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.

In response to what they consider disturbing mandates issued by Medicaid officials in two states and parts of two others, a collection of home care and hospice industry telephony vendors, providers, technology vendors and state associations has formed a new organization, “The Electronic Visit Verification Standards Workgroup.” The organization’s members believe rules established by Medicaid officials in South Carolina, Tennessee, Florida and Texas infringe on free market trade and will have far-reaching, detrimental consequences should other states follow suit.

Concern began with South Carolina’s 2005 decision to create its own Electronic Visit Verification (EVV) software application and mandate its use by all Medicaid providers, essentially preventing the industry’s telephony companies from doing business in the state. That concern heightened in 2010 when Tennessee, in consultation with the state’s Managed Care Organizations (MCO), initiated a pilot program with a similar mandate. Instead of building its own EVV system, however, Tennessee’s MCOs awarded an exclusive contract to one vendor, Port Washington, New York-based Sandata.

Florida’s Agency for Health Care Administration (AHCA) started a pilot program for several southern counties where fraud has been a problem. It mandates use of the same vendor for all providers that send claims to Medicaid. A pilot just underway in Texas involves only Region 9, which includes several western counties. It, too, mandates Sandata’s EVV services.

Washington and Ohio, among others, have mandated EVV implementation but chosen a different route. These states’ Medicaid offices established minimum functional standards but will allow home care and hospice providers doing Medicaid business to use a telephony vendor of their own choosing. Members of the EVV Standards Workgroup prefer this solution and will be encouraging other states to adopt it and eschew both South Carolina’s path and the one adopted by the other three states.

Brief history of home care telephony regulations
For years, companies that market telephony systems to home care providers have lobbied against state regulations that clung to 20th-Century thinking and insisted that paper visit records were the only sure way to verify a home visit took place. Though easily able to demonstrate that EVV improves billing accuracy and virtually eliminates fraud by certifying a home health nurse, therapist or aide’s arrival and departure time, advocates were unable to overcome state workers’ reluctance to trust computers over paper.

Now that some state officials finally appear to be getting the vendors’ message, a handful of Medicaid offices, all in Southern states, surprised telephony vendors and their customers with the ways they chose to update their respective regulations.

“Four of the states that finally heard us after all these years – that you can cheat a payer with paper but not with any of today’s telephone-based EVV systems – are either directly competing with us or preventing all but one of us to serve their home care providers,” said Rick Drummond, co-owner of CareWatch, an Atlanta-based telephony software vendor and a co-founder of the EVV Standards Workgroup.

“I know I speak for my colleagues and competitors when I say that this is a mistake that these states will eventually regret,” Drummond continued. “It would have made so much more sense for them to let free market forces loose in their states. There are many of us who have been offering feature-filled, quality telephony systems for years. How can South Carolina providers be better off with a system that does only EVV when there are several available that offer EVV plus so many more sophisticated features – from controlling unauthorized visits to tracking travel time and creating mileage logs – to meet their entire operational needs?”

Multi-state providers harmed more than others
CareWatch customer Roger Ness would agree with Drummond.

Ness is the CIO of Addus, a provider of skilled and non-skilled home care services. Based in suburban Chicago, Addus operates in 19 states. “We use a hybrid system,” Ness told HCTR, “combining the best features of CareWatch and CellTrak to give us a complete visit documentation and communication system. (“Addus Healthcare Increases Accuracy, Decreases Costs with Hybrid Telephony System,” HCTR, 10/4/10) “We are gradually rolling it out to 129 offices,” Ness elaborated, “but not to our offices located in South Carolina. They have to use the state’s system.”

With data gathered electronically by offices in every other state and rolled up from each one to the central office, having offices in one state stuck with an incompatible system introduces substantial inefficiencies and resultant costs, Ness and his superiors contend. Of course, Addus is free under South Carolina’s rules to add its telephony system alongside the state’s EVV application but that would require asking staff to learn two systems, as well as introduce other unwanted problems, Ness believes.

“Think of the process from the home care worker’s point of view,” Ness argues. “A home health aide arrives at a patient’s home and reports her arrival to our CellTrak system with her Blackberry or uses the patient’s phone to call our CareWatch computers. After hanging up from that call, she places another call to the state system, using the patient’s phone. When it comes time to bill, which time do we use? Those calls are going to be at least two minutes apart. What do we say when the state questions the inevitable discrepancies?”

If Addus did deploy its hybrid system in South Carolina, the company would be able to record home health aide tasks completed, receive real-time data from every visit, communicate with staff instantly when an illness or car trouble would otherwise leave a visit unmet, carefully match authorized hours and scheduled hours with fulfilled hours, track employee location using CellTrak’s GPS capability and upload data to the company’s Palatine, Illinois headquarters every day.

One of telephony’s best features, Ness believes, is the ability to know if a worker is ten or fifteen minutes late in arriving. “You can call them to make sure they are safe; you can call the patient to let them know she is on her way and merely running late; if she cannot make it at all, you can broadcast a message to find who else might be in the area with an hour available. You get none of that with a basic EVV system.”

“Ultimately, it is simply not worth it [to deploy two systems],” Ness shrugs. “When we need data from South Carolina, we can search around and eventually find what we need but, at all of our other offices, that data is immediately available, without any effort to go after it. And, since the mandated EVV system is not compatible with any other application and the state has no desire to help write interfaces to our billing system, our corporate reports are always incomplete until the South Carolina data is incorporated weeks later.”

