Most recently CEO of Alere Health, LLC, Underwood brings over 22 years of healthcare software executive experience to Sandata, including building healthcare technology start-ups and leading large public companies. Alere Health is a $500 million subsidiary of Alere Inc. (NYSE: ALR). The Atlanta-based subsidiary provides health management services incorporating in-home monitoring devices for medium and high-risk patients.

Prior to becoming CEO, Underwood held the roles of President of the Technology Solutions Division and Chief Information Officer. He arrived at Alere through its merger with Matria Healthcare where he was President and Chief Operating Officer. Before Matria, he spent the earlier part of his career in various executive roles including President of Global Shared Services for First Consulting Group and President and CEO of Paragon Solutions.

“I am looking forward to this exciting opportunity and couldn’t be happier to join the outstanding team of people at Sandata,” Underwood was quoted in a company release. “As the clear market leader in home health care with a compelling value proposition for home health providers, state governments and managed care payors, Sandata is in the early stages of capturing an enormous market opportunity. My focus will be to continue to enhance our strategy of decreasing fraud, abuse and waste for state government and Medicaid managed care organizations and providing state of the art technology solutions for home care providers. I am excited to build on Sandata’s reputation of providing quality solutions and excellent service to all our customers.”

“We are excited to have Tom join Sandata as CEO to further build on our leadership position providing technology solutions to the home healthcare industry,” added Bert E. Brodsky, Sandata founder and Chairman. “Tom’s industry and senior leadership success will be a tremendous asset to our customers and our organization.”

“Tom’s proven leadership skills, domain expertise and track record of building innovative, rapidly growing healthcare and technology companies, coupled with Sandata’s dominant leadership position and strong management team, provide a solid foundation to accelerate the Company’s momentum,” said Ken Fox, Managing Partner of Stripes Group. Founded in 2003 and based in New York, Stripes Group is a private investment firm focused on growth stage minority and majority investments in rapidly growing and profitable Internet, software-as-a-service, technology-enabled services and consumer products companies. Stripes Group acquired a minority ownership position in Sandata in March, 2010. Ken Fox also sits on the Sandata board.

• We ran 201 articles in 2011.
• Collectively, they were read 40,687 times.
• 413 articles from past years were read 16,655 times during 2011.
• HCTR’s 17 advertiser sites were visited 7,047 times during the year.
• Since separating from my late mentor’s company and becoming an independent enterprise halfway through 2009, Home Care Tech Report articles have been read 121,230 times.

Last Year’s 25 Most-Read Stories (in descending order):

Editor’s Corner: Is Paul Ryan Another Tom Scully? Medicare Providers and Beneficiaries, on the Brink, Hope He Is Not – 4/6

Editor’s Corner: From Bedside to Billing (a 3-part series)

— Part One: “Prevention + Cure” Works in Business Ops As Well As in Patient Care – 1/19
— Part Two: Let’s Tell the Truth About Clinical Point-of-Care Systems – 2/26
— Part Three: Financial Consequences of Clinical Decisions – 2/2

Controversial Policies of Four State Medicaid Programs Instigate Creation of New Advocacy Group – 3/16

Home Health Care Prepares for Accountable Care Organizations and Payment Bundling – 3/2

Breaking News: HEALTHCAREfirst Acquires CareFacts – 1/3

Recovery Audit Contractors Appear to Have Discovered Home Health Care – 8/3

Futurists Present To-Do List to Home Health Care Providers Hoping to Survive Healthcare Reform – 7/27

New Device-Free Telehealth System Emerges, Combines Internet with Telephone – 6/29

Accountable Care Organization Advent Elicits Somber Forecast from Healthcare Finance Expert – 3/9

New Portal Technology Streamlines Face-to-Face Paperwork Processing – 7/20

Post-Acute Care Provider Cooperation Effort Virtually Eliminates Hospital Readmissions in Las Vegas – 8/10

Reading Between the Lines: Is Home Telehealth Moving Away From Home Care Market? – 5/11

Care Continuum Alliance Releases Free ACO Toolkit – 4/27

New Telehealth Company Caters to Needs of Adult Child Caregivers – 2/9

Researcher Explains Slow Software Sales During Home Health Growth Spurt – 5/25

Bosch Healthcare Names New President, Dr. Jasper zu Putlitz Will Oversee U.S. Home Telehealth Business – 1/19

New Intel/GE Joint Venture CEO Challenges Both Telehealth Vendors and Healthcare Providers – 2/16

HomecareCRM Calls Lawsuit ‘Unfounded’ – 6/22

Something is Going On at Delta Health Technologies – 3/30

County Health Department Home Health Agency Solves F2F Problems with Electronic Signature System – 8/17

BREAKING NEWS: Procura Acquires ContinuLink – 6/8

CMS Offers Sneak Preview of How Bundled Payments Will Work; Requests Your Input – 8/24

