BLOOMINGTON, MN— January 9, 2017 — MatrixCare®, the largest long-term post-acute care (LTPAC) technology provider in the United States, has chosen Microsoft technologies to power the next generation of long-term post-acute care. MatrixCare is the parent company of Soneto, formerly known as Stratis Business Systems. (See HCTR, 12/9/15: MatrixCare and AOD Software Join Forces to Create Largest LTPAC Technology Provider and 7/16/14: AOD Software Acquires Stratis Business Systems). [Details are provided about planned, wide development of MatrixCare’s deployment of its CareCommunity LTPAC Population Care Management and Care Coordination platform on Microsoft Azure, and other uses of new technologies to ultimately improve the quality of life for seniors.  This goal is expanded upon by MatrixCare CEO, John Damgaard and by Laura Wallace, Vice President, Microsoft U.S. Health & Life Sciences.] (more…)

by Rob Love, Senior Account Executive for DeVero, Inc.

We have all heard of the Triple Aim of healthcare. Created by the IHI (Institute for Healthcare Improvement), it has been embraced as a guide to optimize healthcare systems. With aging populations and increased longevity, coupled with chronic health problems, new demands are being put on medical and social services. The Triple Aim is now at the center of many initiatives geared toward addressing these issues.

Everyone is familiar now with the three dimensions The Triple Aim pursues simultaneously:

  1. Improve care
  2. Reduce costs
  3. Enhance the patient experience  [The author provides a fourth. missing link or dimension, to this list–it is to enhance clinicians’ satisfaction with their healthcare delivery routines to their patients.The author calls this new thrust in the Triple Aim: the “missing link to better care.” He credits these thoughts to the philosophy of Herb Keller, of Southwest airlines. who Love says:”set an unprecedented example when he proclaimed that the people in an organization are more important than the customers.” Love goes on to encourage the healthcare at home industry to boost clinicians’ job satisfaction and provides reasons doing so will improve one’s business and patients’ satisfaction, too.  He goes on to provide 7 strategies for increasing clinical satisfaction which will, in effect, as he describes, improve one’s healthcare at home business.]

While a powerful target, there is a key focus  missing from the Triple Aim: Clinician satisfaction. Enhancing clinicians’ experience should be a fourth dimension.

The Missing Link to Better Care
In today’s ever-changing healthcare world, home health agencies have become accustomed to evolving their business models to remain compliant, improve care and reduce costs. Focusing on boosting clinician job satisfaction not only benefits the clinician, but also the agency and patients in their care. The business world has long recognized that employees are their life blood, and if home health agencies can adopt this mentality, better care will come naturally.

One of the pioneers of this concept, Herb Keller of Southwest airlines, set an unprecedented example when he proclaimed that the people in an organization are more important than the customers. If your people are happy, they are much more likely to make your customers happy, he argued. It was a novel concept at the time, but Keller’s method of management is now widely adopted at top companies, but not often in healthcare.

The nursing force in every healthcare institution defines the success of the company, and is the “face” of the agency or institution in the eyes of the patient. During a time when the home care industry is the highest growth occupation, and as agencies are soon to be asked to achieve the Triple Aim through value-based purchasing, one could argue that nurses are more responsible for the patient-satisfaction component than ever before.

Plus, high turnover rates are costly because of recruiting and training time and costs. If home health agencies can reconsider the value of their clinicians, and put strategies in place to increase job satisfaction and retention, better care will naturally result.

Strategies for Increasing Clinical Satisfaction
There is no one-size-fits-all solution for increasing clinician satisfaction. However, there are standards that can be customized to fit the unique business model and culture of any home health agency. Below are some strategies to consider (These are adapted from a presentation delivered at the National Association for Home Care & Hospice’s 2016 Annual Meeting by Sharon Brothers of Institute for Professional Care Education):

