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by Audrey Kinsella

 

I learned this week about a new telemedicine system that brings together home health nurses and remote physicians to care for homebound patients. MedPod, Inc. describes its vision as “developing proprietary technologies to enhance clinical decision-making, particularly in long-distance settings.” The New York City company has just introduced the MobileDoc system, a kind of doctor-to-healthcare-at-home tele-housecall. The system packages tools for a complete remote physician-to-patient visit, calling it a “compact medical office in a bag.”

MobileDoc allows physicians to perform as many as 70 remote diagnostic tests and procedures from their offices for patients already receiving conventional home health services.[Details are provided  about uses of these physician-nurse-patient system, with a case study noted of a remote physician diagnosing the extent odf an elderly patients trauma in his home bathroom shower and avoiding ER visits and costs.  Overall costs savings expected from use of this are noted, as is the anticipated promise of use of this system.]

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Brightree (Lawrenceville, GA) will be sending two teams of home health and hospice experts to lead a panel examining how to effectively utilize readiness assessment methods and characteristics for when an organization is prepared to implement or replace an electronic medical record (EMR) system. Another session will address how technology impacts professional recruiting. The panel will be featured at the 2017 Rocky Mountain Home Care, Home Health and Hospice’s annual conference in Keystone, Colorado, May 17-19.[More details on the panels to be presented at the 2017 Rocky Mountain Home Care, Home Health and Hospice’s annual conference are provided in this short article including the agency’s particular emphasis on educating hospice workers to use EMRs.]

To better educate hospice providers on how to leverage healthcare technology, Brightree’s upcoming panel, “Hospice Agency EMR Readiness Assessment,” will examine effective assessment methods and key characteristics of organizations ready to embark on an EMR implementation or replacement. Panel attendees will learn how readiness assessments reinforce best practices related to organizational efficiency, staff adoption and the successful utilization of technology.

Panelists include:

  • Tarrah Lowry-Schreiner, CEO of Sangre de Cristo Hospice and Palliative Care;
  • Rachel Taylor, hospice manager of Canyon Home Care and Hospice;
  • Nick Knowlton, Brightree VP of Business Development and CommonWell Health Alliance board member;
  • Kim Weddle,BN, BSN, Brightree clinical specialist; and
  • Melissa Polly, Brightree product marketing director (moderator).

“In order to effectively utilize technology, hospice organizations need to assess their technological needs and willingness to undertake an EMR implementation project,” said Taylor. “Readiness assessments are essential in providing agency leaders with an overview of the resources available to them and what steps they need to take in order to successfully adopt and implement an EMR system.”

“The benefits of electronic medical records go beyond the simple ability to access and coordinate patient care, but rather all activities completed through EMRs are aimed at improving quality of care for patients,” said Knowlton. “To move forward with an EMR system, hospice agencies must understand the key characteristics for project readiness and how to identify areas of improvement. This is a vital step in any EMR implementation.”

“Clinician Recruitment, Retention & Satisfaction: Does Technology Help or Hinder?” is the second panel discussion scheduled for this week’s Colorado meeting. Panelists announced will be:

• Kim Weddle, RN, BSN, Brightree clinical product specialist
• Tarrah Lowry-Schreiner, president & CEO, Sangre de Cristo Hospice & Palliative Care
• Rachel Taylor,  administrator, Canyon Home Care & Hospice
• Melissa Polly, moderator, Brightree product marketing director

The session will analyze what changes in the post-acute environment, from regulatory drivers to value-based care initiatives, are spurring technology adoption and how agencies can engage clinicians, including:

• Best practices to identify which technological tools will provide the most value to an agency and their clinicians;
• How to leverage technology to enhance nurse satisfaction, operational efficiencies and clinical documentation; and
• Making sure clinicians can effectively utilize technology to improve quality of care and improve the patient experience.

About Brightree

Brightree is a leading provider of cloud-based software to improve clinical and business performance of post-acute care companies. Ranked one of the top 100 health care IT companies in the U.S., Brightree serves more than 2,200 organizations in the HME, home health, hospice, orthotic and prosthetic, HME pharmacy, home infusion and rehabilitation home care segments.
brightree.com

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

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

Ross Huddleson can no longer drive. He lives in a small, rural town where there is no bus service. Until recently, he lived in that awkward no-man’s-land between being technically homebound, which does not make him eligible for the Medicare home health benefit, but not physically homebound, which would have given him eligibility.

With advanced Parkinson’s Disease, he should be trapped in his home. He is not. A client of The Independence Center in Colorado Springs, Ross had accepted his limitations, which meant walking through the hilly, rough roads and sidewalks on the plains east of Pikes Peak. [Rowan provides details in this short article about a staffperson’s at The Independence Center in Colorado Springs role in connecting  client, Ross Huddleson. living with Parkinson’s disease, with a Colorado company, Biketricity, which is in the business of converting manual bicycles to electric. bicycles.  Excellent results in improved balance and nobility achieved by Huddleson are described.]