Intel/GE Spinoff Moving Away From Device-Based Home Telehealth – 6/15

The Growing Importance of Revenue Cycle Management: Introduction to Decade’s Hottest Topic – 4/6

Vendor Watch: Ken Pereira Discusses Mediware’s Acquisition of CareCentric – 6/22

Ms. Pure comes to the Ozark, Missouri-based long term and post-acute care (LTPAC) technology developer as part of a growth equity investment in HealthMEDX by Spectrum Equity Investors and Trident Capital. The new partners will own a majority interest in the company. As part of the transaction, Jim Quagliaroli and Steve LeSieur of Spectrum Equity, Arneek Multani and John Reardon of Trident Capital, and Ms. Pure will join HealthMEDX’s board of directors.

With Ms. Pure, Vince Estrada, former SVP Business Development and CFO of Visicu, Inc. will join as EVP of Business Development and Chief Financial Officer. HealthMEDX Co-Founder Charlie Daniels will remain as President and Co-Founder Dan Cobb will remain as Chief Technology Officer. Co-Founder Jim Atteberry will move from CEO to a new role as Strategic Advisor.

CEO’s story: from McKesson to caregiver to HealthMEDX
We spoke with Ms. Pure this week to ask about the process that brought her to this new position and her plans for HealthMEDX. After leaving McKesson, Pamela Pure was going to take a year off to spend time with her family and do some traveling but events — including a father-in-law’s heart attack right in her driveway — caused her to spend that time as a full-time family caregiver instead. In succession, she brought three different parents, hers and her husband’s, into her home.

“I was a healthcare executive but I found out that does not prepare you to serve from the other side of the equation,” she said. “I was impressed with the whole post-acute world so much, it inspired me to write a business plan about what could be done to improve it.”

Once her family members were living on their own again, Ms. Pure joined a private equity firm. Her goal was to find a company to manage in order to use its technology as the basis for her post-acute care plan. After looking at twenty companies, she found HealthMEDX, with its origins in long term care, to be unique. “Its medical system allows post-acute providers to follow a patient from one care setting to another with a single patient record and offer integrated billing across that spectrum,” she explained to HCTR.
“There is a great culture here, a great team, and they have been growing dramatically.”

She added that she has long known that even the leadership at the home care division of her former company, based in neighboring Springfield, has always shared a mutual respect with the HealthMEDX founders. “Chris Dollar and his predecessors Craig Frazier and Billie Waldo always spoke highly of Charlie, Dan and Jim,” she said.

Post-acute care will be key
“Post-acute providers are becoming strategic players in the healthcare delivery system,” Ms. Pure was quoted in a prepared HealthMEDX statement. “They serve as the cornerstone of care for senior Americans recovering from significant health incidents, for frail and elderly people requiring ongoing management, and for the millions of people working to manage chronic conditions. HealthMEDX provides a highly differentiated technology platform to facilitate organized, proactive post-acute care delivery.  The system design inspires team-based care and can provide health systems and post-acute providers with the tools required to align incentives and foster collaborative care. Working with a world-class management team and two outstanding financial partners, we will continue to expand and augment the platform to enable long term and post-acute organizations to prepare for value based payment, support blended payment and actively participate in Accountable Care Organizations.”

It would seem from our conversation with her that she intends to stand behind those words as she eases into her new role. Look for HealthMEDX to move into a supportive role for its software customers that are heeding the call to take an active part in the movement toward coordinate post-acute care. “Sharing patient data across the care continuum, proactively moving patients to the proper locale — which is always the lowest cost locale for which they are appropriate — and managing chronic conditions to achieve improved quality of life, not just to reduce avoidable hospital admissions. These are healthcare’s goals for a future that has already started,” she concluded.

HealthMEDX Co-Founder and President Charlie Daniels could not agree more, “HealthMEDX works with skilled nursing facilities, continuing care retirement communities, home care organizations, rehab centers and hospice providers who aspire to use technology to increase quality of care, improve patient safety, reduce costs and dramatically impact the patient experience. As many LTPAC providers are diversifying, we see home care agencies expanding their service offerings to provide rehab and hospice services and many skilled nursing facilities are acquiring home care agencies. The HealthMEDX platform is uniquely designed for our customers who are extending their reach.”

Commenting on the Spectrum and Trident investment, Daniels added, “This transaction will support our efforts to rapidly expand our footprint. Pam’s experience in delivering innovative solutions to large and small health systems and managing growth in evolving markets will be a great asset to the team.” The company release said that the transaction provides liquidity to the Company’s founders, as well as access to additional capital for investment in new products and future acquisitions. Financial terms of the transaction were not disclosed.