  1. Know and track your retention – What is the industry average, how does your agency compare, and what goals can you set to improve retention rates?
  1. Provide training for all employees – Generally speaking, 25 percent of all employees leave their jobs mainly due to lack of training and learning opportunities. On the other hand, companies who provide learning opportunities generate about 26 percent more revenue per employee.
  1. Hire better – Create a more in-depth screening and interview process so the best candidate for each position may be selected.
  1. Provide a pathway for growth – Employees want to know they have the potential to grow within an organization. Create clear paths for growth for each position, outlining the key milestones and goals that must be achieved at each level.
  1. Engage – It’s important to engage on a personal and professional level; showing interest in an employee’s personal life makes them feel like they matter beyond what their daily role is in the organization. Professionally, take the time to collect feedback and listen to ideas.
  1. Increase flexibility – This is a huge factor in today’s mobile-friendly work environment; consider what options you might have to offer your employees, like having more control over their schedules.
  1. Equip staff with the right technology – Home health technology has come a long way. Choosing to adopt easy-to-use technology can do wonders for increasing clinician satisfaction. Allowing clinicians to complete documentation while with a patient, or shortly after, alleviates the necessity for completing documentation during their personal time. Remember this rule of thumb: if the technology does not simplify the job, the job may not get done.


Better for Agencies too?
Targeting clinical satisfaction will position your agency for Value-Based Purchasing, increasing your likelihood of success under this model. However, high clinical satisfaction will reduce turnover as well, driving costs lower. With fewer resources dedicated to onboarding new clinicians, your HR costs go lower and your average experience level goes up. It is the very definition of “win-win”.

The gap that is left is measurement of satisfaction. I suggest that it become an initiative for your agency in 2017. It begins by measuring a baseline of current satisfaction and then creating targets. I suggest a simple tool like Survey Monkey to survey your employees. If you want to be more elaborate and automated, a tool like MoodMap might be the best choice.

If you survey your entire agency, make sure you create a way to measure clinicians separately. You might consider segmenting your clinicians further, as factors affecting nurses is likely different than therapists and aides.

The creator of the Triple Aim, IHI, believes everyone should get the best care and achieve the best health possible. If we as providers add Clinician Satisfaction as a Fourth Target of the Triple Aim, we will have a model that can drive healthcare into the future that will meet the IHI vision.

Rob Love is a Senior Account Executive for DeVero, a provider of EMR software systems for home health agencies and hospices. He has made available a longer version of this article, including more tips to increase clinician satisfaction, in a white paper on the DeVero web site.
©2016 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. The author has given permission for it to be freely copied, provided no changes are made, including this copyright notice.


Vendor Watch

New private duty data service

ClearCare Online, Inc., the San Francisco-based provider of cloud-based software for private duty home care agencies, announced on January 9 the release of ClearCare Insights, a new Big Data analytics system that provides home care agencies access to ClearCare system data related to an agency network.

The company stated that benefits include the ability to actively monitor agency data across an enterprise of any size, analyze data to identify opportunities and inefficiencies, view a complete picture of platform data to ensure compliance, and track performance office by office across an organization’s network. [Details are provided about how Insights leverages forecasting capabilities inherent in Big Data; a second company profiled in this week’s Vendor Watch is The Corridor Group, and its acquisition of Transpirus LLC, a provider of outsourced coding, revenue cycle management and strategic consulting solutions for the home health and hospice industry.  Details about investment organization HealthEdge Investment Partners, LLC are provided near he end of this article. ]

For example, CEO Geoff Nudd told us, Insights leverages forecasting capabilities inherent in Big Data. “You can use analytics or even machine learning to predict when a client is on the verge of going into a nursing home or a caregiver is at risk of burnout and quitting.”

Users gain access to data elements stored in a high-performance cloud-based data platform where they can isolate data sets related to specific criteria such as time frame, office location, billing, schedules and more.

“We are committed to giving our customers the tools they need to harness the power of their data,” Nudd added. “Our goal is deliver a competitive advantage to our customers and empower them to innovate faster.”



Corridor acquires Transpirus
Overland Park, Kansas — January 11, 2017 —Insights leverages forecasting capabilities inherent in Big Dataannounced today that it has acquired Transpirus LLC, a provider of outsourced coding, revenue cycle management and strategic consulting solutions for the home health and hospice industry. The transaction was completed on December 23, 2016. With Transpirus, Corridor says, it becomes the largest national provider of full service revenue cycle, clinical documentation review, advisory and education services dedicated to home health and hospice.

“Transpirus has an excellent reputation for quality,” said Des Varady, Chief Executive Officer of Corridor. “Combining with Transpirus strengthens Corridor’s ability to deliver services at scale and in a tailored way to meet each client’s needs.”

