Sometimes it’s the little things that give you a big bang for your buck. The Home Health Care News Summit in Chicago on Sept 20, 2018 was just that. It was short and sweet, filling the morning with four sessions that were attended by all. Each session had a moderator and three expert panelists who spoke on various subjects with a question and answer period at the end. It was a very informative and efficient offering put on by Home Health Care News. While this blog tends to lean toward providing good information to the private pay side of home care, I find it useful to look at what is going on in home health because there is often overlap in certain areas, even though, overall, the two industries are very different at the core.

Here are my take-aways and interpretations of the opinions of four conference panels.

Session 1 Mastering New Home Health policies and regulatory Changes

Joy Cameron, Vice President, Policy and Innovation, ElevatingHOME

Kaye Keel, Vice President of Clinical Compliance, Alacare Home Health and Hospice

Tracy Clark, CEO, Interim Healthcare

Tracy Clark of Interim Healthcare says that 80% of their business is Medicaid/Medicare, Medicaid being the fastest growing.

Unwitnessed falls in the home are most prevalent. Solving this problem is paramount to improving care and keeping client out of the hospital.

If caregiver companion/agency could call personal physician in the event of an episode in the home, it is suggested that the large majority of hospital admissions could be prevented.

Suggested modelling to teach caregivers the behaviors that are needed and acceptable. What do you do in your agency?

Community based (that’s home care in general) care as opposed to primary care is the wave of the future.

Nursing workforce will feel the impact of 2020/CMS changes, causing shortages, panelist suggests that generally, Home Health’s product is nursing care.

It will be important that home care agencies understand the Medicare Advantage plan and how they fit into that ecosystem. California is doing the most with mixing Medicare and non-skilled care.

It was recommended that agency’s talk to their client or client family about an emergency plan. What’s yours?

Working with Emergency Medical Associates in your community can be a big help in creating a plan.

Hospice pressure is increasing.

Stay agile and flexible in your administration so you continue to provide great structure in the face of this ever changing industry.

Be a data driven business.

There is a hope that with tough home health industry influence and pushback in Washington D.C. that the 6.4% upfront penalties will be removed and that home health agencies with be given incentives to lower hospital readmissions.

Session 2 New Perspectives on Staffing

Angelo Spinola, Shareholder, Littler

Stacey Buechler, Director of Employee Experience, Right At Home- RightTEAM

Sherwin Sheik, Founder and CEO CareLinx

It was suggested that your caregivers are clients too and should be part of the picture of marketing your culture and brand. Marketing to caregivers as a profession is very important. (I have been harping on this for years to our Rosemark customers). It can be as simple as thank you’s to cg’s or as involved as offering life skills training not just job skills.

There is quite a bit of wage and hour litigation especially over live-in’s and 24 hour care. Full time pay per visit is also a very big problem. If private equity were to come in and want to buy your business, they would do an audit that would uncover problems like this. Investigation of these issues with experienced attorney could help in audits, litigation or caregiver management.

Charting should be on the clock.

ADA website compliant really important.

EMR and eMAR and timekeeping should work hand in hand to protect from unpaid charting.

If competitors in your area are being sued regarding wage and hours then you may be at risk of it coming your way.

Scheduling law has affected fast food and retail and may affect home care – that schedules are given in 3 week chunks and if there are any changes to that schedule the caregiver must get some form of compensation. This will most likely come to home care. Gulp!

CareLinx enables an independent connection of caregivers to clients with an agency involved , they are working with Stride health to provide health insurance to cg’s.

Immigration laws are going to be a big problem for home care by adding to the caregiver shortage.

Session 3 Mergers and Acquisitions (M & A)

Darby Anderson, EVP and CDO, AddusCare

Cory Metz Managing Partner of Mertz Taggert

Morris Estes Managing Director, Capital One Healthcare

Ranking for M & A’s: Home Health #1, Hospice #2, Private Duty #3

Valuations of home care and hospice are currently valuated extremely and unreasonably high. This makes it a good time to sell but it is a bit of a bubble. As the merger and acquisition frenzy has saturated the market, values should drop to more reasonable levels.

Home Health is very behind in the technology usage for efficiency, specifically in the telehealth area.

Session 4 Views from the C-Suite

Paul Kusserow, President and CEO, Amedisys

Julie Smith, CEO, Homewatch CareGivers (HWC)

Dr. Roy Beveridge, CMO, Humana

Hospice is currently 16x value but not workable going forward. Cura bought by Humana.

If PDGM (Patient Driven Groupings Model) goes through it will be a big pain for the home health care industry.

World is converting from acute care to chronic care, MCO’s are going to lead the charge here taking care of the “chronics.” This is important for private duty as they move more and more toward serving Long Term Care insurance (LTCi) clients.

HWC suggests that continuity of pay is correlated to continuity of care.

It was suggested to keep an eye on Bill S.3458. Senator John Kennedy(R-LA) has introduced legislation addressing changes to the Medicare home health prospective payment system as made by the Bipartisan Budget Act (BBA) in February 2018. The bill has not as of yet been brought to the Senate.

The BBA called for allowing the Centers for Medicare and Medicaid Services (CMS) to preemptively make adjustments to payment rates on the basis of assumptions of provider behavior in response to structural changes to the prospective payment system. Senators Kennedy and Cassidy’s bill, S. 3458, would eliminate the usage of assumptions in rate determinations, and mandate that and adjustments needed to maintain overall budget neutrality in the Medicare home health benefit be based on observable evidence that provider behavior change did occur.

Should CMS determine there is evidence of behavioral changes in response to the new model reforms, the information would be subject to the standard rulemaking process with a notice and comment period. Additionally, if the total adjustment exceeds two percent, it would be phased in through equal amounts, not exceeding two percent in a year until the desired total is attained. This phase in approach would help to ensure stability is maintained for providers while the payment model transitions.

Medicare agencies are penalized 6.4% before the fact for fraud and others legalities. This group suggested that Behavioral Adjustments are not good because they are not feasible. (Sounds like it is still a hot button issue).

BlockChain/AI and Telehealth are all going to be a big future for data in the industry.

One suggested that you front load client care because the problems mostly occur in the 2 weeks after a hospital stay. Suggest that waiting until the end of 30 or 60 day episodes does not prevent hospital readmissions.

I hope these small bites give you a better picture of the home health industry and their issues and how the overlapping into private pay home care may affect you.