Will Texas and other states and U.S. territories learn from the experience or will Roy-like racketeers continue to thrive until hundreds of millions more taxpayer dollars are lost? State legislatures and their appointed or civil service rulemakers have long had the option to either forbid, permit or require the use of a technology that can virtually eliminate paying for home health care visits that never happened.

Most states have made the wrong choice.

As outlined in this week’s article by guest author Scott Herrmann of Procura, the technology known as Electronic Visit Verification (EVV) uses either patients’ home telephones or cell phones with GPS enabled to absolutely verify the physical location and the date and time when a clinician or aide says a visit began and ended. Treating hundreds of Medicare or Medicaid beneficiaries at a homeless shelter or submitting claims for home visits that never happened at all is rendered impossible when EVV use is mandated.

Dr. Jacques Roy

Were a state to require that home visits be verified electronically, using one of the telephony vendors with EVV systems for home health care agencies, and if the reports those systems generate were required to be submitted with claims or at least available to the payer on demand, no visit could be billed without being performed. Scams like the one Dr. Roy operated would be identified and shut down within weeks, not years.

Benefits beyond crime prevention

As Mr. Herrmann points out in his article, there is a secondary consequence in addition to eliminating fraud. Home care agencies using EVV would see their operational costs
decrease in excess of the amount of their investment in the system. Users report a typical ROI of less than one year, followed, naturally, by ongoing savings that exceed costs year after year.

This raises two questions. Why do home care agencies not choose to voluntarily implement EVV, and
why do states not require them to do so?

Answering the first question requires some speculation. The second one is essentially impossible to answer, given the political nuances extant in 50 states.

In my travels across the country to speak to home care association audiences about technology, I frequently find a way to insert a question about EVV regardless of my presentation’s topic. I hear three answers everywhere I go:

1. I have never heard of this type of technology.
2. We looked at EVV but found it too expensive.
3. Our state requires paper reports to verify visits with patient signatures, even if we have an EVV system, so the technology would be redundant.

None of these answers is legitimate.

1. Ignorance. One would have to proactively avoid updating oneself about home care best practices in order to have missed every advertisement and every news or education story about Electronic Visit Verification over the last fifteen years. An owner or manager unaware of EVV in 2012 reads too little about his or her own craft. People who place education at such a low priority are most likely also unaware of other critical information, including rules and regulations they are required to obey. They are on a path toward fiscal disaster.
2. Cost.Some EVV systems charge a fee per call to the toll-free number, usually less than a dollar. Others charge per minute. Cell phone-based applications require purchasing phones and paying monthly fees. None of these cost structures typically result in charges of more than $100 per Medicare episode or $2 per Medicaid visit. All of them come in at less than the costs of:
   1. Delivering paper timesheets to the office.
   2. Fudged visit start and stop times.
   3. Padded mileage reports.
   4. Jail time for submitting fraudulent claims to government or private payers.
3. 20th-Century laws. Kraig Erickson, a Vice President with home care software developer Sansio, is one of the founding members of the EVV Workgroup, an organization created in an effort to advance a free-market, standards-based approach to EVV. ”Even the FedEx driver collects electronic ‘verification of delivery’ when dropping off a $4.00 package,” he told me as we commiserated over the Texas indictments. “Why shouldn’t something as valuable as a patient encounter also be electronically documented and verified?”State Medicaid offices that continue to insist on paper visit verification may be run by persons who are suspicious of technology in general. They may believe no computer system can be more reliable and accurate than paper. They may simply be uninformed about modern EVV technologies. Informing them is the responsibility of the industry, especially its telephony vendors, but they can hardly be faulted for falling short.While home care’s EVV vendors have spent tremendous resources and time educating state officials over the last 20 years, twin realities stand in their way. The path from forbidding to mandating EVV usage takes a long time to navigate but elected and appointed offices experience a high rate of turnover. Thus, the effort never ends. With 50 states, plus the District of Columbia and several territories, and fewer than a half dozen home care telephony vendors, the image of Sisyphus comes to mind.

   

What if Sisyphus had ten people helping him roll his stone up the hill?

 

What if he had 100?