Ron Malone, Principal of Transpirus and former CEO of Gentiva Health Services, will join Corridor’s Board of Directors. “Corridor has a strong reputation for delivering quality services,” said Mr. Malone. “The combination of Corridor and Transpirus will leverage our joint capabilities and enhance offerings to our customers.”

“Transpirus expands Corridor’s industry leading post-acute services platform in a very meaningful way, consistent with our strategy and investment objectives,” said Guy Bryant, HealthEdge Operating Partner and Corridor Board Chairman. “We are very excited to have Ron join our Board and for Transpirus to be part of the Corridor team.”

About Transpirus
Transpirus is a business process outsourcing and consulting firm specializing in the home health and hospice industry. Transpirus offers end-to-end outsourced coding, revenue cycle management and strategic consulting solutions in the areas of compliance, due diligence, financial, clinical and regulatory services.

About The Corridor Group Holdings, LLC
Founded in 1989, The Corridor Group Holdings, LLC is a leading provider of outsourced coding, revenue cycle management, compliance services, consulting, and educational solutions to the post-acute healthcare industry. Corridor is a portfolio company of HealthEdge Investment Partners.

About HealthEdge Investment Partners, LLC
HealthEdge Investment Partners, LLC is an operating-oriented private equity firm founded in 2005 that focuses exclusively on the healthcare industry. HealthEdge invests in businesses that benefit from the knowledge, experience and network of relationships of its partners.


©2016 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.


Home Care Technology Report

Center to Advance Palliative Care

To: Mr. Andy Slavitt, Acting Administrator, Centers for Medicare & Medicaid Services

November 17, 2015

We have a few concerns about how requirements from the Medicare EHR Incentive Program will translate into the MIPS Meaningful Use Category. For a subset of palliative care providers, particularly those operating out of hospice or working in small hospitals and/or standalone clinics, this will be the first time they are held accountable for their use of certified EHR technology. [A hypothetical example is provided of a palliative care physician’s routine of using multiple EHR systems to enter and bill for palliative care services delivered in different venues  (and the drawbacks of the routine noted). The Center for Palliative Care staff’s recommendations to CMS to simplify reporting requirements of palliative care service providers are described in the rest of this article.]

Editor’s note: CAPC used a hypothetical physician to demonstrate its points. (see sidebar, below)

When Kim provides services at her two hospitals, she uses their EHRs. She has no control over these systems and finds that they do not include many of the fields that she typically uses when delivering services to her patients. As the hospitals do not allow outside access to their EHRs, Kim has to report her billing and quality measures to her organization using a separate tool the practice developed. When she delivers care in her outpatient clinic, she uses the hospice’s EHR, which she finds more practice-appropriate than the hospital or primary care EHR. Up until this point, she has not been required to participate in the EHR Incentive Program, yet she is aware that the Meaningful Use is one of the performance categories under MIPS and the ONC does not currently certify hospice EHRs. Switching or modifying the practice’s EHR in any great capacity is not possible in the near term, and when her vendor has called CMS for technical assistance, he has been informed that “hospices are exempt”. She is unclear what options are available to her moving forward.

Given the potential challenges that a small but critical subset of our clinicians will face with the adoption and use of certified EHR technology, we recommend that CMS exempt palliative care providers working in non-hospital settings from reporting under this category until such point as the ONC develops a process for certifying hospice and other non-primary care-based EHRs OR the field develops an alternative that will allow these providers to satisfy both CMS and ONC reporting requirements.

Meanwhile, for palliative care clinicians who are able to attest for meaningful use and meet a certain percentage of the measures, we strongly urge CMS to discard its “pass-fail” approach to compliance. Rather, we favor providing partial credit to physicians who demonstrate that they are making a good faith effort to meet the requirements for certified EHR use.


Hypothetical Clinician

Kim is a physician who works in a palliative care consultation-based practice that is operated out of hospice. She is in the process of obtaining her board certification in Hospice and Palliative Medicine; however, she is currently classified in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) under her primary specialty of Family Medicine. She sees patients in two mid-size community hospitals as well as in a freestanding outpatient clinic the organization just opened. As Kim typically treats patients who are not dying (and therefore not eligible for the Medicare Hospice Benefit under Part A), she bills Part B – making her an eligible professional (EP) under the various CMS quality reporting programs. When she provides care in the two hospitals, she uses their EHRs; however, when she is in the outpatient clinic, she uses the hospice’s EHR. Given that her patients have a wide range of diagnoses and she and her colleagues are primarily concerned with treating patients’ symptoms, her hospice has developed its billing system around ICD-10 codes.



