Tag Archives: home health care

Home Health Care Agencies Must Innovate To Meet Demand

Home Health Care Report: Innovate Or Die

Home Health is considered by many analysts to be a major are of growth in healthcare in the coming years.  With the retiring Baby Boomer demanding more convenient, personalized and home based care options, Home Health Care is in an excellent position to capitalize on massive influx of new patients.

But with all the potential in the home care market there have been even more challenges.  Fraudulent activity and substandard care have caused consumer trust in home health care to erode.  In response to the fraud, regulatory agencies have added restrictions, cut reimbursement and doubled down on law enforcement.  The punitive nature of this enforcement has stifled innovation and caused home health agencies to be overly cautious with new service delivery models.

Home Health Companies are looking for the next great money making innovation. photo courtesy Freedigitalphotos.net
Home Health Care companies are looking for the next great money making innovation. photo courtesy Freedigitalphotos.net

The regulations surrounding insurance reform and the proliferation of Accountable Care Organizations have many independent small to medium-sized home care companies grasping at ways to grow census in a system becoming increasingly exclusive.  The companies who fail to innovate and develop multiple revenue streams have been forced to close their doors while other are working to develop new service delivery models to meet the rising demand for home care services.

Some of that demand can be found in specialized services focusing on diagnoses that cause the most hospital readmissions.  There is a push to reduce hospital readmissions under the new Accountable Care system that penalizes hospitals for return trips to the ER after a hospital stay. To accomplish this goal hospitals are partnering with Home Health Care companies to find new ways to treat patients who are at high risk for readmission.

These programs often include disease education, raising awareness of community resources and frequent visits from Home Care professionals to help with the transition.  What is more, these programs are often reimbursed outside of the traditional Medicare system Home Care companies have become comfortable with.

Home Health Care programs that prove the ability to reduce health care cost are often funded by third-party insurance “carve-outs” or grants which fund healthcare innovation.  Palliative Care, Care Transition and disease management programs are all examples of programs that are being funded by these sources.

The innovation game isn’t just for the large Home Care companies.  A small to medium sized company can jump in if they have a solid structure that favors permanent over contract employees. A company who works almost entirely with contractor may find it difficult to control cost and quality in a newly developed program that could sudden operational changes.  However companies who focus on permanent employees may find the cost of change easier to manage.

Home Care companies who are able to innovate in the new Accountable Care system would thrive in the years to come.  More innovation can only serve to improve the greatest healthcare system in the world.

Questions about this post?  Email AnthonyFischer@elderadvocacygroup.info

Michigan’s Medicare Fraud Problem Caused By Lax Home Care Regulation

Michigan Lags Behind Other States In Home Care Regulation

Home Care services will play a key role in the ever-changing healthcare system.  With an avalanche of Baby Boomers nearing retirement age, the healthcare system is desperate for services that provide quality care cost efficiently while keeping patients from making costly emergency room visits.

Baby Boomers are also demanding more innovation and service improvements in healthcare just as they have of every other service they have consumed. Skilled Home Care, Hospice and Telemedicine have proliferated as a result.  So much so that lawmakers and policy wonks in Washington are expecting a dramatic increase in Home Care utilization over the next decade.

So what’s holding the rapidly growing home care industry back? Fraud.  New companies have sprung forth to meet demand with many founders having little to no experience in healthcare service delivery. Without the proper expertise to compete by providing quality service, owners turn to fraudulent schemes to make ends meet.

As a deterrent to fraudulent behavior the FBI has made a public spectacle of Medicare fraud busts.  The FBI press releases have had their intended effect but they have also had the unintended consequence of deterring patients form using the service.  That combined with the reluctance of doctors to refer to potentially fraudulent providers has slowed the development of this much needed service.

Falling Short

Most states have faced the fraud problem head-on by requiring companies to apply for a state license in addition to the federal Medicare license.  The extra requirements have served as their own deterrent to Medicare fraud.

Still there are four states in the union that don’t require any additional licensing to operate a home care company.  Michigan, Ohio, Iowa and Massachusetts all refrain from further regulating the home care industry. To their credit Ohio and Massachusetts require additional licensing for the professionals that work in the industry.  However Michigan Home Care Companies remain the least regulated and companies in the state remain a major target of the FBI’s Medicare fraud task force.

A Hot-Bed Of Activity

mcquade
Barbara MCquade, US District Attorney, Eastern District

Since 2013 the FBI’s Medicare Fraud Task force has indicted more than 70 Michigan healthcare professionals for medical fraud worth over $410 million. Even the FBI has noticed that southeast Michigan has become a hot bed for fraud activity.