Investors understand post-acute importance
Arneek Multani, Senior Managing Director of Trident Capital, added, “We are excited to invest in a company that is addressing the needs of patients and providers in one of the fastest growing areas of healthcare. The long term and post-acute care continuum is an essential and growing component of healthcare delivery. We are excited to partner with Spectrum, Pam, Vince and the team at HealthMEDX.”

Spectrum and Trident were advised by Brian Lenihan and Rees Hawkins of Choate Hall & Stewart LLP.  HealthMEDX was advised by Dennis Gallitano and Robin Bergman of Gallitano & O’Connor LLP.

About HealthMEDX
HealthMEDX offers an interoperable SaaS platform to skilled nursing, assisted living and independent living facilities; continuing care retirement communities and rehabilitation centers; and to private duty home care, certified home care and hospice providers with a software application that supports integrating them all. The HealthMEDX Vision Platform is currently used in more than 3,000 locations across the country.

About Spectrum Equity Investors
Spectrum Equity Investors is a private equity firm focused on investing in growth businesses.  Spectrum’s current and historical healthcare investments of note include Passport Health Communications, a provider of patient access solutions for hospitals and physicians; and QTC Management, the nation’s largest provider of outsourced disability evaluations (acquired by Lockheed Martin). Spectrum has been an active investor in software and information service providers including iPay Technologies (acquired by Jack Henry & Associates), RiskMetrics Group (acquired by MSCI), Seisint (acquired by LexisNexis/Reed Elsevier), and World-Check (acquired by Thomson Reuters), as well as digital media franchises including Ancestry.com (NASDAQ: ACOM), Demand Media (NYSE: DMD), NetQuote (acquired by Bankrate), Seamless, and SurveyMonkey. Founded in 1994 with offices in Boston and Menlo Park, Spectrum has raised $4.7 billion in capital across six funds.

About Trident Capital
Trident Capital is a leading venture capital firm with more than $1.9 billion of capital under management, including its most recent fund, Trident Capital Fund VII. Trident invests in software, internet and business services companies across multiple stages, from startup to growth equity. The firm has helped build large numbers of successful companies within its areas of focus since firm inception in 1993. Trident is broadly recognized as one of the leading investors in cloud computing, IT security, health care IT, online advertising and outsourcing. Current and former health care IT investments include: Acclaris, a SaaS based software platform and services company that manages the administration of employee reimbursement accounts, including consumer directed healthcare accounts; Advanced ICU Care, a telemedicine company focused on delivering outsourced intensive care to hospitals; Teladoc, a telemedicine company that provides patient care through a nationwide network of board-certified doctors; Resolution Health, a health care informatics company (NYSE: WLP); and Chamberlin Edmonds, a revenue cycle management company focused on eligibility management (acquired by Charterhouse Group and MTS Health Investors).

www.healthmedx.com

Add your comments below.

As I helped Dad navigate his morning routine — bed to walker to bathroom to walker to the table in the extended kitchen he built with his own hands — the bathroom, admittedly an odd place for deep meaning to present itself, spoke to me. Modern cabinets and fixtures faded from my view as 50s-era linoleum and sinks reappeared and the shadowy figure of a very familiar-looking little boy appeared, perched on an antique training seat atop the toilet.

Shaking off the vision, I removed a soiled pair of the “special pants” we had to force on Dad last year and replaced them with clean ones. As I guided his halting footsteps toward the commode, the boy said, “He used to do the exact same thing for you in this very room.”

The realization transcended mere memories of the days when Dad was big and I was small. It was more important than that. Here I was, caring for my frail, incontinent father, not just in any bathroom but in sacred space, the same room where he had cared for me, given me baths, bandaged my knees and taught me to shave.

Dad does not often speak today and, this time, it was just as well. If he noticed the redness that was surely visible in my eyes, the redness that returns as I write this, he did not mention it.

Dad’s legs barely hold him up today, partly from age, partly from living 68 years with some kind of primitive cement-based compound that was inserted in his right shin in 1943 to replace a 4-inch piece of bone that had been shattered by a sniper’s tracer bullet. According to a hometown news report at the time, he had apparently run screaming and waving his arms down a Belgian hillside to draw the sniper from his nest, where the sniper was holding a company of G.I.s at bay. The small band of brothers did finally take the town; one small, forgotten component of the Allies’ victory at the Battle of the Bulge. “My buddy got the guy who shot me,” was the legend I grew up with.

His actual brothers once pointed out to me a three-story Pennsylvania house where they had lived, three-to-a-bed, during the Great Depression, apparently anxious to ensure I knew my heritage fell somewhere between courageous and nuts. “Your father used to do handstands on the top of that chimney,” they claimed. It was not fraternal joking; the story turned out to be true.

