in six states to determine if Recovery Auditors could effectively be used to identify improper payments for claims paid under Medicare Part A and B.

This demonstration allowed for additional review of Medicare claims for payment by utilizing Recovery Auditors on a contingency fee basis to identify and investigate claims with calculated risk. The demonstration established Recovery Auditors as a successful tool in the identification and prevention of improper Medicare payments. Section 1893(h) of the Social Security Act authorized the Recovery Audit Program expansion nationwide by January 2010.

Only one RAC for HHAs
The RACs in Regions 1-4 will perform postpayment review to identify and correct Medicare claims that contain improper payments (overpayments or underpayments) that were made under Part A and Part B, for all provider types other than Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) and Home Health/Hospice.

The Region 5 RAC will be dedicated to the postpayment review of DMEPOS and Home Health/Hospice claims nationally. Region 5 contractor, Performant, will conduct a webinar on March 21 for Home Health and Hospice providers. Click here for further information.


Medicare Fee For Service RAC Contact Information
Updated 12-06-2016

Region 1: Performant Recovery, Inc.
States: CT, MI, IN, ME, MA, NH, NY, OH, KY, RI and VT

Region 2: Cotiviti, LLC
States: IL, MN, WI, NE, IA, KS, MO, CO, NM, TX, OK, AR, LA, and MS

Region 3: Cotiviti, Inc.
States: AL, FL, GA, NC, SC, TN, VA, WV, Puerto Rico and U.S. Virgin Islands

Region 4: HMS Federal Solutions
States: AK, AZ, CA, DC, DE, HI, ID, MD, MT, ND, NJ, NV, PA, OR, SD, UT, WA, WY, Guam, American Samoa and Northern Marianas
Part A: 1-866-590-5598
Part B: 1-866-376-2319

Region 5: Performant Recovery, Inc.
Nationwide for DMEPOS/HHA/Hospice
333 North Canyons Pkwy, Suite 100 Livermore, CA 94551

[A©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. One copy may be printed for personal use; further reproduction by permission only.