The nation’s health care system is moving from volume to value, yet it remains fragmented and complex. Post-acute health care providers are facing increased pressure to move from fee-for-service to value-based payment. However, current market technology solutions to accelerate this journey have been criticized as too rigid and difficult to meet complex provider needs. In order to meet these needs, Maxwell Healthcare Associates (MHA) launches an operational and technology optimization consulting firm focused on collaborative use of people, process and technology for the future of healthcare in the home.

MHA Co-founder and Chief Executive Officer, Tom Maxwell, spent many years working with customers helping them adopt technology and gain efficiencies.The former Chief Operating Officer and Chief Strategy Officer for HomeCare HomeBase explained, “I was getting daily calls asking for help with utilization, adoption, optimization and interoperability. We saw the gap in the industry and decided to help bridge it.”[Details are provided in this article about MHA’s many past services to assist healthcare at home business providers amd about MHA that now operates “as an elite business consulting firm specializing in the home health and hospice industry” with details on the many needed services it can provide.]

MHA provides complete, in-depth operational assessments to both home care and hospice agencies across the nation. The operational assessment is more than skin deep. MHA identifies opportunities for agencies to become more efficient, cost effective and most importantly regulatory compliant from top to bottom, while adopting technology.

“Our objective is to enable all of our provider clients to succeed in an extremely competitive and disruptive health care environment,” says Jennifer Maxwell, President and co-founder.

“Whether a provider’s business is focused on commercial, Medicare or Medicaid patients, MHA has the know-how and engagement experience to deliver better quality. We will meet healthcare organizations where they are with the services and capabilities they need,” Maxwell said. “Some will need us to provide or build core capabilities…also work collaboratively with clients that already have those capabilities in place to help them achieve greater alignment and clinical integration.”

Other services provided:

  • Merger & Acquisition services (Clinical/Financial review) Full scope- management, operational, clinical/financial consulting
  • Strategic planning
  • Project Management services; EMR oversight, EMR implementation

About MHA
Maxwell Healthcare Associates describes itself as an elite business consulting firm specializing in the home health and hospice industry. MHA has a laser focus on management and strategic consulting solutions in the areas of compliance, due diligence, financial and clinical outcomes, as well as regulatory services. Leveraging over 20 years of experience and proven outcomes, MHA demonstrates the ability to marry technology and healthcare to their clients, enhancing the care delivery model and ultimately delivering stronger results. Visit their website at to contact Tom or Jennifer Maxwell and learn more.
MHA has hand-picked experts in the field to create a combined knowledge unlike any other consulting team in the industry. “We are building the dream team,” says Maxwell, “We are focused on hiring consultants that not only have experience in the technology focused around post-acute care, but also have the ability and history working on specific areas to deliver the systems, capabilities and management services that providers need to be successful under the new risk-sharing models across the spectrum.”

©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.


Springfield Mo. — February 17, 2017 — HEALTHCAREfirst has announced expansion of its workforce “to meet the rapidly increasing market demand for its products and services as well as the growing needs of its customers.” A company news release indicated that growth is expected to continue through 2017 as substantial investments in product development and client service are made. [The article notes a number of changes in executive staffpersons to help fulfill  the company’s mission to “continue to sustain their mission of enabling customers to focus on patient care instead of paperwork;”  and other staff changes and additions of new staffpersons with healthcare at home and business development experience are  noted as well.]

In an effort to continue to sustain their mission of enabling customers to focus on patient care instead of paperwork, HEALTHCAREfirst made some significant changes to their executive team, including the promotion of Steve Sablan to Chief Information Officer and Amy Anderson to Vice President of Product Management. Sablan, formerly Senior Vice President of Products for HEALTHCAREfirst, brings more than 15 years of healthcare information technology experience in both acute and post-acute settings while Anderson, formerly Director of Product Development for HEALTHCAREfirst, has more than 20 years of healthcare information technology and home health agency experience.

Additionally, to accommodate an influx of interest in HEALTHCAREfirst’s suite of home health and hospice solutions, three seasoned professionals were recently added to the sales team as Regional Sales Directors.