These are the kinds of memories that make tolerable the work of the family caregiver, a person continually aware, “This is a human being who, though approaching the end, was once young and self-sufficient, a breadwinner and parent, who coached Little League and met his life partner at a square dance, who was capable only a couple years ago of cradling his great-grandchild in his arms.”

Certainly, family caregivers work hard and grow weary, sometimes short-tempered. Yes, they often compromise their own health by putting someone else’s health needs first. Of course, they save the Medicare Trust Fund millions, perhaps billions, of dollars every year. I have written about these things with an air of “this is newsworthy” but, it turns out, they are secondary to the family caregiver experience.

What is primary is that ever-present awareness, “This shrinking body and slowing mind are not the full story of who this person is.” It would be a great gift if they could put across the full story to people who meet him at age 90 for the first time, people such as home health nurses, therapists and aides.

Family caregivers do not see a 90-pound 90-year-old, they see the soldier, the square dancer, the Little League coach. Whether dressing him or cleaning him or reminding him of his grandchildren’s names, there is no moment when the feats and legends of his youth are not vividly present, living not only in what is left of him but in the people who inhabited the house he built and made sacred by more than 60 years of memory-making.

Every time I walk him from the bathroom to the kitchen, I steal a look over my shoulder at the seemingly ordinary suburban bathroom. A little boy smiles up from his comic book at me and says, “Take good care of him. He’s my Daddy.”

Tim Rowan
December 7, 2011

Attorney General Holder and Secretary Sebelius were joined in the announcement by FBI Executive Assistant Director Shawn Henry, Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division and HHS Inspector General Daniel R. Levinson.

As part of a coordinated action, 70 individuals were charged by Strike Force prosecutors in indictments unsealed Tuesday, September 6. On Wednesday, they accused persons in six cities of a variety of Medicare fraud schemes involving approximately $263.6 million in false billings.

As part of takedown operations last week, 18 additional defendants were charged in Detroit and one defendant was charged in Miami in cases unsealed on September 1, for their alleged roles in Medicare fraud schemes involving approximately $29.4 million in fraudulent claims.

Additionally, two individuals were scheduled to appear in court Wednesday on charges filed on August 24 for their roles in a separate $2 million health care fraud scheme. This coordinated takedown involved the highest amount of false Medicare billings in a single takedown in Strike Force history.

The joint Department of Justice-HHS Medicare Fraud Strike Force is a multi-agency team of federal, state and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing. Over the course of the past week, approximately 400 law enforcement agents from the FBI, HHS-Office of Inspector General (HHS-OIG), multiple Medicaid Fraud Control Units, and other state and local law enforcement agencies participated in the takedown. In addition to making arrests, agents also executed 18 search warrants in connection with ongoing strike force investigations.

“The defendants charged in this takedown are accused of stealing precious taxpayer resources and defrauding Medicare  – jeopardizing the integrity of our health care system and our nation’s most critical health care program for personal gain,” said Attorney General Holder. ”Our highly coordinated, nationwide Strike Force operations are working aggressively to combat Medicare fraud and our anti-health care fraud efforts have never been more innovative, collaborative, aggressive – or effective.  We will continue to work with our law enforcement partners and partners across government to fight against health care fraud.”

“Today’s arrests are a powerful warning to those who would try to defraud taxpayers and Medicare beneficiaries,” said HHS Secretary Sebelius.  “These arrests illustrate close cooperation between the Medicare program that identified these fraudsters and the law enforcement officials who acted swiftly to cut them off.  And our efforts to stop criminals don’t end here because the Affordable Care Act gives us new tools to prevent Medicare fraud before it is committed – better protecting seniors and the integrity of the Medicare program for generations to come.”

The defendants charged are accused of various health care fraud-related crimes, including conspiracy to defraud the Medicare program, health care fraud, violations of the anti-kickback statutes and money laundering.  The charges are based on a variety of alleged fraud schemes involving various medical treatments and services such as home health care, physical and occupational therapy, mental health services, psychotherapy and durable medical equipment (DME).

Claims for non-existent services

According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and oftentimes never provided.  In many cases, indictments and complaints allege that patient recruiters, Medicare beneficiaries and other co-conspirators were paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could submit fraudulent billing to Medicare for services that were medically unnecessary or never provided. Collectively, the doctors, nurses, medical professionals, health care company owners and others charged in the indictments and complaints are accused of conspiring to submit a total of approximately $295 million in fraudulent billing.

“The health care system is part of our nation’s infrastructure and we must do everything in our power to protect the integrity of Medicare and the system at large,” said FBI Executive Assistant Director Henry. “Working together as partners, we can stop criminals who seek to steal American taxpayers’ hard-earned dollars and we help ensure our nation’s health care system is there for those who need it.”