From the June 27, 2016 letter:

We fully support CMS’s push to accelerate the use of CEHRT in patient care. Health information technology (HIT) done well can unlock previously unheard of capacity to effectively and efficiently communicate between providers; this is made all the more important given the increasing emphasis on following patients over time and across care settings. In order to survive in this new world, all providers must be able to gain access to pertinent clinical information electronically, and participate in health information exchange so that information can follow the patient.

Concerns and Recommendations
Our primary concerns in this category are those of time and money. Palliative care providers – particularly those in standalone or community-based practices – have disproportionately struggled to stay afloat under FFS. Even in large hospitals, FFS reimbursement generally covers only about one-third of the palliative care department operating budget; the rest comes from hospital overhead and philanthropy. Some hospitals are willing and able to invest in their palliative care clinicians, but programs in many of our important service sites (e.g., SNFs, NFs, home care, assisted living, office settings, and PACE) have not had this luxury. In their efforts to stay afloat, many were not able to participate in the early years of the Meaningful Use EHR Incentive Program (MU) that would have provided them with some of the startup funds required to invest in CEHRT. As adoption was not required, these practices had to make difficult decisions around priorities.

Another situation that may be unique to palliative care is the fact that several practices are actually business lines being run under the corporate umbrella of a hospice. Hospice EHRs were exempt from MU, and so a majority of hospice-based EHRs are not compliant with MU standards. This means that many palliative care providers employed by a hospice but billing Part B for non-hospice palliative care patients cannot receive credit for EHR activities.

MACRA has now changed the game. All clinicians understand that they must adopt CEHRT in a rapid timeframe or close their doors. Unfortunately, many palliative care practices remain in the same position that they were five years ago – completely under-resourced – but now there are no longer MU incentives available to ease their transition. As the Advancing Care Information calculations currently stand, palliative care clinicians are at such an extreme disadvantage as to threaten their ongoing viability. Therefore, we request that CMS make new money available to help support the purchase and adoption of CEHRT for palliative care practices – especially small practices and those based out of hospices – that missed the MU incentive payments. We suggest that CMS also build in new timelines for EHR adoption in small practices, since EHR use is essentially the cornerstone of all the other reporting mechanisms under MIPS, and yet a majority of these practices are unlikely to successfully launch their EHRs by January 2017.

©2016 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— January 11, 2017 — HEALTHCAREfirst, a leading provider of Web-based home health and hospice software, billing and coding services, and advanced analytics, announced its partnership with Qualis Management, the nation’s first DME management company that enables hospices to effectively manage DME orders, costs, and utilization to provide the best patient experience. [Specifics are described about the valued interface enabled by these companies’ alliance. Comments are provided by the 2 companies’ executives and by a customer of both companies– on value the alliance will bring to improved care of hospice patients.]

This interface provides automatic transfer of demographic data from HOSPICE to the Qualis DME software. This saves valuable time for hospice staff by eliminating duplicate data entry, and it expedites the DME order process to more quickly accommodate patients. The interface will also include a bi-directional data feed that transfers equipment information back into firstHOSPICE, further reducing redundant documentation and increasing efficiency of clinical staff.

“We are thrilled to partner with Qualis,” said J. Kevin Porter, CEO of HEALTHCAREfirst. “They have been great to work with as they share our philosophy of patients before paperwork. We know that these interfaces are meaningful in the day to day workflows of a clinician. We are looking forward to expanding our interfaces and interoperability as part of our strategic initiatives for 2017 and will continue to partner with the best in the industry.”

Ray Thomas, President of Qualis Management said, “We hear more and more from our customers that they are looking for ways to increase efficiency. We are excited to be a part of this solution to help hospices work smarter and not harder. It is partnerships like this that are positively impacting care delivery, and we are thrilled to be working alongside of HEALTHCAREfirst to bring these enhancements to our mutual customers.”

“As a customer of both HEALTHCAREfirst and Qualis, we are very excited about this interface,” said Angela Sipe, Executive Director of State of the Heart Care in Indiana and Ohio. “When we can respond to our patients more quickly and be attentive to their needs, they have a better end of life experience and the family feels more supported. We depend on advancements in technology to help us provide excellent hospice care and we have great partners.”