Tripp Matthews has more than 12 years of experience in the health care market, where he has most recently focused on business development for a number of large home health EHR organizations. He is responsible for HEALTHCAREfirst sales efforts in the southeastern United States, including Florida, Georgia, South Carolina, North Carolina, Kentucky, and Tennessee.

Brad Evanovich comes to HEALTHCAREfirst as a senior-level business development professional with more than nine years’ experience in the home health and hospice industry, most recently serving as Vice President of Business Development at AMC Health. He manages sales efforts in northeast United States, including New York, Ohio, Pennsylvania, Virginia, and Maine.

Rob Harriman brings six years of home health and hospice EHR business development experience to HEALTHCAREfirst. He directs sales efforts in a large part of the Midwest United States, including Illinois, Indiana, Michigan, and Missouri.

“Our new innovations and the increased interest in our products and services has led to greater demand in the marketplace,” said J. Kevin Porter, HEALTHCAREfirst President & CEO. “As a result, our team is quickly growing to support our customers as well as to enable strong sales efforts.”

HEALTHCAREfirst also increased staff in service delivery, to include 23 new hires. Growth in workforce continues with additional staffing expected at HEALTHCAREfirst in service delivery, product management, and product development to continue to meet the needs of its customers.

HEALTHCAREfirst provides cloud based technologies and services to improve business and clinical operations for over four thousand U.S. home health and hospice providers. Based in Springfield, Missouri, the company provides agency and clinical management software, revenue cycle management services (billing, coding and chart audits), CAHPS surveys, and advanced analytics, in any combination.

©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 Michael Giudicissi, CEO & Principal of Power Shot Training  (more…)

WESTBURY, N.Y. — Feb. 6, 2017 — Enhancing the telemonitoring services it has been delivering for more than a decade, Northwell Health Home Care Network announced an agreement with Health Recovery Solutions. The Hoboken, NJ-based telehealth company will provide Northwell patients with Bluetooth-enabled remote monitoring systems.

Patients like 100-year-old Bernard Feinstein of Queens (see inset) will benefit from wireless, Bluetooth-enabled tablets that include a moveable video camera, blood-pressure and digital weight monitors, a pulse oximeter and a stethoscope. The device transmits vital sign and symptom information to patients’ physicians, nurses and family members in real time, and also triggers alerts for patients at high risk of a medical emergency.[The article provides details on Northwell’s provision to healthcare at home providers  and delineates differences of this mobile  service from Northwell Home Care Network’s previous telemonitoring technology which operates from a desktop computer. Other features of the new system are noted as are comments from satisfied customers and from executives at both Northwell Health Home Care Network announced an agreement with Health Recovery Solutions.]

Northwell is one of the first home care providers in the New York metropolitan area to provide Bluetooth-enabled telemonitoring capabilities — and the only one on Long Island

Unlike the Northwell Home Care Network’s previous telemonitoring technology, which was integrated into a desktop computer, the portability of the new system provides clinicians with remote access to patients, enabling them to communicate 24/7, including on their mobile devices.

One very satisfied customer is Bernard Feinstein of Little Neck, Queens, who turned 100 years old in November 2016. “It gives me comfort that somebody is checking on me; if my nurse sees something that’s not normal, I know she will reach out,” said Mr. Feinstein. “I have a wonderful relationship with my nurse and all the doctors in this program. I feel very blessed to be a part of this program.”

Mr. Feinstein’s wife, Charlotte, added, “We are not computer experts. We don’t even own a computer, but we can manage this very well. With this program, we don’t have to leave the apartment and go back-and-forth to doctor visits.”

In addition to Bluetooth-enabled tablets, new telemonitoring features of HRS’ system include a digital weight monitor and a live-listening stethoscope that assesses patients’ heart and lung functions through video encounters on the tablets.

“The Northwell Health Home Care Network is committed to using technology to enhance patient outcomes while increasing patients’ involvement in their own health,” said Diane Asquino, RN, the agency’s director of patient services. “Telemonitoring is a wonderful tool to help reduce re-hospitalizations,” she continued. “It engages the patient in managing their health by helping them to identify symptoms early. If they think something is wrong, they can notify their physicians immediately to reduce hospitalizations.”

“We are thrilled to partner with an organization that recognizes telemonitoring as the future of home-based and outpatient care,” said HRS Chief Executive Officer Jarret Bauer.