“As charged in these indictments, the defendants cover nearly the entire spectrum of healthcare providers, and perpetrated a variety of fraudulent schemes,” said Assistant Attorney General Breuer.  “From Brooklyn to Miami to Los Angeles, the defendants allegedly treated the Medicare program like a personal piggy bank. Today’s Strike Force operations should serve as a wake-up call to would-be fraudsters nationwide.   With Strike Force teams now in nine cities across the country, and employing sophisticated, data-driven law enforcement methods, we are determined to hold criminally responsible those who defraud Medicare.”

“The warning should be unambiguously clear by now,” said HHS Inspector General Levinson.  “We will continue using the combined law enforcement might of Strike Forces around the country to combat health care fraud.”

Multiple home health providers accused

• In Miami, 45 defendants, including one doctor and one nurse, were charged for their participation in various fraud schemes involving a total of $159 million in false billings for home health care, mental health services, occupational and physical therapy, DME and HIV infusion.  Another defendant in Miami was charged on September 1 for a $1 million Medicare fraud scheme.
• In one case, 24 defendants are charged for participating in a community mental health center fraud scheme involving more than $50 million in fraudulent billing. According to court documents, the defendants allegedly paid patient recruiters to refer ineligible beneficiaries to the mental health center.  In some instances, beneficiaries who were residents of halfway houses were allegedly threatened with eviction if they did not agree to attend the mental health center.
• In Houston, two individuals were charged with fraud schemes involving $62 million in false billings for home health care and DME. According to an indictment, one defendant allegedly sold beneficiary information to 100 different Houston-area home health care agencies in exchange for illegal payments.  The indictment alleges that the home agencies then used the beneficiary information to bill Medicare for services that were unnecessary or never provided.
• Ten defendants were charged in Baton Rouge for participating in schemes involving more than $24 million related to false claims for home health care and DME. According to one indictment, a doctor, nurse and five other co-conspirators participated in a scheme to bill Medicare for more than $19 million in skilled nursing and other home health services that were medically unnecessary or never provided.
• Six defendants, including two doctors, were charged in Los Angeles for their roles in schemes to defraud Medicare of more than $10.7 million. In Brooklyn, three defendants, including two doctors, were charged for a fraud scheme involving more than $3.4 million in false claims for medically unnecessary physical therapy. Two defendants, including a doctor, are making initial appearances today in U.S. federal court in Dallas after being charged for a scheme to defraud Medicare of approximately $2.1 million.
• In Detroit, 18 defendants, including three doctors, were charged last week for schemes to defraud Medicare of more than $28 million. According to an indictment, 14 of the defendants participated in a home health care scheme that submitted more than $14 million in false claims to Medicare.
• Finally, four defendants including one doctor were charged in Chicago for their alleged roles in schemes to defraud Medicare of more than $4.4 million.

The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.

Since their inception in March 2007, Strike Force operations in nine locations have charged more than 1,140 defendants who collectively have falsely billed the Medicare program for more than $2.9 billion.  In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

The cases announced today are being prosecuted and investigated by Medicare Fraud Strike Force teams comprised of attorneys from the Fraud Section of the Justice Department’s Criminal Division and from the U.S. Attorney’s Offices for the Southern District of Florida, the Eastern District of Michigan, the Eastern District of New York, the Southern District of Texas, the Central District of California, the Middle District of Louisiana; the Northern District of Illinois, and the Northern District of Texas; and agents from the FBI, HHS-OIG, and state Medicaid Fraud Control Units.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.

These are important questions for home health care organizations. While it may be safe to assume that all home health care professionals need to stay abreast with technologies that can promote their organization’s success, it is not always as obvious that they also need to learn to differentiate among products that promise to improve care quality, patient and employee satisfaction and the ability to effectively compete.

This summer, Home Care Technology Report (HCTR) invited readers to participate in the Home Care Technology Report 2011 Technology Utilization Survey in order to learn what technologies are currently in use and what near-term acquisitions are planned across the industry.

Sponsored by Magnolia Prime, a new telehealth services company profiled by HCTR in July, and conducted in conjunction with an independent consultant, the study provides a look at how diverse home health care organizations use technology and provides insights into their expectations and experiences to date.

Positive response to the survey indicates significant interest in technology among HCTR readers. A complete report on the survey, published this month, summarizes responses of nearly 200 home health care owners and employees, including executives, nurses, clinicians, administrative personnel and others involved directly or indirectly in providing patient care. Responses from vendors and consultants were not included in the analysis.

The findings are revealing. HCTR readers, with their answers, provide insightful and useful information to home health care organizations striving to differentiate their organizations and deliver quality care that is cost-efficient, responsive and effective.

Among the key findings:

• All of the technologies addressed in the survey offer home health care providers significant benefits on multiple dimensions, according to respondents whose organizations have adopted or plan to adopt them.
• Despite the potential benefits of all the technologies covered in the survey, adoption rates vary considerably, ranging from 10% – 94%.
• A majority of respondents whose organizations use these technologies report a moderate to high degree of satisfaction and/or benefit realized by their organizations and/or patients.
• Half or more respondents say their organization has no future plans to purchase, replace or upgrade any of the technologies addressed in the survey.