 

If people like Jacques Roy can be prevented from stealing from Medicare and Medicaid, who benefits? Taxpayers, yes. But every law-abiding home care provider also has a vested interest in getting people like him and his 500 alleged co-conspirators out of our industry.

This suggests two calls to action:

• Implementing an EVV system in your agency sends a message to government and private payers, “Go ahead and look at us closely; we actually do every visit we claim to do. We have nothing to hide.” Crooks will never say that. It will set you apart from them.
• Joining the effort to educate your state officials about EVV will deliver the message faster than vendors can do it alone. It will hasten the day when owners of shady agencies give up and leave.

The results of everyone joining the verified visit movement and supporting the effort to educate state officials will be twofold. Home care’s reputation in the eyes of MedPAC and Congress will begin to improve. Dollars left in the system instead of going to criminals will ease some of the pressure on both of these bodies to continue payment rate reductions.

I will be asking my telephony question at presentations in several states this spring and summer. Have your answer prepared.

Tim Rowan, Editor

By combining Telephony with Integrated Voice Response (IVR), providers of services in the home can gain better analysis of cost data, increase staff productivity, reduce errors in care, as well as eliminate potential timesheet and travel fraud.

Let’s explore the ways in which Telephony and IVR can reduce the costs of delivering care.

Visit verification as it stands today

Home care agencies are required to keep records of their services for accountability/audit purposes to prove those services were actually delivered. Currently, most companies use manual, paper-based processes to obtain and file these records. What if we changed this? After all, it is a system that is highly vulnerable to waste, inefficiency and inaccuracy, and one that presents several areas where costs can be reduced.

Consider the following:

• All paper from the field must be returned to the office and entered into one or more databases for payroll/ billing purposes.
• Many agencies pay for the travel time and mileage back to the office, merely to deliver documents.
• Caregiver arrival and departure times are self-reported, with little to no accountability. In most cases, caregivers appear to arrive when they are told to and leave on time. Rain, traffic, even snowstorms never seem to be a problem, even at 8:00 on a Monday morning. Could it be that accountability is lacking? Patient signatures on paper verify the visit took place but cannot attest to arrival and departure times. When times are rounded up five or ten minutes per visit, it may appear the staff member’s day was full when actually there was time to do one more visit that day. Eliminating this practice might mean increased agency revenue without increasing the number of field staff.
• Most days, the patient is alert and their signature is readable. But what about the days that the best they can manage is simply a scratch on that paper? Does that truly prove the visit occurred?

Integrated Voice Response

Telephony or IVR systems respond to each of these concerns by offering a very simple way to improve accountability, deliver accurate time and attendance data, and eliminate travel costs for bringing paper back to the office. IVR can be used not only to record visit times but also to provide proof that each visit actually tool place in the home. It eliminates the need for paper timecards and the labor required to verify them, and makes paper storage unnecessary as well.

Most importantly, IVR systems go beyond merely verifying time and attendance. They can also collect what was completed on the care plan (the tasks) by recording spoken yes/no answers.

Here is how it works. When the caregiver arrives or leaves a client’s home, they simply call a toll free number from the client’s home phone. The automated system prompts them to enter their own personal staff identification number. The simplicity of the application allows the least technically savvy staff members to automate time and attendance reporting.

Proof of visit location comes from collecting the caller ID from the patient’s home telephone. Time data collected from calls is used for payroll and billing, one call to start a visit and another at its completion. Precise start and stop times means fraud is not possible. The benefits of accurate timesheets can help agencies on many levels, including proactively managing visits and gaining insight into whether staff is working a full eight hour day or not.

The agency will also know if a caregiver has not shown up for an appointment versus waiting for the call from an irate patient or family member waiting for that worker to arrive. Alerts can be built into these systems based upon an agency’s criteria. You decide if five or fifteen minutes is considered late and have the system call your attention to it at that time.
Similar alerts can be set up for missed visits, staying too long or not staying long enough.

Counting benefits

In this scenario, as telephony system data is analyzed, the agency might discover it is possible to add more client visits to the schedule of one or more field staff member, increasing revenues but not increasing staff.
We have eliminated paper and manual processing by replacing self-reported time cards. We have also improved accountability and now know what is really occurring in the field. Savings are realized from reduced paper costs, reduced data entry costs and associated errors, reduced storage space and reduced payroll expenditures previously wasted on fraudulent times for both visits and travel.