The sensible alternative, Drummond maintains and Ness agrees, would have been for the state to establish certain minimum functional requirements and allow each provider to select its own EVV system from a list of approved vendors, the solution Washington and Ohio chose. “There are a number of competent vendors out there; it would not have been a major undertaking. Instead, they have saddled South Carolina’s Medicaid providers with a very simplistic system. Sure, the state makes it free to providers but in doing so it restricts them to an EVV system that has no other telephony features to offer, even if a provider wanted to pay extra for them. So it is not only the multi-state providers, like Addus, that are experiencing operational limitations. It is every provider, from small to large.”

Texas, Florida, Tennessee take different tack
Indiana-based Arcadia Homecare and Staffing has encountered the same problem in Tennessee, where an exclusive contract was awarded by all three of the state’s licensed Managed Care Organizations to one vendor. “We implemented the Dial-N-Document system in order to qualify to bid on a California contract,” explained Arcadia VP of HR and Operations for the Midwest, Victoria Hollister. “When we were awarded that contract and found Dial-N-Document to work so well in California, we rolled it out in our offices in eleven states. Part of the process in each case was to secure the approval of each local payer source before implementing.”

Arcadia participates in Tennessee’s “CHOICE” waiver program (see sidebar) and had begun using Dial-N-Document there before TennCare’s single-vendor plan was implemented. “We pleaded with the state to let us continue to use our own telephony system, but to no avail,” Hollister told HCTR. “Our IT Director met with TennCare staffers to describe our current system’s functionality. He explained to them that it includes EVV but offers so much more. He told them how Dial-N-Document had reduced our number of questioned visits in Washington and Ohio, but they would not shift their position.”

Non-standard vendor selection process
“I would like to know more about Tennessee’s bidding procedure,” CareWatch’s Drummond told HCTR, “especially if there is a danger that more states might mandate a single vendor system.” When comparing notes after TennCare introduced Sandata as its exclusive EVV vendor, Drummond and Dial-N-Document president Don O’Rourke discovered that, unbeknownst to each other, they had both been in communication with the state to discuss its EVV plans in advance of a final decision.

“I told them about our existing Tennessee clients and our desire to be approved as an EVV vendor in Tennessee for those clients,” O’Rourke told us. “I was told the next steps were not firmed up but that TennCare would contact us when appropriate.”

“I was told the same thing,” Drummond remembers, “but the next thing we heard was that a vendor had been selected and the decision was final.” Drummond and O’Rourke concur that the Tennessee process ended with neither of them having had the opportunity to bid.

TennCare CHOICE providers using Sandata’s EVV to record visits and tasks and submit claims to their respective MCOs are free to use other vendors in addition to Sandata if they want full telephony features, or they can contract separately with Sandata to use that company’s full telephony system in addition to its EVV service, but they may not use another vendor instead of Sandata for EVV.

“These pilot programs are a major improvement for state Medicaid offices,” declared Jeff Silverman, Chief Sales and Marketing Officer for Sandata. He disagrees that a designated vendor system is detrimental. “Such contracts are predicated on providing controls over billing that could not be accomplished with a paper system. By selecting one vendor, the one with the most robust system for tracking visits, the state gets consistency of data. Having a single EVV system statewide means you can implement rules to ensure that billed activities are consistent across all providers.”

Regarding the problem of limiting providers to basic EVV functions, Silverman said that Sandata is ready and willing to add its complete telephony system to the one the state pays for. Nothing in the rules in Tennessee, Florida or Texas preclude a provider from contracting with the designated EVV vendor for other software that vendor has available.

“As pilot programs, Silverman added, “there is not enough experience yet to say whether and how much they will control Medicaid costs and improve patient care. We fully expect, however, that the data will eventually show significant advantages in both these areas.” Tennessee began in the fall of 2010, Florida’s pilot began after that, and Texas is just now beginning its Region 9 pilot.

Providers have limited options
As in Addus’ South Carolina dilemma, Arcadia could have asked its Tennessee staff to learn two telephony systems so that the company could comply with state rules while using Dial-N-Document to gather the larger data set its offices in other states enjoy, but decided that would have been too much to ask of the staff.

The Indiana-based provider could also have contracted with Sandata to add telephony features to its mandated EVV system but IT personnel were put off by the prospect of having to figure out how to assimilate data from two disparate systems into one set of management reports every month. “We would write the interface for them,” offered O’Rourke. “It’s the kind of thing we do to keep customers happy.” Arcadia has elected not to proceed with those development efforts at this time, Ms. Hollister told us.

Telephony systems providers not the only affected vendors
The interface question brings up the issue of how widespread the problem has already become. It affects all home care software vendors, not just those offering telephony systems. Equally impacted by decisions made by Medicaid officials in these three states, back office billing/clinical software vendors have begun to express concern as well. HealthMEDX and Sansio, for example, built interfaces between their billing/clinical software applications and Dial-N-Document to accommodate the needs of customers they held in common. CareWatch and CellTrak put in a great deal of effort to make their systems work together seamlessly for Addus.

“These interfaces are expensive to build,” explained Charlie Daniels, CEO of HealthMEDX. “When you can spread the cost across several customers, it makes sense to go ahead and build it. But to build a second interface for customers in just three states, we would have to pass that cost on to those few customers, directly or indirectly.”

“A state mandate like this imposes additional cost burdens and administrative overhead on providers,” Daniels added. “Our other customers have to place one phone call, to us, when they have an issue that is not clearly ours or the telephony vendor’s. We handle it. They only have to deal with one lease document and one tech support department for product upgrades. As soon as you add a third vendor into the mix, there is immediately more complexity and therefore more cost.”