Survey results imply that many home health care organizations not yet investing in automation technologies would benefit by catching up with their colleagues. The majority of respondents who are utilizing the technologies examined — point-of-care software, home telehealth systems, remote patient monitoring and interactive voice response systems — report significant benefits and satisfaction.

Notable observations

• Just under half (49%) of respondents who say they use point-of-care software report moderate to high satisfaction with their current system.
• In a significant contrast, 80% report moderate to high benefits from using point-of-care software
• The same dichotomy appears in answers about home telehealth systems. 56% report satisfaction compared to 80% acknowledging benefits
• At 74%, HCTR readers seem to use point-of-care systems more than the traditionally estimated national average of 50%
• The same is true for home telehealth systems and other forms of remote patient monitoring, used by 51% of those completing the HCTR survey as opposed to the 20% to 25% reported by recent, more scientific surveys conducted with broader ranges of home care agencies
• Least surprising are the reasons given for not investing in home telehealth systems. 55% of respondents who have not already begun some type of remote patient monitoring say they are deterred by “insufficient perceived benefit” of the technology. 52% believe their patients may not be receptive and a full 71% name cost as their primary obstacle.

Following is a summary of survey responses from HCTR readers. To read a complete report of survey findings, click here.

Who participated in the study?

The nearly 200 HCTR readers who participated in the survey came from all home care job descriptions: executives, technical and administrative staff, nurses and clinicians working in rural and urban locations for organizations of varying sizes, specialty and technology utilization.

Respondent Profile

Job function:

• 20% owner/president
• 20% director level and above
• 20% technical staff
• 16% administrative staff
• 13% nurse
• 5% clinicians

Organization’s annual revenues:

• 40% more than $6 million
• 11% $3 million – $6 million
• 25% $1 million – $3 million
• 13% less than $1M

Geographic region:

• 29% mostly rural locations
• 29% mostly urban locations
•  42% mix of rural, urban.

Ownership:

• 40% hospital-owned
• 37% freestanding
• 4% government-owned
• 25% for-profit
• 51% non-profit
• 13% VNA

Member of a collaborative provider group or Accountable Care Organization:

• 7% yes
• 35% no
• 58% under consideration

Services provided by organization:

• 93% Skilled nursing
• 88% therapies
• 43% non-medical home care/private duty
• 49% hospice
• 43% palliative care
• 14% home medical equipment
• 45% home IV
• 16% other

Average number of patients served per day:

• 25% Less than 100
• 17% 100-199
• 8% 200-299
• 21% 300-500
• 28% more than 500

Payor mix:

• 93% Medicare
• 82% Medicaid
• 87% Private insurance
• 58% out of pocket payments by patients
• 9% other

Percentage of non-English speaking patients served:

• 65% less than 5%
• 24% 5%-24% patients
• 11% more than 25% patients

Key sources of technology information:

• peers in the home health care industry (76%)
• HCTR (63%)
• industry conferences (62%)
• internet (42%)
• colleagues at respondents’ own organizations (25%)
• general media (8%)

Current Technology Utilization Reported by Respondents

• 94% Software application to submit electronic claims to Medicare
• 74% Point-of-care system to collect patient data in the patient’s home
• 36% Telephony software for electronic visit verification
• 71% OASIS checking and analysis or benchmarking software
• 32% Home telehealth (two-way communication) technology
• 19% Remote patient monitoring (one-way communication) technology
• 10% Fall detection device technology
• 20% Medication Management Technology

Respondents Who Report Moderate to High Satisfaction with Current Technology

• 49% Point-of-care system
• 72% Telephony system
• 56% Home telehealth technology
• 60% Remote patient monitoring technology
• 53% Fall detection device technology
• 53% Medication management technology

Respondents Who Report Moderate to High Benefits Realized from Technology

• 82% Home telehealth
• 80% Remote patient monitoring
• 74% Fall detection device
• 81% Medication management technology

Future Plans to Invest in Technology within Next 12 months

• Home telehealth: Buy 19%, Replace 13%, Upgrade 10%
• Remote patient monitoring: Buy 12%, Replace 5%, Upgrade 5%
• Fall detection device: Buy 4%, Replace 1%, Upgrade 1%
• Medication management: Buy 6%, Replace 0, Upgrade 0

Future Plans to Invest in Technology within 1-5 years

• Home telehealth: Buy 11%, Replace 5%, Upgrade 6%
• Remote patient monitoring: Buy 7%, Replace 2%, Upgrade 1%
• Fall detection device: Buy 5%, Replace 1%, Upgrade 1%
• Medication management: Buy 5%, Replace 1% Upgrade 2%

Dione Chen is an independent consultant who provides marketing, research, communications and strategy services. Her personal experiences as a family caregiver led to a strong interest in the importance of technology and innovation in aging services. She worked with HCTR and Magnolia Prime to develop the HCTR 2011 Technology Utilization Survey and resulting report.