While the number one goal of a telephony-with-IVR application is to automate payroll and the time and attendance process, in other words to shift the focus from paperwork to patient care, the agency also gains the ability to monitor staff visit functions, for safety purposes, timeliness, as well as accountability.

Caregivers in the field who are using this technology are confident that their patient data, time and attendance, and visit tasks are all captured and securely transmitted back to the office. With that in mind they can concentrate on delivering the best patient care possible.

If you are looking for a better way to gain accountability and reduce operations costs, you may want to think about the following:

• Could we be more responsive to our clients if we could manage staff proactively?
• How many times have we lost the visit paperwork?
• Timely/accurate payroll enhances worker relationships and minimizes turnover
• Travel reimbursement costs can be dramatically reduced
• Paper storage costs can be slashed or even eliminated

Telephony’s benefits may help an agency develop new and better processes in the delivery of home care services, knowing, not assuming that services are delivered as needed. As operational processes improve, costs decrease. Most telephony adopters find that cost reductions exceed their investment in the system. The same cannot be said about paper and manual processes.

Scott R. Herrmann is the Director of Mobile Solutions for Procura. This is the first in a series of periodic articles we have scheduled Scott to write for HCTR this year. He can be reached at sherrmann@goprocura.com

Jacques Roy, MD, founder and leader of the largest home care Medicare fraud ring in history, has been brought down by federal authorities. The indictment detailing his $375 million operation was unsealed Tuesday in the U.S. District Court for the Northern District of Texas, Dallas Division.

Seventy-eight Dallas-area home care companies were named as participants in what Assistant Attorney General Lanny Breuer described as “the largest alleged home health fraud scheme ever committed.”

The book found in Roy’s Dallas home was simply icing on the cake for investigators.
The Health Care Fraud Prevention and Enforcement Action Team (H.E.A.T.) also found deposit slips from Cayman Island banks, a guidebook on how to register your yacht in the Caymans, a copy of “The Offshore Money Manual” and a Canadian driver’s license among the doctor’s effects. Roy’s medical degree was earned at Canada’s Université Laval but the driver’s license was under the name Michel Poulin.

Stealing from taxpayers for six years

Between 2006 and 2011, according to the 13-count indictment, Dr. Roy certified more Medicare beneficiaries for home health services and had more patients than any other medical practice in the United States. The vast majority of these certifications were bogus.

Seventy-eight home care companies have had their Medicare billing privileges suspended
for cooperating in Roy’s scheme and as many as 500 more may have participated. Not content to falsely certify patients who happened to pass through his practice, the indictment alleges, Roy paid home care agencies a bounty to knock on doors and troll homeless shelters, looking for Medicare beneficiaries who would exchange their name and number for cash or groceries. Actual home care services were rarely provided to Roy’s “patients.”

As one example of the scheme, the indictment charges that Charity Eleda of Charry Home Health Services visited The Bridge Homeless Shelter in Dallas to find Medicare beneficiaries. She allegedly sat in a parked vehicle outside the shelter while hired recruiters delivered prospects to her car at $50 per “patient.” If Ms. Eleda provided any treatment, it was either in her vehicle, in the courtyard of The Bridge, or on a park bench, the indictment said.

Other employees of Roy’s company, Medistat Group and Associates, worked all day in a boiler room dubbed “The 485 Department.” Their only duties were to forge his name on hundreds of Medicare plans of care and claims per day. Since 2006, according to prosecutors, the phony company “certified more than 11,000 unique patients from over 500 home healthcare agencies in the Dallas-Fort Worth area.”(Editor’s note: there are over 500 home healthcare agencies in the Dallas-Fort Worth area?)

Before the operation was exposed,
Medistat and cooperating home health care agencies billed Medicare for more than $350 million and Medicaid for more than $24 million. Six Roy associates were also indicted as co-conspirators, operating under the company names Apple of Your Eye, Ultimate Care and Charry Home Care.

After watching him for years, regulators moved in when they discovered he had begun to move money offshore. They feared his departure was imminent and knew that they had already identified as many cooperating home care agencies as they could.