The interface has been completed allowing customers to immediately take advantage of efficiency gains. For more information, customers can contact either company.

©2016 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.


Dear Healthcare at Home Colleague,

In our annual year-end summary, we offer you a collection of articles that you, our readers, decided were the most interesting news items of the past year.

And what a year

2016 has been! (more…)

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

What are the two most important factors home care agency owners and administrators look for in an Electronic Medical Record? According to Caryn Coff, owner of a Pennsylvania Visiting Angels franchise, they are responsive software and a responsive vendor partner. [Rowan describes Ms. Coff’s 12-year experience with Rosemark software provided by Shoshana Technologies of Ann Arbor Michigan and the value she has derived from this product and her very satisfied relationship with its vendor. Details about Rosemark software’s capabilities are provided.]

For the last twelve years, Ms. Coff’s software has been Rosemark, provided by Shoshana Technologies of Ann Arbor Michigan. Her reasons for staying with one vendor for so long include both her satisfaction with software performance and with the people who sold it to her.

“The way we have structured our business, everything goes through Rosemark,” she told us, “every aspect of our business from notes to scheduling to business contacts, billing and patient history.” She emphasized that that practice makes her operation almost completely dependent on its computers.

“That is why it means so much to us that they act as a business partner,” she continued. “They taught us how to use it and they continue to help us use it better. Customer service and support are excellent. Every time we have a problem or a question, Linda (Teaman, Shoshana founder and CEO) is right there. And not just with instructions about the software but with business coaching that helps us do things right.”

Acknowledging that generalities about good vendors are less convincing than examples, Ms. Coff described one representative incident. “I kept saying to Tom (Voiles, Shoshana President), ‘I need to run this business from my phone; I am so often out of town or at meetings out of the office.’ Then, out of the blue, at a meeting in Orlando, he walked up to me and showed me a mobile app they had just released.”

Rosemark is a schedule-centric, electronic medical record software application for private duty home care agencies. It is a cloud-based system that features software functions such as:

  • Client acquisition and retention
  • Marketing activities
  • Revenue management
  • Billing
  • Payroll
  • Caregiver management and schedules
  • FTE reporting

Client education services include regular webinars. Contact Shoshana for information about access to a recorded webinar by Home Care Technology Report editor Tim Rowan.


©2016 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 Audrey Kinsella, HCTR’s Telehealth Reporter

Care-Coach avatarA major theme of last fall’s Partners Health Connected Health Symposium in Boston was the need to blend old and new ways of caring for the growing number of elderly Americans who live with multiple chronic diseases.

So often reduced to an either/or discussion — more office visits; more in-home visits; more remote vital sign monitoring — developing new care models, experts at the symposium repeated over and over, must start with a more personable connection with care providers and include socially supportive levels of care. What they were getting at was the need to blend conventional service delivery models with new ones, toward the goal of keeping seniors well, engaged and on track. [care-coach, a new technology company that helps provide a blending of old and new care modes to seniors by pet avatars is described, with details about human specially-trained health advocate team members. Case examples are provided, and details about this team’s training are discussed by company founder Victor Wang. Needed acceptance and use of this technology is discussed by Jennie Chin Hansen (formerly a key executive of AARP and the American Geriatric Society.]

care-coach (Millbrae, CA and New York, NY), is a new technology company helping providers create this blend of old and new care modes through the use of pet avatars. Though new, its staff has a history in addressing healthcare needs of elderly patients via “companioning” technology. [GeriJoy was care-coach’s earlier, avatar-based product billed as offering “care and companionship”] The latest iteration takes the connection between elderly patient and pet avatar to a new level.

At start-of-care, conventional care plans are loaded into 24/7-accessible avatars of the patient’s choosing — cats, dogs and others. These “pet-like companions” are not toys. They are actually guided by a specially trained “Health Advocate” team. As care-coach CEO Victor Wang explains, “Team members work from home all around the world, and provide a compassionate, psycho-social level of support and personal interaction, 24×7.”

Health Advocates, not clinicians
While the specially-trained health advocate team members are not clinicians, Wang explains, they are required by care-coach to complete extensive training and achieve several certifications, often from Partners HealthCare, in the use of a conversational technique known as “motivational interviewing.” They also learn from the Alzheimer’s Association to master targeted dementia care for appropriate clients. Health advocates are further guided by care-coach‘s proprietary software to follow targeted directives, ensuring that patients are properly coached to execute the details of their personalized self-management plans.