Merryl Siegel, senior vice president and regional executive director of post-acute services at Northwell Health, added, “Together, Northwell Health Home Care and HRS are finding new ways to bring cutting-edge and compassionate care to all our patients.”

About Northwell Health
Northwell Health is New York State’s largest health care provider and private employer, with 21 hospitals and over 550 outpatient facilities. The system cares for more than two million people annually in the metro New York area and beyond, thanks to philanthropic support from local communities. The system includes 61,000 employees: 15,000+ nurses and nearly 3,400 physicians, including nearly 2,700 members of Northwell Health Physician Partners. Among facilities under the Northwell umbrella are the Feinstein Institute, Hofstra Northwell School of Medicine and the School of Graduate Nursing and Physician Assistant Studies.

About Health Recovery Solutions
HRS works with leading hospitals, insurance companies, home health agencies, and ACOs to deliver a platform that reduces readmissions and takes care of high risk patients post-discharge.


©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 and Publisher

In January, I was invited to speak at a compliance-oriented conference, organized by a couple of attorneys. We learned about Medicare rules and labor laws that certified and private duty home healthcare providers violate at their own peril. As if the urgency of their message was not already apparent, fate stepped in to underscore it…with a bright red pen.

On Saturday, January 14, as we speakers and conference attendees were being introduced to each other, we got word that a large Texas home health agency had abruptly closed its doors the day before. Bethany HomeHealth Services was a CMS 1.5-star HHA serving more than 20,000 patients a year in 160 counties since 2004 but it had recently been battling a 100 percent payment suspension by Health Integrity, LLC, the CMS Zone Program Integrity Contractor for region four. Many of Bethany’s 19 branch operations were allegedly averaging lengths of stay of over 220 days when the national average, depending on how it is measured, falls between 50 and 80 days. Rather than continue the battle, ownership made the decision to cease doing business with CMS. As Medicare represented nearly 100 percent of its revenue, that meant locked doors and layoffs.[More details about Bethany Home Health agencies’ shut down  by ZPIC [ Zone Program Integrity Contractor] auditors are provided in this article, along with warnings to other East Texas agencies, and directives to learn from others’ “misfortunes.”]

According to our sources, Bethany owners were good people and the healthcare system is, on balance, better off with them in it rather than out of it. They were neither career criminals nor consciously in business for the purpose of defrauding Medicare. They were just guilty of what we have in the past labeled Toxic Census Syndrome, the practice of clinging to existing patients to make up for the failure to win new referrals. The Feds no longer put up with the practice of four, five or six (or more, sometimes a lot more) consecutive PPS episodes the way they used to, especially when OASIS assessments and visit notes do not support medical necessity.

Take this as a warning: Bethany was not doing anything different than many of you who are reading this. This will not be the last HHA brought to its knees by MAC claim denials and ZPIC investigations.

Note to other East Texas agenciesIf you find yourself absorbing former Bethany patients and employees, notify your MAC immediately. As attorneys Lucian Bernard and Liz Pearson warned one of your colleagues when they heard this news at their compliance conference, any sudden, unexplained census spike automatically generates an ADR. The only protection you have is if your intermediary knows the reason for your spike in advance.

How did this happen?
The ZPIC investigation and 100 percent payment suspension centered around Conditions of Participation 42 CFR 405.371-372, allegedly due to extraordinarily high average lengths of stay for patients with low acuity. As we have frequently warned, in print and in live presentations, ZPICs do not acknowledge the difference between fraud and abuse. If your clinical documentation does not demonstrate a clinical reason to be in that home, you are a criminal in their eyes, not a lazy chart writer.

The old joke, “I don’t care what you publish about me, just spell my name right,” does not apply in these kinds of cases, where you do not want to see your name in print. The Longview News-Journal was the first to raise questions about whether the decision to close was planned or sudden. Writing from the employee perspective, the local daily pointed out in its January 13 story that Texas legal code requires home health entities that are closing permanently to notify the state Department of Aging and Disability Services within five days before closing an agency, branch office or alternative delivery site. The article added, “According to Christine Mann, spokeswoman for the Texas Health & Human Services Commission, the commission’s staff learned about the closure plans in a phone conversation Thursday [January 12] from Bethany. ‘At this point, we are not sure if this is a permanent closure or just temporary,’ Mann said. ‘We have only had verbal confirmation.'”