He said that he has not lost any Tennessee customers yet, as the home care community tends to be used to taking in stride constantly changing, often inconvenient, government regulations. “But they do not like having their choices limited,” he emphasized. “Either do we. Our task now is to encourage other states not to make the same mistake South Carolina, Tennessee, Texas and Florida made. There should be a standards-based EVV mandate – requiring electronic visit verification is obviously good for providers, payers and patients alike – but it is not right to limit provider choice to one specific vendor.”

Sansio’s Vice President of Sales, Kraig Erickson, states the vendor position on this issue even more strongly. “Payer-mandated EVV strategies do not allow home care agencies to realize the full benefits of electronically collecting visit information via their integrated software solutions. Instead, they result in an inefficient ‘silo’ effect across jurisdictions and program types.

Speaking for the newly formed EVV Workgroup, Erickson added, “We believe it forces duplication, adds cost and complexity, and creates data integrity concerns to have relational data such as time and attendance, scheduling records, services, client records and billing stored in multiple places.

“EVV is great, but it is like have the ice cream cone without the ice cream. Numerous additional benefits can be realized by allowing agencies to utilize electronic documentation methods that meet a standard and are integrated with their centralized back office scheduling and billing systems. We’ve highlighted a list of those benefits on the Home Care Agenc Perspectives page of our new EVVworkgroup.org website.”

Pointing out that more and more home care agencies provide services in multiple jurisdictions for multiple payers, and that many agencies of this size already use telephony systems that are tightly integrated with their scheduling, billing, payroll and patient management functions, Erickson reiterated Daniels’ call to get the message out quickly to other states that may be already choosing between the South Carolina and Washington models. “Seamless data exchange between telephony and billing systems is what gives telephony systems their ability to reduce costs and increase efficiencies,” Erickson underscored.

Spreading the word
This theme, communicating with the other 44 states before it is too late, runs through every conversation we had when researching this issue, with telephony software vendors, billing/clinical software vendors and providers. Some emphasize the inherent restrictions on free market commerce; others bemoan the inconveniences to multi-state providers; and others point out the costs imposed on software vendors by the need to create multiple EVV interfaces for one customer. Whatever each one’s focus, they all agree that remaining state Medicaid officials need to hear their common message.

With the exception of Sandata’s Silverman, all agree that Tennessee, Florida and Texas could have gone about this in a better way. Everyone agrees that South Carolina’s system causes more operational problems than it solves, especially for multi-state providers.

In coming months, we will keep a watchful eye on the EVV Standards Workgroup, as well as on developments in other state Medicaid offices, and offer periodic progress reports on this critical issue. The EVV Standards Work Group has a standalone web site and hosts a LinkedIn discussion group. Erickson indicated that membership is open to home care providers, technology vendors and state and national associations.

The deal may have created home care’s largest software company, measured by total number of clients. HealthCareFIRST acquired Lewis, Inc. and its 1,000+ clients last spring. CareFacts adds approximately 300 more.

In an exclusive interview on December 30, HealthCareFIRST CEO Bobby Robertson told HCTR that the deal had been in the works for some time. “We knew we were not finished with our growth plans after we acquired Lewis,” Robertson said, “but we took our time looking for another acquisition that would be a good fit. Our due diligence left us quite impressed with CareFacts.”

Robertson said one of the most impressive findings during his research phase was the percentage of CareFacts customers that have adopted the vendor’s optional point-of-care application. CareFacts CEO Gordon Raup, who also participated in the interview, reports that adoption rate at 69%. Excluding the vendors that require point-of-care as an integral part of their clinical system, the average rate in home care is often estimated at well below 50%.

The acquisition will catapult HealthCareFIRST into the public health arena. Perhaps as many as a third of CareFacts’ clients are county health organizations. The dollar amount of the purchase price will not be released.

Raup and Robertson said that CareFacts customers were to be informed on Thursday and Friday, December 30 and 31, with a detailed packet of information arriving via overnight mail on Friday. The acquisition is effective immediately.

Software support and development will continue uninterrupted. Robertson’s plans for the company include keeping the St. Paul office open and operating as it has been. Sales efforts will also remain largely unchanged, Robertson said, though the CareFacts reps will now be able to offer ancillary products such as Episode Master, HMO Watch and Receivables Master, which came to HealthCareFIRST via the Lewis acquisition.

Raup will depart immediately but not go far. He plans to begin work on a healthcare software product idea that may include a product of interest to home care agencies and hospices in the future.

www.carefacts.com
www.healthcarefirst.com

Federal agents charged 94 people in Miami, Florida; Baton Rouge, Louisiana; Detroit, Michigan, and the Brooklyn borough of New York Friday with defrauding Medicare, the Department of Justice and other federal agencies said in a joint statement.

It is the largest health care fraud takedown since the creation of the Medicare Fraud Strike Force, known as H.E.A.T., three years ago. The defendants include doctors, health care company owners and executives, the statement said.

“Today’s arrests send a strong message that attempts to defraud Medicare will not be tolerated,” said Health and Human Services Secretary Kathleen Sebelius. “With the help of new tools in the Affordable Care Act, including stiffer penalties and better information sharing, we will continue to work with our federal, state and local partners to stamp out Medicare fraud and protect beneficiaries and the American taxpayer.”

The defendants are charged with conspiring to submit over $280 million in false claims to the federal health care program designed to aid the elderly.
Thirty-six defendants charged in the schemes have been arrested and additional arrests were expected throughout the weekend, federal officials said.

Charges include filing fraudulent claims for HIV/infusion services, home health care, physical therapy and durable medical equipment.

The Medicare Fraud Strike Force is a joint effort by the Department of Justice and the Department of Health and Human Services. The team works with federal, state and local investigators to analyze Medicare data and emphasizes community policing.