Motivated by greed, destroyed by greed

Medicare had tried to shut Roy down last year by
suspending his billing privileges but, the indictment alleges, he simply created a new company, “Medcare HouseCalls,” and continued working through the same home care companies. Had he cut his losses and moved to the Cayman Islands at that time, instead of staying around to run the profitable scam a few more months, he may never have been caught.

The indictment states that the actual takedown was facilitated by evidence gathered by Roy’s business manager, identified in the indictment only as “J.A.” He allegedly recorded phone calls with Roy during which he objected to the fraudulent activity and suggested that the company “invest in legitimate marketing” to attract business instead. According to the indictment, Dr. Roy told J.A., “I’ve done enough marketing to know it’s b___s___, and I don’t want to do it.”

Roy’s has surrendered his passport and bail has been denied pending trial.

Home telehealth announcements

Honeywell HomMed released a tablet version of its popular patient monitoring device. The Genesis Touch is an FDA-approved home telehealth software system running on the Samsung Galaxy Tab™ 7.0 platform with a 2.3 OS and both 3G and Wi-Fi
capability. The 7″ display appeared to be as clear and readable as any tablet we have seen. It connects via Bluetooth with all standard vital sign peripherals and uploads patient data wirelessly to the company’s LifeStream™ application.

hommed.com

Philips has created a new division that will bridge the gap between hospital discharge and home health care admission. Known as “Hospital-to-Home,” the division will begin to serve the need to reduce avoidable hospital readmissions with a browser-based, device-agnostic communications portal, set for release later this year. A complete personal health record, it will also deliver medication and appointment reminders, promote healthy dietary tips and link with the company’s hospital, physician and home telehealth systems.

philips.com

Senior-friendly social media

Startup patient portal developer Independa has secured investment from LG Electronics. (HCTR readers were introduced to Independa in these two articles:

http://homecaretechreport.com/article.asp?id=1267

http://homecaretechreport.com/article.asp?id=1348)

The companies plan to offer Independa’s cloud-based Angela™ application on LG Electronics’ Pro:Centric™- enabled commercial televisions. Seniors can conduct video calls with loved ones, review shared photos, access email and Facebook, browse the Web, play games and receive medication and calendar reminders – all directly through the TV – without any computer knowledge, and without interrupting the TV program they are watching.

independa.com

Jardogs is a software developer based in Springfield, Illinois that has two products at least as unusual as the company’s name. “Universal Health Record” is more than a PHR. A browser-based patient portal, it interfaces with and downloads data from an individual’s health records no matter on how many separate EHRs they may be found. Sitting at home, an individual can view his or her own lab results, vital sign readings, upcoming appointments and the notes doctors have written during previous appointments.

The company’s second product is an avatar-directed guide for physical therapy exercise programs. It runs through a home PC or an XBox 360 and demonstrates PT-prescribed exercises. Simultaneously, it uses either device’s camera to “watch” you do your exercises, telling you how many repetitions you have completed, how many more you have to go and whether or not you are doing them correctly.

jardogs.com

Mobile devices as tough as mobile clinicians

Intermec provides ruggedized mobile devices that combine portability and weight with a large-enough, high resolution display in a Windows-mobile OS unit. It includes a bar code reader and camera with a small QWERTY keyboard and touch screen. We saw the newer version of the model currently in use by Caritas Home Care in Massachusetts with its HealthWyse application and were favorably impressed with its usability. Intermec marketing director Dan Albaum told us that these ruggedized units are in use in construction, delivery trucks and other industries but that no group is harder on the equipment than nurses.

intermec.com

Speaking of mobile devices, be sure to look for a separate article in this week’s issue in which we summarize a mobile device “lessons learned” presentation by Sutter VNA and Hospice CIO Phil Chuang.

Renting monitors and fall detectors

In October, 2010, David Kovach of Reflection Solutions, LLC wrote an article for us titled, “Telehealth and Mobile Computers: A Prescription for America’s Healthcare System.” This year, he announced his company’s joint venture with Acadian Telehealth Monitoring. We will bring more detail on this soon. The summary is that the combined effort will add more patient monitoring products to the ones Acadian rents to its customers.

reflectionsolutions.com

Another competitor to watch

We have long warned that hospitals and physician practices will purchase home telehealth equipment and monitor patients at home if they cannot find a home care provider in their area to do it for them. Now we hear, in a conversation with Philips’ sales and marketing people, that ambulance companies, such as American Medical Response, are buying home telehealth equipment. They offer their EMT expertise and ability to deliver, install and remove equipment to to hospitals who desire to control readmissions but do not want to establish home telehealth programs of their own.