Enter a Colorado company, Biketricity, which is in the business of converting manual bicycles to electric. Ross and his independent living coach, Fran Dorrance, ran across a few articles that mentioned the healing benefits of bicycling for people with Parkinson’s. Intrigued, they decided to pursue obtaining a bicycle for Ross. The benefit of a bicycle would be two-fold: to help combat the degeneration of Parkinson’s and to help Ross with his transportation needs.

Fran set up Ross with Paul Spotts, Independent Living Specialist (Assistive Technology Emphasis) at The Independence Center, to help obtain funding for an adaptive bicycle and helmet. Funding was granted and Ross was fitted by Biketricity for a brand new adaptive trike with motor. The trike helps Ross maintain stability despite balance issues, while the motor is available for use when Ross tires.

Ross’ new mobility has freed him. “When he first got on it, we had to get in a car and chase him down,” Fran recalls with a laugh. “When I go someplace not, it doesn’t take me a half hour to get there,” Ross adds. Both mentioned that Ross’ coordination of movements has improved after riding.

“We’ve all noticed a huge difference. We really have. The therapy part of the trike has been very beneficial,” Fran says as she smiles at Ross.

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

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By Michael McGowan, former OASIS coordinator for CMS Region 9, and currently  CEO of OperaCare, a software/consulting company

If you are a Medicare-certified home health agency either responding to a bottomless pile of ADR requests, entering into the second round of Probe and Educate, or maybe even enduring a ZPIC pre-payment review, I suggest you take a step back and ask yourself one important question: “How are my clinicians doing their charting?”

Do they chart by checking boxes? Or are the records my agency submits for review filled with robust, data-rich, longitudinal charting? Are they charts that speak to each patient’s unique individual story in direct correlation to the severity of the illness or injury being treated? [McGowan provides need-to-know details about CMS’s expectations of healthcare at home agencies’ longitudinal patient charting with many examples of  acceptable charted submissions–and, it’s noted, failure to meet CMS’s expectations may well lead to payment denials.]

 

If you answered ‘yes’ to the first question and ‘no’ to the rest, you need to know about CMS’s not-so-well-kept secret: CMS expects longitudinal charting. It has for many years now. However, like many CMS rules, it has been lying dormant, on the books but not enforced. This is changing, sooner than many will be ready for.

CMS has published a blueprint to aid in the development of longitudinal charting. I have shown it to hundreds of agencies over the past few years a the typical response has been, “CMS expects too much.” Worse, the most common response is, “My EMR does not support that.”

Way back in the MBPM 5-11-2015 update, CMS clearly communicated what longitudinal charting is, through the use of examples. Let’s look at what follow-up notes should and should not say.

First, the should not’s:

“Vague or subjective descriptions of the patient’s care should not be used. For example, terminology such as the following would not adequately describe the need for skilled care:

  • ‘Patient tolerated treatment well’
  • ‘Caregiver instructed in medication management’
  • ‘Continue with POC’

These warnings tell us they really have been reading your charts. They are familiar with your practices and want to educate you with feedback from their medical review teams. If that doesn’t work, they will use payment denials as an educational opportunity.

Now the should’s:

“Clinical notes should be written such that they adequately describe the reaction of a patient to his/her skilled care. Clinical notes should also provide a clear picture of the treatment, as well as ‘next steps’ to be taken. (Longitudinal Charting)”

Thus, the clinical notes are expected to tell the story of the patient’s achievement towards his/her goals as outlined in the Plan of Care. In this way, the notes will serve to demonstrate why a skilled service is needed. Therefore, the home health clinical notes must document as appropriate:

  • The history and physical exam pertinent to the day’s visit, (including the response or changes in behavior to previously administered skilled services) and
  • The skilled services applied on the current visit, and
  • The patient/caregiver’s immediate response to the skilled services provided, and
  • The plan for the next visit based on the rationale of prior results.

Following these bullet points in the order presented creates a longitudinal chart with each note building on the last, developing a clear demonstration of medical necessity for the services provided and outcomes obtained. On the other hand, tolerating clinical documentation laxity drastically increases the likelihood that a ZPIC letter will soon arrive on your desk. It could be the most expensive letter you ever open.

 

Michael McGowan is a former OASIS coordinator for CMS Region 9. He has been a Medicare payment denial appeals consultant and now is the CEO of OperaCare, a software/consulting company that helps home health agencies avoid payment denials, payment takebacks, ADRs and ZPIC audits.

 

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

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