Wang adds, “These plans are often very involved, including coaching individual seniors so they can follow their daily care routines and stay on track with medication adherence, exercise routines for fall risk mitigation, and self-management of chronic conditions such as heart failure, COPD, diabetes, hypertension, and others. All the while, their coaching is layered on top of developing a patient’s relationship with their chosen avatar.”

As an example of how this works, a care-coach website video shows a dog avatar encouraging his assigned patient to bring a sunhat, sunscreen and back-up medications for his upcoming fishing trip. These reminders are followed by well-wishes and suggest development of what the company calls “seamless integration of software-driven health coaching on top of a people-driven social relationship.” Supporting a patient’s regular routines is another way of customizing care delivery and cementing the one-on-one relationship between patient and avatar.

care-coach typically serves patients ages 50-85+, an age group one would assume is more comfortable with traditional ways of receiving healthcare services and possibly a hard sell for high-tech care delivery. But no, Wang believes. According to patient and researcher views posted on the care-coach web site, participating patients understand that avatars are there to help. For example, at the end of a particularly less-engaged day, the avatar may say, “Remember that you want to get well enough to attend your granddaughter’s graduation from college!”

CEO Wang added that the company is now engaged with hospitals and health plans, participating in clinical research with avatars mounted on inpatient hospital bed rails. “They significantly reduce the rate of falls and delirium by, you guessed it, socially supporting patients and layering on top of that relationship protocols to drive these clinical outcomes.”

To those who argue this technology forces a choice between avatars and high-touch nurses and other caregivers, Jennie Chin Hansen, former CEO of the American Geriatric Society and former AARP President replies, “care-coach is pioneering a game-changing innovation for aging and geriatric care that leverages the best of both human and technological capabilities.” Clearly, animated avatars driven by remote health advocates aware of each patient’s needs supplement but do not replace the work of high-touch, in-person clinicians.

I have been convinced that such technologies should be judged by what keeps patients well, not by what keeps the status quo in place. Aided by evidence of what works, such as that provided on the care-coach web site, I believe we all may finally come around to thinking positively about different kinds of touch.

Audrey Kinsella, MA, MS, is HCTR’s telemedicine reporter. She has written on home telehealthcare and new technologies for home care service delivery for 20 years, in 6 books, multiple web sites, and more than 150 published articles. Audrey can be reached at or 828-230-0895.

©2016 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

Is a healthcare provider obligated to comply with a regulation if the regulator has made compliance impossible?

This is the question hospice-based palliative care providers are asking themselves this month after listening to CMS-sponsored educational webinars about a provision of the MACRA regulation (see sidebar) that took effect this month. Along with their hospital-based peers, they are suddenly required to submit quality data using certified electronic medical record software, which does not exist. [Rowan provides exacting detail about HHS’s announcement of its final rule “to implement key provisions of the bipartisan Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) in a new program called the Quality Payment Program. The Program advances Medicare’s value-based transformation for hundreds of thousands of physicians and other eligible clinicians by tying these payments to quality patient care” for palliative care patients. Identification of only two

home health and hospice software vendors who “actually did go through the expensive, time-consuming process and won certification for their applications” is provided, as are comments from the person designated by the Center to Advance Palliative conduct educational webinars. Ongoing work of providers, along with state and national organizations ” to get CMS to understand the Catch-22 situation they have inadvertently created” is mentioned at the conclusion of this article.]

From ONC

On October 14, 2016, the U.S. Department of Health and Human Services (HHS) announced a final rule to implement key provisions of the bipartisan Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) in a new program called the Quality Payment Program. The Program advances Medicare’s value-based transformation for hundreds of thousands of physicians and other eligible clinicians by tying these payments to quality patient care. A number of the provisions in MACRA directly relate to the use of certified electronic health record (EHR) technology and health information technology (health IT), including the Advancing Care Information performance category under the Quality Payment Program. The Advancing Care Information category will modernize, streamline, and replace the Medicare EHR Incentive Program for eligible professionals (also known as “Meaningful Use”). The Quality Payment Program advances the use of certified EHRs and health IT as tools to improve the flow of health information among clinicians and, ultimately, improve the quality of care provided to patients.