Handy low-tech innovation

Otter Box not only makes hard shell covers for smart phones, but has apparently heard the cry of the mobile clinician. We saw a hand strap that can be affixed to the back of an iPad or other similar-size tablet device. If you have ever dropped a device while trying to hold it in one hand and tap its screen with the other, it might be worth a look.

otterbox.com

Revolutionary but not yet released

Watch Sprint partner DayaMed toward the end of the year. They were showing a prototype of a medication management device, the MedPod, that dispenses a patient’s pills in custom packets for each time of day. It reads a bar code on each packet as it is removed from the machine. The top of the lid is a full-feature communications system, about the size of a smart phone, with a high resolution display, medication and appointment reminders and two-way video communications.

dayamed.com

Why deploy mobile devices?

— favorable cost as compared to laptop or tablet PC

— usability, portability, instant on

— instant internet access

— the “cool factor” (clinicians like it)

Preferred architecture: local software with central database

— application is always available, never limited by cell tower or Wi-Fi availability

— centralized data is protected, not subject to device theft

— ensure that everything a clinician needs is on the mobile device

Devote resources to security

— there has been a 60% growth of malware on mobile phones in recent years

— a Mobile Device Management (MDM) policy includes
encryption, policy controls, remote data wipe capability, application protection, inventory provisioning, over-the-air maintenance

— even with remote data wipe, make sure you receive wipe confirmation

— the iPhone is easier to manage as its OS is controlled, originates from one factory

— the Android OS, while available to more home care applications, introduces many variants, many different players. When using it, you must add your own controls.

— the organization must establish different policies for iPhone OS, Droid 3 and Droid 4 because of device variances

— IT management must understand these variations, such as how to control passwords

— best practice is to encrypt at device level. Lesson learned: some software may store cached data elsewhere on the device, encrypting only the application may be insufficient.

— watch out for voice recognition apps. PHI may pass from device to server and back in clear text. — when and where are clinicians going to talk into their device? Will they be alone, in private, in front of a patient or family?

Enhance but control the user experience

— in spite of platform variations, you must remain on top of hardware releases

— craft a common user interface across various devices to streamline training and ease of use

— control access to App Store and Droid Market

— have a policy about installing foreign apps

— Ergonomics will be a challenge. It is impossible to provide an ergonomically safe environment in the field as you would at a desk. Invest resources into teaching users how to sit, how to hold it, control length of continuous use.

— even if they have their own smart phone, work-related use will be different

— after some experimentation, Sutter decided the 7″ tablet, used in landscape mode, is the ideal configuration. 10″ screens may be more readable but bigger is not always better.

— invest sufficient time in field testing every potential new device.

— add-on keyboards are nice, either in a docking station or Bluetooth, but they may make the device harder to carry

— consider providing a stylus or template text

Whose device is it? The BOYD dilemma

— Bring Your Own Device, or company-provided device? Establish a policy.

1:  evaluate the risk

2:  identify and control introduction of all new devices

3:  what if you have to wipe the employee’s phone; what are your HR policies?

4:  identify limits of safe integration; what level can you tolerate?

5:  can you isolate personal apps from enterprise apps?

6:  can you use GPS tracking or geo-fencing 24/7 or only during business hours?

Nomophobia

Editor’s note: According to B.K. Winstead, writing on “WindowsIT Pro” blog. “I learned a new word this week: nomophobia. It’s a made-up word, but then all words were made up at some point. When I first saw it, I thought it might be the fear of baseball players with names like Hideo Nomo or Nomar Garciaparra. Instead, it’s defined as a fear of being out of mobile phone contact — ‘no-mobile-phone phobia.’”

— prepare for clinician frustration when the encounter less than 100% up time

— will they lose trust in mobile computing? Will you be able to win them back?

— do not make the assumption that, because they use a mobile device in their personal life, they are ready to use one at work:

1: have you selected a device on which data entry is a significant barrier?