“With today’s arrests, we’re putting would-be criminals on notice: Health care fraud is no longer a safe bet,” Attorney General Eric Holder said. “The federal government is working aggressively – and collaboratively – to pursue health care criminals around the country and to bring these offenders to justice.”

Health care fraud fighters in Florida will now have additional funding to help find potential fraud and abuse in the state’s Medicaid program through use of Medicaid claims data.

Secretary Kathleen Sebelius announced this week that the U.S. Department of Health and Human Services (HHS) has approved Florida’s Medicaid waiver request to help fund a demonstration program that will allow the state’s Medicaid Fraud Control Unit (MFCU) to “mine” Medicaid Management Information System (MMIS) data to identify cases of potential Medicaid fraud.

Medicaid billing for many health care services in South Florida is disproportionately high compared to other parts of the country. Although significant progress has been made, fraudulent health care billing continues to cost Medicaid millions of dollars.

“To fight health care fraud, we need to coordinate all of the resources and data we can muster,” said Secretary Sebelius. “By allowing the state of Florida to use more information to find potential fraud in Medicaid, this waiver will improve Florida’s ability to effectively identify and combat fraud and abuse.”

The announcement comes in advance of the first joint HHS and Department of Justice (DOJ) Regional Health Care Fraud Prevention Summit, held at the Knight Center in Miami.

The summit, which featured keynote remarks by U.S. Attorney General Eric Holder and Secretary Sebelius, kicked off the first in a series of day-long summits bringing together a wide array of federal, state, and local partners, beneficiaries, providers and other interested parties to discuss innovative ways to eliminate fraud within the U.S. health care system.

As part of its efforts to coordinate the fight against fraud across the nation’s health care systems, including Medicaid and Medicare, data mining will allow Florida’s MFCU to sort electronic claims through the use of statistical models and intelligent technologies to uncover patterns and relationships. Using the identified patterns, investigators can review Medicaid claims activity and history to find abusive or abnormal use of services and potentially fraudulent billing. Data mining is done with software programs which include algorithms that automatically analyze MMIS data.

Currently, state MFCUs are prohibited from using federal Medicaid matching funds to detect potential fraud through routine claims review procedures such as screening of claims, analysis of billing practice patterns, or routinely verifying that billed services were actually received by patients, since these functions are a primary program operation function of the state Medicaid agency. Instead, MFCUs generally rely on referrals from the State Medicaid agency. The newly approved waiver will allow the Florida MFCU to use federal matching funds to apply sophisticated electronic data mining tools that are beyond the scope of the claims review activities normally performed by the State Medicaid agency to identify potential fraud.

CMS expects the MFCU to work closely with AHCA to ensure their collective efforts are effective. CMS will monitor progress of this waiver in conjunction with the HHS Office of Inspector General, which has oversight of MFCUs.

“The demonstration approved today will allow Florida’s Medicaid Fraud Control Unit to take full advantage of its expertise in detecting and investigating Medicaid fraud,” said CMS Administrator Don Berwick, M.D.

In other federal news, HHS has announced awards of $10 million to 10 national non-profit organizations to support public health efforts to reduce tobacco use and reduce obesity through increased physical activity and improved nutrition.

These competitive awards are part of the HHS Communities Putting Prevention to Work (CPPW) initiative, a comprehensive prevention and wellness initiative funded under the American Recovery and Reinvestment Act of 2009.

“Communities Putting Prevention to Work” will help communities implement prevention policies including incentives to food retailers to locate and offer healthier options in underserved areas; healthier choices in child care, schools, and the workplace; subsidized memberships to recreational facilities; safe routes to school; and evidence-based strategies that discourage tobacco use and increase utilization of cessation programs.

“In the United States, seven of 10 deaths result from chronic disease, with tobacco, obesity, poor nutrition and lack of physical activity as the key risk factors for disease,” said HHS Assistant Secretary for Health Howard K. Koh, M.D., M.P.H.

The awardees are:

• American Academy of Pediatrics
• American Heart Association
• American Lung Association
• Association of American Indian Physicians
• BlazeSports America
• Community Food Security Coalition
• National Association of Latino Elected Officials
• National Recreation and Parks Association
• Sesame Workshop
• Society for Public Health Education

In addition to these new grant awards to national organizations, HHS will soon launch a National Prevention Media Campaign that will deliver hard-hitting advertisements to complement and support the work of CPPW. A contract for $28 million was recently awarded to the Academy for Educational Development (AED).  This new media contract will also develop consumer materials for First Lady Michelle Obama’s Let’s Move! campaign aimed at preventing childhood obesity.

Links:

http://www.hhs.gov/ophs/funding/cppwfactsheet.htmlhttp://www.hhs.gov/recovery/programs/cppw/factsheet.htmlhttp://www.cdc.gov/chronicdisease/recovery

In an exclusive interview hours after the news was released, Sandata CEO Harold S. Blue told HCTR that the deal had quietly been in the works for several months. "This acquisition will add about 200 customers to Sandata and will round out our product line." Sandata, he said, has always focused on the Medicaid and medical staffing side of home care; adding the HSS product line will place them squarely in the Medicare world.

Relatively new himself, Harold S. Blue joined Sandata as Vice-Chairman and CEO in November, 2009 but had worked closely with Chairman Bert E. Brodsky for years in his capacity with HealthEdge Investment Partners, a private equity healthcare buyout fund.

HSS began as a benchmarking software company, once known as HQS, but grew through acquisitons of its own in recent years, adding CareKeeper’s private duty software system, VividNet, as well as a growing line of peripheral systems designed to supplement an agency’s capabilities over what its back office application might be able to do. The Analyzer is a PPS episode manager and OASIS analysis tool. PreciseTrax is a GPS system to provide a real-time view of a mobile workforce. Other HSS products include Clinical PDA, CareTab, Executive Dashboard and Advantage.