Our periodic search for the word “home” on the web sites of the four collection agencies acting as Recovery Audit Contractors (RAC) got a hit for the first time last week. As we have long advised, all Medicare providers should perform this exercise themselves each month. There is still too little profit available to attract much RAC interest in home care but you never know when one of them will decide to test the waters, as the two largest of the four did this month.

As a reminder, here is where you go. Once there, simply press Ctrl-F and perform your own word search. Below these instructions, we have copied new issue descriptions from the web sites of the RACs from Regions C and D.

REGION C:

REGION C:

REGION D:

Stamford, CONN. – August 1, 2011 – IVANS, Inc., a national health information exchange, announced Monday that 73 percent of hospitals agree that the Recovery Audit Contractor (RAC) Program helps to reduce Medicare fraud and errors.

However, more than 60 percent do not think the audit process is fair.

According to IVANS 2011 RAC Audit Survey, respondents cited that the extra time and money it takes to substantiate a RAC claim is impacting budgets and resources that are already stretched too thin, and that the frequency (every 45 days) with which they can be audited is burdensome to their administrative workflow. The study also revealed that hospitals believe the review process is too subjective and they need education on how to reduce future audits.

“IVANS survey demonstrates the need to ensure that these programs, which are valuable in their end results, are not too burdensome for providers,” said Clare DeNicola, IVANS president and CEO. “Using automation to streamline the workflow can help reduce the administrative challenges providers are facing with these audits.”

In this instance, CMS appears to agree. The government agency that manages the Medicare program and contracts with the four collection agencies to provide recovery audits recently implemented the “electronic submission of Medical Documentation” (esMD) program. It enables Medicare contractors, such as RACs, MACs, CERTs and PERMs, to accept electronic attachments from providers, a significant timesaver over printing and delivering many pounds of paper via fax or overnight courier.

IVANS is one of the CMS-approved Health Information Handlers (HIH). It offers a gateway, IVANS LIME™ AuditDocs, that conforms to Nationwide Health Information Network (NHIN) standards and leverages a web-based health information exchange (HIE) portal. A tracking feature confirms when documents have been received by an auditor and a document archiving function keeps each document set available throughout the RAC appeals process.

An IVANS news release underscored the importance of filing appeals and following them through the lengthy process, citing a 64% appeal win rate during the 2007-2009 RAC demonstration.

The IVANS survey also found:

Many home health care and hospice providers are understandably concerned with the tight deadlines required by Medicare auditors for submitting medical documentation to support an audited claim, especially considering limited available time and the financial impact of adding staff. Now that ZPIC activity is accelerating and some of the RACs have added home care language to one or two of their CMS-approved
audit issues, forward-thinking agencies will investigate CMS’s esMD program and evaluate software companies ready to help them use it.

The IVANS survey was conducted electronically from June 7-22, 2011, and the results represent responses from 128 hospital providers across the United States. A full summary is available. Write to Cecile.Locurto@ivans.com.

www.ivans.com

Quinn reports that the objective was to test whether adding coaching provided via a software application running on a smart phone, coupled with patient/provider web portals to community primary care, to standard diabetes management would reduce glycated hemoglobin levels in patients with type 2 diabetes more than standard management procedures alone.

Research Design and Methods

The University of Maryland School of Medicine “Mobile Diabetes Intervention Study” was a 12-month, cluster-randomized clinical trial. Researchers randomly assigned 26 primary care practices to one of three stepped treatment groups or a control group.

A total of 163 patients were enrolled and included in analysis. The primary outcome was change in glycated hemoglobin levels (HbA1c) over a 1-year treatment period. Secondary outcomes were changes in patient-reported diabetes symptoms, diabetes distress, depression and other clinical (blood pressure) and laboratory (lipid) values. Maximal treatment was a mobile and web-based self–management patient coaching system and provider decision support.

Patients received automated, real–time educational and behavioral messaging in response to individually analyzed blood glucose values, diabetes medications, and lifestyle behaviors communicated by mobile phone. Providers received quarterly reports summarizing patients’ glycemic control, diabetes medication management, lifestyle behaviors, and evidence-based treatment options.

Conclusion

Mobile phone management is efficacious in patients whose glycated hemoglobin levels are above desired levels as well as patients whose glycated hemoglobin levels are less egregiously elevated.

Although there were mean declines across all groups in lipid values and blood pressure readings, Diabetes Distress, Diabetes Symptoms, and PHQ-9 Depression, none of the 12-month changes comparing the UC to any of the active interventions were significantly different (P>.05).