Implemented through the Office of the National Coordinator for Health Information Technology, MACRA is intended to gradually convert payment standards from clinical activities to patient outcomes. The latest implementation of the law requires providers of palliative care services to submit quality reports via certified EMRs. Its language exclusively mentions the activities and obligations of “clinicians” as it is based on legislation aimed at physician practices and hospitals that offer palliative care services. “Agencies” offering palliative care are not mentioned but apparently fall under the regulation.


This is where the problem lies. More home health agencies and hospices provide palliative care than hospitals do and they all use software that has never been involved in the certification process. Home Health and Hospice were excluded from the financial incentives that reward hospital and physician software vendors for winning certification so vendors did not subject themselves to the expense of seeking certification.

Except for two of them
Digging into our archives, we found that two home health and hospice software vendors actually did go through the expensive, time-consuming process and won certification for their applications.

Thornberrry, Ltd. went through the Certification Commission for Health Information Technology which, before it was disbanded in 2014, had a post-acute EMR category. CCHIT was an ONC Authorized Testing and Certification Body. What made the process so arduous, Thornberry CEO Tom Peth told us, was that home health was not separated out as a sub-category. That meant his developers had to add features to their NDoc software that are needed in skilled nursing facilities but irrelevant to home health. That obstacle alone may have kept other vendors from attempting the process.

HealthMEDX, the Springfield, Missouri-based company now owned by NetSmart, went directly through ONC, the Office of the National Coordinator of Health Information Technology, to earn its certification in six specific categories (

Educational webinars were conducted for palliative care providers by Stacey Sinclair of the Center to Advance Palliative Care. When palliative care providers pointed out to her that most care of this type is provided not by hospitals but but hospices and that hospice software vendors have been discouraged from seeking certification since the beginning of the Meaningful Use era, her response was no more than, “Oh, yeah, I didn’t realize that. I guess that’s going to be a problem for you, isn’t it?”

Naturally, frustration rides high among palliative care providers. Some have told us that they are faced with two bad choices, either convince their current vendor to spend tens, perhaps hundreds, of thousands of dollars to get their existing applications certified or switch vendors. Either path takes time.

On the bright side, they also told us they are working hard with state and national associations to get CMS to understand the Catch-22 situation they have inadvertently created. We will keep an eye on this dilemma for our readers, whose feedback is welcome.


San Jose, CA – January 3 – DeVero, Inc. announced today that 2016 was the best year in company history as measured by recognition, customer growth, revenue, and product development. A company news release stated that its cloud-native, post-acute healthcare software is “enjoying tremendous market acceptance.”

With a 10-year anniversary in sight, the San Jose-based software company earned national recognition as one of America’s fastest-growing companies by, and ranked 26th in the Silicon Valley Business Journal’s Fast 50, in the highly-competitive San Jose region. [Details are provided about this company’s scalable healthcare platform designed to adapt to multiple care settings and its use in healthcare at home and hospice markets as well as its adoption in other markets  that need to provide clinical documentation needs outside the traditional Home Health and Hospice markets are discussed.  DeVero’s multiple achievements earned in 2016 are noted and its plans  for product improvements in 2017 are indicated.]

A scalable healthcare platform designed to adapt to multiple care settings, DeVero is best known amongst home health and hospice agencies, but company CEO Joe Randesi says the software is gaining recognition with other healthcare-at-home providers. “We’ve seen amazing growth with our core base, as we continue to enhance the product for the home health and hospice customers. Where we’ve seen increased interest is with opportunities that have clinical documentation needs outside the traditional Home Health and Hospice markets. Because we’ve built our solution with the broader healthcare market in mind, customers are able to leverage our platform and take their business to any type of care they desire, all while managing their patients on a single platform. We’ve heard from providers in behavioral health, pediatrics, and even government agencies that need to launch a program that involves clinical data collection.”

New features introduced
2016 also saw DeVero roll-out a number of key features, including Secure Communication via an integration with TigerText. Document Manager, which automates many of the processes behind document and physician order management was widely adopted by existing DeVero customers. Also during 2016, DeVero achieved SOC2 (formerly SAS70) certification, based on a report that measures security, availability, processing integrity, confidentiality, and privacy of a system.

“We saw numerous enhancements and achievements in 2016, and we look forward to even more in 2017,” Randesi added. “We plan to continue to address the needs of the ever-changing marketplace and will ensure that DeVero will be a partner that will adapt and grow with our customers and the industry.”

©2016 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.