CEO Blue indicated that the HSS acquisition would increase Sandata’s overall size by about 15% – 20%. "It brings in a nice IT group," he told HCTR. "They know home care and they know their product line. Development and support will continue without interruption." Sandata will add 38 HSS associates to its existing team of more than 160 and bring Sandata’s total base to more than 1,500 customers nationwide. 

In fact, HSS development teams in Manhattan and sales department in Tampa will remain intact, Blue said. The only former HSS staff not joining Sandata will be company president Stan Vashovsky and his team of software engineers who had been working on non-homecare contracts for Philips Medical’s hospital products division.

Vashovsky stated, "HSS’s corporate management team will continue to work closely with Sandata as part of a Transition Services Agreement and has entered into a long-term strategic relationship with Sandata for Sandata to exclusively distribute our advanced tracking and location-based technology tools such as Precise Trax™."

HSS acquisition closely followed arrival of new investor and a name change
On March 25, Sandata announced that Stripes Group completed a minority investment in the company.  Ken Fox, Founder and Managing Partner of Stripes Group, will become a member of the Sandata board.  In connection with the Stripes investment, TD Bank provided new senior debt financing to retire existing debt and to fund future growth.

The announcement marked a renewed marketing and branding effort that the home care community will see evolve over the coming year, Sandata CEO Harold Blue said. "To mark the beginning of the rebranding effort, we have changed the company’s official name from Sandata Technology Inc. to Sandata LLC."

Chairman Brodsky said Stripes will be a minority investor and partner who will "help us manage the next stage of our evolution and growth."

Fox added that Sandata is "well-positioned to take advantage of what we believe will be a period of hyper-growth as the home healthcare market continues to implement technology to improve quality of care, efficiency in operations, and reduce fraud and abuse."

A Sandata news release announcing the acquisition briefly described the HSS products mentioned above.

• Advantage – a suite of web-based, integrated applications designed to facilitate the clinical, financial and operational aspects of Medicare agencies
• Clinical PDA – Point-of-Care “Smart Phone” applications that enable the real-time capture of clinical information, real-time data transmissions and improved communication among care team members
• Analyzer – decision support tools that enable home healthcare agencies to manage Medicare PPS episodes on a real-time basis; executive dashboard provides instant desktop access to key statistics and metrics
• Performance Advisors – a specialized healthcare consulting service that helps agencies understand and improve outcomes by capturing and benchmarking key data to reveal opportunities to improve quality of care, financial performance and business operations
• Vivid – a set of hosted, enterprise and IVR telephony products for Medicaid/Private duty agencies, which integrate client and caregiver profiles, scheduling, billing and payroll into a single, comprehensive tool
• Precise Trax ™ – a sophisticated GPS tracking application for mobile devices, which can be used to pinpoint the location of field staff in any urban, suburban or rural environment; Sandata will utilize Precise Trax™ under an exclusive license agreement

Another scenario is more common in hospitals than during a start of care home visit. The octogenarian arrives via ambulance through the emergency entrance, about to lose consciousness. “Sir, do you have an advance directive?” Same answer as above, from his wife, hours later.

These logistical obstacles experienced frequently by health care providers are reminiscent of a scene in the 1983 classic, “Terms of Endearment” where Jack Nicholson takes Shirley MacLaine for a ride in his hard-top convertible Corvette. When it starts to rain, they find themselves miles from home on a country road. “Can’t you put the top up?” she asks. Jack answers, “The top is at home in my garage.”

The way most people store their signed and notarized Advance Directive (AD) documents recalls Shirley’s problem, with considerably less humor. No one carries the document with them everywhere they go, nor is anyone standing near their home filing cabinet or bank safe deposit box when they come face to face with end-of-life decisions.

New company; new solution

It appears that a technology solution is finally on the horizon. A new company calling itself “Embark Health” is preparing to introduce an electronic Advance Directive next month that can be accessed when needed, instantly and easily. The new company’s management team and its product idea were apparently impressive enough to have attracted former United Healthcare and SecureHorizons CEO Kenneth A. Burdick to invest and serve as Chairman.

According to the company’s advance materials, obtained by HCTR, Congress enacted the Patient Self Determination Act in 1991, giving patients and families, not healthcare providers, the legal right to make critical end-of-life decisions. However, all too often, patients are still not getting the care they have chosen in advance, 19 years later. Only 15%-20% of Americans have an AD. Those who do have one do not always have their instructions carried out.

“If providers do not see a document stating patient choices, patients have little chance of controlling their own care,” the company’s explanation begins. “If
a patient cannot speak, providers may make the decisions alone. In some states, families can be excluded from decisions, even if they are confident they know what the patient would want. When families disagree among themselves, courts could assign a guardian who does not know the patient to make the decision.”

What Embark Health has done is to create an electronic storage service with a number of fail-safe features. When released next month, Embark’s Advance Directives Clearinghouse will not only store documents but keep them “clear, correct and current.” Documents will be reviewed by Embark staff for compliance with laws in the patient’s state.

An alert system consisting initially of wallet cards and stickers will let providers know that an AD exists and can be immediately accessed on the Embark site or via a 24/7 toll-free call center.
The company is also setting up education and communication programs to reduce confusion among all parties involved in end-of-life decisions.

Legal support services

In addition, there will be a nationwide legal support network to ensure Embark members’ wishes are properly observed. Patients will be guided to designate a healthcare agent and an alternate, whom Embark will educate about their responsibilities. Members will pay a low annual fee to use all Advance Directives Clearinghouse services.

