Home Health Care Leadership Minute

Medicare ID Theft Growing as Quickly as Boomer Elders

noreply@blogger.com (Mandy Besek) — Tue, 26 Jan 2010 13:56:00 +0000

Digital medical records have become the favorite fraud outlets for ID theft hackers. Published reports from late last year stated that approximately $47 billion were stolen from questionable Medicare payments.

The Medicare system has become the "single biggest victim" of health care fraud in America, according to Rob Montemorra, chief of the FBI's Health Care Fraud Unit.

The payoff for health care identity fraud is mind boggling. In 2008, criminals pocketed more than $19,000 per incident of health care fraud, which is more than three times the amount gained through overall ID theft, according to Javelin. The cost to the individual victim was nearly $1,200, more than double that of overall ID theft.

Health care identity theft has outgrown all other crimes in the field last year, according to Louis Saccoccio, executive director of the National Health Care Anti-Fraud Association (NHCAA).

"Since we all pay taxes, we are all our victims because the cost of this [crime] is coming out of our pockets," according to Montemorra.

Continue to encourage your clients to review their Medicare receipts and be cautious about who they share their medical health and billing information with. Promoting awareness and support about this issue will help strengthen relationships and prevent Medicare ID theft in your community.

Additionally, when Medicare fraud becomes rampant, it’s an easy decision for legislatures to tighten the belts on the Medicare system. It saves the system some money, and looks great on election day. Unfortunately, it means that the true savings are often negligible, yet the additional expense and increased scrutiny for good quality Medicare providers is a hardship.

Source: CNN

Hispanics More Likely to be Admitted to Poor Quality Nursing Homes

noreply@blogger.com (Mandy Besek) — Sat, 09 Jan 2010 13:27:00 +0000

Mary Fennell, study leader and professor of sociology and community health at Brown University, found that the elderly among the Hispanic population are more likely than non-Hispanics to live in nursing homes of poor quality.

In traditional Hispanic households, care for family seniors has been handled by adult daughters at home. The dilemma is that there are an increasing amount of young Hispanic women that work outside the home.

When daughters are working full time and unable to attend to older family members during the day, they must seek out a solution. According to Fennell’s study, some 4.5 million senior Hispanics are expected to need care sometime in 2010.

From 2000-2005, the percent of Hispanic residents increased from 5 percent to 6.4 percent, but the percentage of non-Hispanic white residents dropped from just under 83 percent to 79.4 percent.

To reach the oringinal article that this post was inspired from or for more information about this study, click here.

“Avoidable” and “Unavoidable” Pressure Sores

noreply@blogger.com (Mandy Besek) — Sat, 12 Dec 2009 17:45:00 +0000

The development of pressure sores on a client can easily go unnoticed to the untrained eye. They can cause serious infections, some of which can be lethal. Pressure sores are a major concern for any home care company.

The Center for Medicare & Medicaid Services (CMS) categorizes pressure sores under both “Avoidable” and “Unavoidable”. These definitions serve as a map for potential malpractice situations, and need to be understood by all home care companies.

“Unavoidable” pressure sores are defined as when the client developed a pressure ulcer even though the team had evaluated the client’s clinical condition and pressure ulcer risk factors; defined and implemented interventions that are consistent with client needs, goals, and recognized standards of practice; monitored and evaluated the impact of the interventions; and revised the approaches as appropriate.

“Avoidable” pressures sores are termed so because the clinical team was at fault because the process above was not implemented.

Pressure sores will be an unfortunate reality for many of your clients that are at high risk, such as those that use a wheelchair or are bed bound. You can use the CMS definitions as a starting point “checklist” to make sure that your company does everything possible to prevent, address and document pressure sore issues.

It is a good idea to assess each client for pressure sore risks at their first caregiver visit. Provide all of your caregivers with basic training about signs of pressure sores and sore prevention. A handy one page checklist tucked in a client journal can keep caregivers refreshed to this often overlooked, but serious issue.

How to Avoid Medicare Marketing Scams

noreply@blogger.com (Mandy Besek) — Tue, 03 Nov 2009 15:23:00 +0000

The new post on the Private Duty Today blog has a great article about helping your clients avoid Medicare marketing scams. Click here for more information.

Parent's May Misguide Senior's Long Term Care

noreply@blogger.com (Mandy Besek) — Fri, 16 Oct 2009 14:59:00 +0000

When seniors are searching for home care, they often seek the advice of their children first, particularly their daughters. Many seniors assume that their children have a better grip on the current economic situation and understand the health care system. The American Association for Long-Term Care Insurance found some unsettling results in a recent study.

Although the study was about long term care planning for women, if daughters of seniors misunderstand their own long term care plans, they also have the potential to misguide the care plans of their parents.

Almost 20 percent of women participants in a national survey believed that they already had long-term care coverage, while only about 5 percent of U.S. adults over the age of 45 actually had it. The survey suggests that many women may assume that their health coverage includes long-term care, when in reality it doesn’t.

Investigating long term care plans for both the senior and their child will help both understand the ins and outs of the system.