In a follow-up report in its January 16 online edition, the News-Journal added that Ms. Mann said that “Bethany had disclosed pending closures only in Longview, Carthage, Nacogdoches, Texarkana and Lufkin, not companywide.”

A January 18 report by KTRE-TV, the ABC affiliate serving Lufkin and Nacogdoches, however, quoted Ms. Mann as saying that Bethany told the Commission “seven offices would be closing effective January 27.” Still, phone calls to company headquarters in Plano from KTRE, Longview News-Journal and us went unanswered as early as January 13. The television report stated that “several clients and workers with the company have called KTRE seeking answers, saying the company has not been in communication with them about the future of its services.”

KTRE also posted a photograph of a sign posted on the locked door of the Lufkin branch office, reading, “Attendant’s Checks: All checks were mailed out from are [sic] corporate office, if you have any questions please contact are [sic] corporate office at (972-248-2441)… Thank You” Calls to that number were answered by a generic voice recording Monday afternoon.

While the state Health & Human Services Commission had been notified one day in advance of the closing, the newspaper added, “the company had not notified the real estate company that manages and leases its Longview building, Zach Williams Commercial Real Estate, or the Texas Workforce Commission of its closure plans. In contrast, Workforce Commission Communications Director Lisa Givens said American HomePatient Services notified her office before laying off 98 employees at its Longview support center and closing on December 31.”

Learning from others’ misfortune
There is a lesson to be learned here. Bethany’s MAC, Palmetto GBA, could have prevented this. Their practice is to continue to pay claims that should not be paid, promoting a false sense of complacency by allowing providers to believe they are compliant. All the while, they take notes and quietly prepare a case against those providers. Finally they pounce, usually without warning. This is not a lesson just for PGBA clients. All of the MACs are now under the corporate umbrella of one owner, CGS, A Celerion Group Company, so one should assume they will all begin to behave similarly.

Yes, it would be better if MACs educated, or at least gave stern warnings, before punishing an HHA into an early demise. But it is not likely MACs will heed that advice from this newsletter. Remember what we have said for years: CMS would be happy to be writing 6,000 checks per month instead of 12,000.

Therefore, it is HHAs that must change if their MAC’s and ZPIC’s will not:

  • Feed your revenue requirements with sales, marketing and growth, not with unlimited recertifications!
  • Make compliance your #2 priority after patient care!
  • Raise your clinical documentation standards!
  • And, most importantly, do not assume that a paid claim means you are doing the right thing and that you are therefore safe from a ZPIC investigation.
Ask yourself, is the U.S. healthcare system better off with you in it, or out of it? OK, now go do what you have to do to stay in.


©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 Elizabeth Hogue, Esq.

On February 1, 2017, a judge in the so-called Jimmo case ordered the Centers for Medicare and Medicaid Services (CMS) to enter into a Corrective Action Plan (CAP). The CAP requires CMS to provide more education about the addition of a coverage standard for maintenance therapy. That is, CMS is required to (more…)

ATLANTA–(BUSINESS WIRE)– Curaport, LLC, the new online resource for healthcare education, has announced new features and content for 2017. The Curaport web site now offers new webinars, podcasts, articles and an expanding library of on-demand content designed to give users and subscribers access to quality healthcare information and continuing education tools. (more…)

by Tim Rowan

The uncertainty that hangs like a cloud over Healthcare at Home providers and patients, employees and investors, seems heavier and perhaps harder to peer through than it was the last two times a moving van had recently pulled away from the White House. (more…)

by Tim Rowan

The first month of 2017 has seen a number of familiar faces printing up and handing out different business cards. For those who follow such things, here are a few examples.


by Julianne Haydel

Imagine if every one of your Face-to-Face documents and plans of care were scrutinized prior to payment. Would 90 percent of them be found compliant with existent rules? If a non-clinical person determined that your documentation did not meet Medicare coverage guidelines, would you take their word over your nurses’? How would you feel about submitting a perfectly valid claim for eligible services and being paid 25% less than your peers? (more…)