Embark Chief Development Officer Bill Behnke told HCTR the company’s mission is to provide a service that solves a problem for both patients and providers. The problems are not caused by mal-intent on the part of providers or family members but by logistical challenges inherent in the current system, or lack of one, he explained.

Behnke also explained Embark’s business model. “We plan to partner with health plans, hospitals, employers, charities, physician groups, home care companies and other organizations who want to offer this to their clients and members,” he told HCTR, adding that the company plans additional products after this one has been established.

Burdick wrote in his letter introducing himself as CEO, “While this is not a silver bullet cure for all that ails the American health care system, I am proud and privileged to be engaged in a mission that can accomplish three important objectives:

1. honor the most personal decisions of individual patients
2. protect physicians and hospitals from unnecesssary legal liability
3. more effectively utilize the vast resources of our moden health care system

We will follow up on this story when Embark introduces the system on February 1. A web site, www.embarkhealth.com, will be turned on Monday, January 18.

Effective January 1, Sarah A. Myers, a Certified Association Executive (CAE)* with more than 13 years of experience leading state and national associations, assumed the positions of President and Chief Executive Officer of CGI. Ellen Caruso will remain as CGI’s Director of Government Relations; CEO Fred Caruso is retiring.

A registered lobbyist, Ms. Myers hails from Oregon where she has served as Executive Director for the Oregon Association for Home Care since 1996 in her capacity as a Government Relations Consultant for Legislative Advocates, Inc., a private consulting and lobbying firm. She has also been a supervising manager to the Oregon Cable Telecommunications Association and, through 2009, Chair to the national Council of State Home Care Associations.

“We are extremely pleased that Ms. Myers, with her talents and accomplishments, will lead our team of association professionals,” said Ellen Caruso. “CGI will continue to provide a high level of service to the association business community of Colorado as well as to national and international clients. Her leadership and expertise ensure CGI continues to grow through our core mission and principles.”

“I am pleased to bring to CGI a diverse level of knowledge and experience and to be leading a team of professionals dedicated to quality service to the association community,” said Myers. In her new position with CGI she will direct all services for the current client base as well as seek new opportunities for growth for the 30 year old firm.

“I am a dedicated marathon runner who knows what it takes to go the distance with patience, perseverance, dedication and commitment in order to achieve long term goals” Myers added. “We will continue the work and achievements to-date and build on our strengths to advance new opportunities.”

CGI was founded in 1980 by Ellen Caruso, who will continue to focus on and expand the firm’s legislative and regulatory division, concentrating primarily on state and federal health care issues. “I have always enjoyed legislative and policy work; now I’ll have the opportunity to concentrate on and expand these arenas that have been growing rapidly over the years,” said Caruso.

Ms. Myers’ arrival coincides with CGI CEO Fred Caruso’s retirement from the firm after 42 years in the association management field. He will concentrate on his writing and publishing career from his offices in Colorado and West Cork, Ireland. Since 1977, he has written and published four books, two on the role of trade and professional associations in society, one on Montana history and a personal memoir, “Born Again Irish,” describing how a near-tragedy led to a New Yorker of Italian descent falling in love with Ireland.

A special open house will be held for the association community at the CGI offices on January 29 to welcome Ms. Myers and honor Fred Caruso’s accomplishments and contributions.

In addition to the Home Care Association of Colorado, CGI has managed operations of the American Physical Therapy Association / Colorado Chapter since the early 1980s. Ms. Myers brings with her the Oregon Association for Home Care. In 2010, CGI will welcome the Colorado Center for Hospice and Palliative Care (CCHPC). Other clients include the Colorado Nurses Foundation, the Colorado Chapter of APTA Private Practice physical therapists and the International Association of Reservation Executives. CGI also manages audio- and web-based educational programs for the nationally-acclaimed Institute for Participatory Management & Planning and dozens of associations throughout the U.S. Last year these programs provided education to an estimated 10,000 individuals.

hcaconline.org

*Editor’s Note: ASAE awards the designation of CAE to less than 5% of association executives worldwide. The designation is a mark of excellence and commitment to advancing the knowledge of and achievement in the profession of association management.

According to a company statement, the dual acquisitions, Mediware’s fourth and fifth in the last 24 months, continue the company’s market expansion strategy to increase its penetration of the home care solutions market. Terms of the deal include a cash payment of $5.5 million, with an additional cash payment of up to $1.5 million if performance targets are met. Mediware expects to complete the acquisition before December 15.

This is not the first ownership shuffle for HAI during the past decade. CEO Ken Pereira sold the company he founded once before but bought it back in 2003. He explained to HCTR what he had to do with the company’s home care software development upon his return. “HomecareNet was 80% finished when we got the company back in 2003,” Pereira began. “We completed work on it in 2004 and converted our customers from our legacy product between 2005 and 2007.”

It was then that HAI turned its attention from modernizing existing customers to winning new ones. The vendor rapidly signed deals with Johns Hopkins and then Duke University. This year, HAI announced a contract with Apria. “With that kind of growth,” Pereira continued, “we began to look for the next level. One path would have been to raise equity to acquire one of the many companies out there with older software and offer our updated system to their customers. Another would have been to join up with a larger, growing company. That was when Mediware contacted us.”

Mediware had acquired Hann’s On Software (HOS) in 2008, Pereira explained. “Once they were owners of a very good pharmacy system, they approached us because of our strong reimbursement side, something they did not already have.” In addition to HAI software, Pereira has an interest in Advantage Reimbursement, which billing, A/R and collection services. Takes them from $40m to $47m.