“For whatever reason I think Southeast Michigan has become an opportune area to operate in,” said F.B.I. Special Agent in Charge Andy Arena. “That’s what this task force is trying to show. That this is not the place to be. Get out.”

The Reasons Fraud Runs Rampant In Michigan

Owners Lack Health Care Service Experience

The increase in fraud could have something to do how easily an entrepreneur can open a home care agency in Michigan. Even with little to no knowledge of the healthcare system.  Potential owners can also obtain a license to operate a home care at a relatively small cost. Normally expensive costs like labor can be purchased cheaply through contractual agreements with payment deferred until after the operator receives the license.

This year the federal agency overseeing Medicare and Medicaid reimbursement (CMS) finally issued a moratorium on new home care licenses. However the move comes after many fraudulent companies are already in operation in Michigan.

Infrequent Inspections

Another factor contributing to fraud is the infrequency of home care regulation provided in the current system.  Federal Medicare regulations require that licensed home care agencies be inspected

Photo Courtesy www.FreeDigital Photos.net David Castillo Dominici
Photo Courtesy www.FreeDigital Photos.net David Castillo Dominici

every two years. The Centers for Medicare and Medicaid Services (CMS) depend on third-party regulators to facilitate the survey process. Organizations like the Community Health Accreditation Partner (also known as CHAP) and the Joint Commission provide professionals to conducting inspections.  Although all inspectors receive training a shortage of inspectors often puts the process behind schedule.

The gap between inspections (known in the industry as surveys) opens a window of non-compliance with agencies able to ignore regulations without fear of inspection.  During this time agencies often go without key staff like Qualified Administrators, Clinical Directors, Medical Directors and key office staff to cut overhead cost and squeeze more profit out of the bottom line.  This practice adversely effects care and lowers the inter-agency accountability.  Without key healthcare professionals taking an active part in the company, owners often cut corners and open the door for fraud.

Not A Small Problem

The fraud problem isn’t limited to small companies or start-up companies.  Large companies with years of experience have also fallen into fraudulent habits either through malicious intent or negligent.

More regulation, especially in Michigan can help stem the tide of fraudulent behavior. Additional state licensing, requiring licensed administrators and an increase in inspection frequency can help fix a horribly flawed system.  For now consumers should make themselves aware of the warning signs of Medicare fraud as well as asking their lawmakers to increase home care regulations.

The cost efficiency of home care service can go along way to saving the healthcare system.  Until fraud is rooted out however the American taxpayers will have to foot the bill for billions of dollars in increased healthcare cost.

Baby Boomers Poised To Change Healthcare

The Baby Boomers have drastically changed nearly every industry over the last sixty years.  So it should be no surprise that they are having significant effect the healthcare industry as well.

In fact Baby Boomer’s present the single largest challenge the American healthcare industry has ever faced. The Boomers will be using the system at historic rates as the industry tries to meet demand with an aging  and depleting workforce.

This is the most powerful force operating in our health system right now, this generational change,” says Jeff Goldsmith, president of Health Futures Inc., Charlottesville, Va. So far, the growth in the number of senior citizen boomers has been incremental, and its impact on health care has been overshadowed by federal reform and budget battles. “People aren’t paying much attention,” via hhnmag.com

The Post World War II generation is also demanding changes in the healthcare system causing a shift to home-based services such as home care, visiting physician services and hospice.  That is a demand lawmakers believe America’s health care system can rise too.

In July, Senator Ron Wyden (D-ORE) told Medpage Today that he believes a Baby-Boomer inspired revolution is coming to healthcare.

“I believe Medicare and Medicaid are going to lead a revolution in caring for people at home,” Wyden said, especially for chronic illnesses such as cancer, diabetes, stroke, and Alzheimer’s, which account for 93% of Medicare’s costs.

Home Care can save the Medicare system money.  With technological advances in the Bio-med field and electronic medical records, the licensed healthcare professional can access medical information and order treatments just as efficiently than a hospital facility.  For patients who don’t need 24 hour monitoring by a Register Nurse or physician, home care can be a very cost effective service delivery system.

Hospital systems have already figured this out.  They are investing more time and resources into home care services as a way to boost patient outcomes and cut hospital readmission. Minimizing readmission is a key part to the new reimbursement system Medicare has put in place as a result of the affordable care act. By having some control over the patients healthcare delivery after discharge, hospitals hope to curb readmission and provide better outcomes.

With the healthcare industry already embracing the shift to home care and lawmakers willing to fund it.  Look for more innovation in the field of home health care over the next fifteen years.  Innovation that could save the Medicare system from financial collapse.