Research Team

Charlene C. Quinn, RN, PhD

Michelle D. Shardell, PhD

Michael L. Terrin, MD, MPH

Erik A. Barr, BA

Shoshana H. Ballew, BA

Ann L. Gruber-Baldini, PhD

“Telemedicine and telehealth have the potential to transform aspects of rural health care, improving accessibility, quality and affordability,” the summary of the paper’s sixth chapter declares. “This working paper discusses the current technological frontiers and likely advances, together with new survey data on current usage of telemedicine by rural and urban doctors, and what they perceive as barriers that need to be overcome.”

Continuing from the synopsis of Chapter 6: “To make full use of telemedicine’s potential, a number of practical changes are now required. These include: building on work by the Federal Communications Commission and others to expand rural broadband capacity (estimated at around 60 percent of rural areas versus 70 percent of urban areas); introducing new public and private payment models for telemedicine, perhaps linked to the move away from traditional fee-for-service reimbursement models; and continued action by the Food and Drug Administration and others to remove outdated regulatory barriers to adoption.”

The complete, 84-page report is available for download from unitedhealthgroup.com/reform. The rest of the Executive Summary contains additional insight into the report’s scope and conclusions.

Three quarters of rural U.S. residents live in the South and Midwest, compared to only one-quarter in the Northeast and West.

Though five million people live in isolated and remote locations, around 31 million people who technically live in rural counties actually live close to an urban area.

Chronic conditions such as cardiovascular disease and diabetes are more prevalent in rural populations than in urban or suburban areas. This is worst in the South, especially among rural minority communities, for whom obesity rates and other risk factors are markedly elevated.

The paper sets out to answer five questions:

1. What are the health challenges confronting rural Americans?
2. How is the care delivery system currently organized to respond?
3. What do we know about the quality of rural health care?
4. What will the expected Medicaid and insurance coverage expansions from 2014 mean for rural areas?
5. Are there practical solutions to these health, access, and quality challenges?

In remote rural areas there are fewer than half the number of primary care physicians per 100,000 population than in urban areas, yet there are slightly more hospital beds per 100,000 residents in rural than urban areas. Nevertheless, about a third of hospitalizations for rural patients occur at urban hospitals.

The paper also includes:

• new empirical research on rural versus urban quality of care
• new projections for rural Medicaid and insurance exchange 2014 coverage expansions
• new state-by-state and county-level analysis of future pressure on primary care capacity
• new models for rural care delivery and care coordination

Outcome quality evidence is mixed

This paper finds new research suggesting that quality scores for urban and suburban areas are higher than those for rural areas in 75 percent of the hospital referral regions (HRRs) for which representative data are available. In a further 20 percent of HRRs there is no statistically significant difference in rural/non-rural measured performance, and in 5 percent of HRRs rural quality scores are higher.

Both rural consumers and rural primary care physicians rate the quality of local care lower than do their urban and suburban counterparts. For example 49 percent of rural consumers rate the quality of local care as ‘very good’ or ‘excellent’, compared to 64 percent of non-rural consumers who do so. Twenty-four percent of rural consumers think their local care is only ‘fair’ or ‘poor’, compared to 12 percent of urban and suburban consumers who believe that.

Healthcare reform

UnitedHealth finds that, by 2019, there could be an increase of around eight million rural residents in Medicaid and state insurance exchange plans, compared with what would have happened without the ACA legislation.

Five million rural residents already live in designated ‘shortage areas,’ defined by the federal government as counties with fewer than 33 primary care physicians per 100,000 residents. Attempting to identify locations where the pressures will be greatest, this paper finds that these areas tend to be in the South, and often have some of the tightest scope-of-practice restrictions on nurse practitioners and other non-physician health professionals.

A range of approaches are discussed that states and the federal government can take to confront the question of how to ensure there are enough high quality health plan choices and rural provider networks to serve rural residents.

These include: recognizing the role that nurses and other suitably qualified health professionals can play in meeting network adequacy standards, alongside mobile and telemedicine-enabled providers where appropriate; taking care in designing insurance market and exchange rules explicitly to recognize the distinctive population and provider characteristics of more rural parts of each state; using the state’s purchasing power to provide incentives to participation by rural providers, as states such as Georgia have done; driving greater transparency on quality; and ensuring new federal initiatives on Medicare reform are tailored for rural communities.

The paper concludes that the next few years will be times of considerable stress on rural health care, but also times of great opportunity. “Across the country there are already impressive examples of innovative new care models providing high quality care, tailored to the distinctive needs of their local community. The challenge for all involved in rural America now is to build on that track record of innovation and self-reliance, so as to ensure that all Americans — wherever they live — can live their lives to the healthiest and fullest extent possible.”