“The addition of these organizations to Mediware is an exciting expansion of a growth strategy that includes strategic acquisitions, developing new products, and expansion of our existing customer base,” said Thomas Mann, Mediware’s president and chief executive officer. “Adding to the acquisition of HOS just over a year ago, our home infusion customer base will increase to more than 450 facilities.”

Home health products and services became a focus for Mediware last year with the acquisition of HOS and the Ascend pharmacy management system. These products help ensure safe and efficient drug therapies in small acute care and outpatient hospitals, as well as home infusion providers and specialty pharmacies.

The HAI acquisition takes Mediware from $40 million to $47 million in annual revenue and expands Mediware’s market penetration by adding complementary pharmacy, home medical equipment, home healthcare and billing capabilities as well as mobile documentation technologies and remote hosting capabilities.

“Research into the specialty pharmacy market indicates the segment is growing at an impressive 20% annual rate,” continued Mann. “These types of services are becoming increasingly popular as they allow therapies to be continued on an outpatient basis to lower the overall cost of care. While cost management is always a concern, medication safety remains our industry’s highest priority.”

Mann said key leaders for each business are being retained, including the group’s CEO, Ken Pereira, and other operational leaders. Pereira will become a Mediware vice president and general manager, leading the Company’s new Alternate Care Solutions group. All staff at both companies will remain in their current positions as Mediware employees, Pereira told HCTR.

According to Mann, Mediware’s strategy is to acquire sound businesses with products and services in or adjacent to the company’s core markets. Prior acquisitions include:

• November 2007: Integrated Marketing Solutions provided donor recruitment technologies to blood centers. IMS formed the basis for Mediware’s Blood Center Technologies product group that provides integrated technology for blood and plasma centers.

• November 2008: Hann’s On Software added a medication management system targeting smaller healthcare organizations. HOS expanded Mediware into home health technology solutions.

• June 2009: SciHealth added a business intelligence solution used by more than 100 hospitals. Its Insight product allows hospitals to create performance managing dashboards.

About Mediware

Headquartered in Lenexa, Kansas, Mediware delivers interoperable software systems that integrate with electronic medical records. Core Mediware products include blood management technologies for hospitals and blood centers; medication management for hospitals, behavioral health facilities, infusion and specialty pharmacy providers; and business intelligence-based performance management systems for clinical, regulatory and financial aspects of the broader healthcare market.

www.mediware.com
www.healthcare-automation.com

• Two new guides on Premixed Insulin Analogues available from AHRQ
• Healthcare industry still posting job growth – especially in home care
• Have you decided about CAHPS?
• Surgical masks proven as effective as N95 respirators in safeguarding healthcare workers – implications for home health clinicians and organizations
• 2010 OIG Work Plan shows major focus on Medicare & Medicaid home health; hospice issues also included

Two new guides on Premixed Insulin Analogues available from AHRQ

Two new free publications are now available through the AHRQ Effective Health Care Program.

The Clinician’s Guide on premixed insulin analogues for treating adults with Type 2 diabetes, titled, “Premixed Insulin Analogues: A Comparison with Other Treatments for Type 2 Diabetes,” is available at: http://effectivehealthcare.ahrq.gov/repFiles/Insulin_Clinician5.pdf

A free Companion Guide for consumers, “Premixed Insulin for Type 2 Diabetes: A Guide for Adults” – AHRQ Pub Number 08(09)-EHC017-A is available at: http://www.effectivehealthcare.ahrq.gov/healthInfo.cfm?infotype=sg&DocID=125&ProcessID=18

For free printed copies, call 800-358-9295 and ask for the documents by their AHRQ publication number.

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Healthcare industry still posting job growth – especially in home care

An October 2, 2009 article in Modern Healthcare reported that an estimated 19,200 jobs were added to the healthcare industry in September while unemployment in the economy as a whole pushed to a 26-year-high of 9.8%. The industry has added 195,400 jobs during 2009, growing by 1.4%.

Most of the growth has been in outpatient settings such as physician offices and home healthcare. Home healthcare services grew by 0.4% in September, adding 4,400 workers to a total employment of 1 million, the same percentage as a year ago.

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Have you decided about CAHPS?

What is it? The Consumer Assessment of Healthcare Providers and Systems (CAHPS) Home Health Care Survey, (Home Health Care CAHPS Survey) is designed to measure the experiences of people receiving home health care from Medicare-certified home health agencies. The Home Health Care CAHPS Survey will be conducted for home health agencies by approved Home Health Care CAHPS Survey vendors.

The survey is designed to meet the following goals:

• Produce comparable data on the patient’s perspective that will allow objective and meaningful comparisons between home health agencies on domains that are important to consumers.
• Public reporting of survey results are designed to create incentives for agencies to improve their quality of care.
• Public reporting will serve to enhance public accountability in health care by increasing the transparency of the quality of care provided in return for public investment.

Is it Mandatory? Home Health CAHPS is a voluntary process in which home health agencies may choose to participate through approved vendors. For now, CMS only intends to use the survey data for public reporting but there could be a future tie to Prospective Pay and Pay-for-Performance. That the data would be publicly posted can be a great marketing tool, or not, depending on results.

What is the Timeline?

• Voluntary HH-CAHPS participation time period is from October to December 2009.
• Another option is for an agency to begin with the “dry run” period between January and March 2010.

NOTE: Agencies must complete a dry run or participate in the voluntary implementation to be eligible for national implementation.