2: does its form factor reduce data entry speed or increase errors?

3: is it a good device for data reading but not for data entry?

Training and Application Complexity

— device and software training will still be key

— personal use fluency does not translate to business use

— expect that your users will have to train just as much as they did with a PC-based point-of-care application

— as your devices age and need to be replaced, or as your staff grows and you must purchase additional equipment, remember that smartphone and mobile tablet manufacturers discontinue and replace models far more often than PC manufacturers do.

— try to establish a standard screen appearance but plan to revise your device training with every new smartphone or tablet purchase.

Alert for home care and hospice software vendors:
I asked Dr. Farzad Mostashari, MD, ScM, the National Coordinator for Health Information Technology, about any possibility of stimulus funds for meaningful use of certified home health care Electronic Health Record software. He said, even though the current rules under ACA do not extend official certification for Meaningful Use to post-acute software systems, he wants to hear from you about it. Public comment, especially from vendors themselves, is not only welcome but specifically requested.

Just so you won’t have to look it up:
Office of the National Coordinator for Health Information Technology
U.S. Department of Health and Human Services
200 Independence Avenue S.W.
Suite 729-D
Washington, D.C. 20201

Telephone: 202-690-7151
Fax: 202-690-6079
Email: onc.request@hhs.gov

To all of you who wrote me about my father’s hospice experience, a sincere thank you. You are correct, hospice nurses are angels.

Have a great week. Keep making a difference!

Your Editor,

Tim Rowan

Colorado home care providers are celebrating this week over nine dollars and forty-five cents. It is not exactly the same as the factory workers who sang the lyrics above about the hourly raise they sought in the 1954 Broadway musical, “The Pajama Game,” but it is certainly a reason for celebration.

After more than six years of writing and re-writing a series of bills, educating state legislators about each one, and pursuing grants, Ellen Caruso and the Home Care Association of Colorado announced that the state’s first Medicaid telehealth visit will be billable today, February 1.

“Effective February 1, 2012, the Colorado Medical Assistance Program will reimburse for Home Health Telehealth services. Telehealth allows a home health agency to collect clinical information via electronic transmission from the client’s home to the home health agency for evaluation and management. The purpose of providing Telehealth services is to manage and monitor the care of clients whose medical needs can be appropriately and cost-effectively met at home, through the monitoring of data and early intervention.”

There are some limitations but the association believes its long effort is paying off well:

• Home Health Telehealth services must be prior authorized before an agency may submit a bill for Telehealth services.
• The unit of reimbursement for Home Health Telehealth is one day and is only reimbursed for those days on which the client information is reviewed and responded to as needed.
• The initial visit to install the equipment and train the client may be billed as a set-up visit. Only one set-up visit may be billed per client.
• Payment for approved Home Health Telehealth services is based on the established fee schedule, unless a lower amount is billed.
• The purchase and maintenance of the equipment is the responsibility of the home health agency. The agency must ensure that the equipment is Food and Drug Administration (FDA) certified or Underwriter Laboratories (UL) listed/certified.
• Providers may submit a claim for Telehealth services only when there is at least one other home health service on the claim. Providers may not submit a claim for Telehealth services only.

Reimbursement rates will be $9.45 for both acute and long-term home health telehealth encounters and $50 for equipment set up. One encounter may be billed per patient per day, up to 31 encounters per month. One set up may be billed per patient per agency.

To research the background on Colorado’s telehealth reimbursement law, see these HCTR archives:
State of Colorado Nears Law to Pay Same Rate for In-Person, Telehealth Care (4/19/06)

FOLLOW-UP FILE: Colorado Poised to Make Home Care History (4/26/06)

Colorado Governor Signs Telehealth Bill into Law (6/7/06)

A Tale of Two States: Telehealth Reimbursement Lowers One’s Costs; Budget Cuts Raise Another’s (5/14/08)

Home Care Association of Colorado Wins Grant for Colorado Foundation for Home Care Technology and Education (1/5/11)

There is also a video interview with Ellen Caruso, past HCAC president Sonya Neuman and Oregon Home Care Association Executive Director Sarah Myers at http://homehealthsurvivor.com

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

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