CMS proposes that participating home health agencies conduct a dry run of the survey for at least one month in the first quarter of 2010 (January, and/or February, and/or March 2010) and submit the dry run data to the Home Health CAHPS Data Center by 11:59 P.M. EST on June 23, 2010. The dry run data would not be publicly reported on Home Health Compare.

CMS proposes that all Medicare-certified HHAs continuously collect HH-CAHPS survey data every quarter beginning in the second quarter (April, May and June) of 2010 and submit these data for the second quarter of 2010 to the Home Health CAHPS Data Center by 11:59 EST on September 22, 2010. The proposed CMS rule requires agencies to participate in the April 2010 national implementation to be eligible for their full annual payment update.

From August 13, 2009 Federal Register, p. 40962 at http://www.gpo.gov/fdsys/pkg/FR-2009-08-13/pdf/R9-18587.pdf

A guidance manual that describes agency and vendor obligations and list of approved vendors as of September 14, 2009 is on the Home Health CAHPS website www.homehealthcaphs.org

Other vendors are in the approval process. A Spanish version of the interview script was posted to the site on October 2, 2009. You can download a copy of the questionnaire in MS-Word format from the Survey and Protocols tab on the CAHPS website.

What is the cost? The cost will be determined by the vendors, patient population and survey type (i.e. phone versus mail) that the individual agency chooses.

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Surgical masks proven as effective as N95 respirators in safeguarding healthcare workers – implications for home health clinicians and organizations

Increasingly, a variety of masks are available for purchase, from big box stores to medical supply companies. Although these products are likely not comparable to surgical masks developed for medical settings in how they are made or in materials, the effectiveness of surgical masks as compared to other protection methods is important to consider.

Scientific data about the effectiveness of the surgical mask compared with the N95 respirator for protecting health care workers against influenza are sparse. Given the likelihood that N95 respirators will be in short supply during a pandemic and not available in many countries, knowing how effective a surgical mask protects health care workers against influenza is very important.

A research study published in the Journal of the American Medical Association on October 1, 2009 found that using a surgical mask was comparable with using an N95 respirator. A randomized controlled trial of 446 nurses in emergency departments, medical units, and pediatric units in eight tertiary care Ontario, Canada hospitals was conducted by randomly assigning nurses to wear either a fit-tested N95 respirator or a surgical mask when providing care to patients with febrile respiratory illness during the 2008-2009 influenza season.

Influenza infection occurred in 23.6% in the surgical mask group and 22.9% in the N95 respirator group and the results were found to be statistically significant. These findings are important to home care clinicians who are exposed to various home settings every day.

As the country prepares for the H1N1 and regular influenza season, home health agencies should be stocking an adequate number of masks for staff as well as establishing a relationship with a supplier who can quickly replenish stock.

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2010 OIG Work Plan shows major focus on Medicare & Medicaid home health; hospice issues also included

The Office of the Inspector General (OIG) of the Department of Health and Human Services has issued its Work Plan for Fiscal Year 2010. As in previous years, the Plan identifies many investigations of home health and hospice. Of the two services, the main focus by both Medicare and Medicaid is home health.

The bullets listed below each have further explanations in the Plan that can be accessed at http://oig.hhs.gov/08/Work_Plan_FY_2010.pdf

Medicare Home Health, the OIG will be investigating:

• Part B payments to outside suppliers for services and supplies that are included in home health agency (HHA) prospective payment and the adequacy of controls to prevent inappropriate Part B payments;
• HHA claims and medical records to assess the accuracy of home health resource groups (HHRG) listed on the claims and identify patterns of miscoded HHRGs;
• The incidence of Medicare home health services outlier payments for insulin injection and billing patterns in geographic areas with high rates of home health visits for insulin injections;
• The Centers for Medicare & Medicaid Services’(CMS) methodology for calculating outlier payments to determine whether the methodology reimburses HHAs as intended for high cost episodes;
• Compliance with billing for the appropriate location of services provided, and trends regarding the number of claims submitted to Medicare, of visits furnished to beneficiaries, arrangements with other facilities, and ownership information;
• Cost report data to analyze HHA profitability trends to see if the payment methodology should be adjusted, including profitability in Medicare and overall profitability trends for freestanding and hospital-based HHAs;
• Billing patterns in geographic areas with high utilization of diabetes self-management training services;
• CMS’ process for ensuring that Outcome and Assessment Information Set (OASIS) data submitted by HHAs is accurate and complete; and
• Contractor’s screening mechanisms and post-enrollment monitoring to identify HHA applicants that pose fraud risks to Medicare and the extent to which applicants omitted ownership information on enrollment applications.

Medicare Hospice, the OIG will be investigating:

• Part B billing for physician services furnished to hospice beneficiaries, including frequency and total expenditures for physician services under Parts A and B for hospice beneficiaries and whether physicians double billed these physician services to Parts A and B;
• Hospice claims to identify trends in hospice utilization, including the characteristics of hospice beneficiaries, geographical variations in utilization, and differences between for-profit and not-for-profit providers; and
• Whether Medicare is making duplicative payment for drugs to hospices under Part A and to individuals under Part D, and to identify controls to prevent duplicative payment.

Medicaid Home Health will include:

• Review of HHA claims to determine whether agencies have met applicable criteria to provide services and whether beneficiaries have met eligibility criteria;
• Review of Medicaid payments for personal care services to determine whether states have appropriately claimed federal financial participation;
• In selected states, review whether attendants furnishing personal care services met state qualifications;
• In selected states, review the extent to which Medicare and Medicaid have paid for the same home health services, and the controls these states have established to prevent duplicate payment; and
• Review states’ compliance with federal regulations for home- and community-based services (HCBS) waiver programs and CMS’ oversight of states’ compliance with these HCBS waiver programs.