Blackberry Report: The National State of the Home Care Industry Study

noreply@blogger.com (Stephen Tweed) — Thu, 15 Oct 2009 18:01:00 +0000

The National Association for Home Care & Hospice (NAHC) has announced the completion of The BlackBerry® Report: The National State of the Home Care Industry Study. The study, conducted to provide insights into essential advances and reforms in the delivery of home
health care services, is intended to help providers of these crucial services
prepare for pending overall health care reform.

The study, the largest of its kind, is designed to drive best practices that
can be shared for the benefit of the whole industry. The study demonstrates
the collaboration within the home care industry to prepare for proposed
reimbursement cuts, and to retool to use technology and data to improve
quality and patient care.

The first analysis of the BlackBerry Report (available at
http://fazzi.com/research/state_of_industry_study.html) revealed key insights
that underscore the home care industry's commitment to the utilization of
technology to enhance quality and improve efficiencies and productivity
through the adoption of Electronic Medical Record Systems, Point of Service
(POS) Systems, hand held devices and telehealth.

Our friend and colleague, Dr. Bob Fazzi, presented the results of the survey at the NAHC annual conference in Los Angeles earlier this week. Some highlights from the study are:

Just over 65% of all agencies now have Electronic Medical Record
       Systems.

Eighty-three percent of these agencies report that the use of
       these systems has led to improvement in quality of care coordination.

Nearly 40% of all agencies now use some form of POS system in the
field.

Handhelds account for 6.3% of hardware presently being used

Just over 36% of those agencies seeking to purchase new hardware report that they are
       interested in handhelds.

Twenty three percent of agencies report using telehealth systems.

Shield Healthcare Announces Story Contest to Honor Caregivers

noreply@blogger.com (Stephen Tweed) — Thu, 15 Oct 2009 00:28:00 +0000

VALENCIA, Calif., Oct. 14 -- Shield Healthcare, a leading
provider of medical supplies for care at home, is pleased to announce its 9th
annual story contest on "What Makes Caregiving Rewarding?" designed to
recognize and hear the voice of caregivers and home healthcare professionals,
featuring celebrity contest judge, Sandra Mitchell of KCAL 9/CBS 2 News.
Shield Healthcare understands that caregiving is a demanding job. A
significant number of our customers are family caregivers at home, tending to
a loved one with a chronic medical condition. They unselfishly take on the
challenge and responsibility of meeting the daily health and emotional needs
of the person in their care. This story contest is a positive way to recognize
and reward this important role. The contest runs through November 30, 2009 in
celebration of National Family Caregiver's Month.

Last year's winners included 3 mothers of special needs children, a nurse, and
a social worker. Winner Susan Agrawal wrote, "Among all the blessings that my
daughter has bestowed upon me, seeing her grow through inchstones has granted
me the best gift of all: the ability to see wonder and joy in the most
unexpected places."

The top three story winners will receive $1000 in American Express Gift
Cheques and a 1-year subscription to Today's Caregiver Magazine. The two
runner-ups will also be awarded the magazine subscription and $250 in American
Express Gift Cheques. All contest entries must be one-page, typed or
hand-written and postmarked by November 30, 2009. Entries should be mailed to
Shield Healthcare, Attn: Caring Solutions, 27911 Franklin Parkway, Valencia,
CA 91355 or emailed to caring@shieldhealthcare.com. Full contest details are
available on Shield's website at www.shieldhealthcare.com.

Recovery Audit Contractors

noreply@blogger.com (Stephen Tweed) — Wed, 14 Oct 2009 16:09:00 +0000

RACs have been established to reduce improper payments by Medicare, to detect and collect overpayments, and to identify underpayments. They are to implement actions to prevent future improper payments.

There is no phase in strategy, and all Medicare provider types are available for RAC review once they have reached out to the providers. However, Mary's thought is that they will focus on recovering big dollars from hospitals, Rehab, and major surgeries, since that's where the biggest opportunities lie. The RACs are paid based on a percentage of the dollars they recover.

There are 4 RACs in place, and each covers one fourth of the country. The RACs jurisdictions match the MAC jurisdictions for DME. Mary suggested that everyone attemd the RAC presentation provided by CMS - Program 814. You need to know where previous improper payment have been found and if you are submitting claims with improper payments. Mary St. Pierre, Vice President for Regulatory Affairs at NAHC suggests that you prepare to respond to RAC Medical Record Requests, and stay calm and stay informed.

Medicare Administrative Contractors

noreply@blogger.com (Stephen Tweed) — Wed, 14 Oct 2009 16:06:00 +0000

Congress amended section 1816 of the Social Security Act to replace Medicare fiscal intermediaries and carrier contracting authorities with new Medicare Administrative Contractors (MACs). It requires all providers and suppliers to be generally assigned to a MAC based on geographic location. Large chain providers - EXCEPT Home Health & Hospice - are permitted to consolidate their billing activites under the MAC with jurisdiction over the chain's home office.

Home Health Care Regulatory Update

noreply@blogger.com (Stephen Tweed) — Wed, 14 Oct 2009 15:44:00 +0000

At the annual conference of the National Association for Home Care & Hospice, Mary St. Pierre, Vice President for Regulatory Affairs presented her update on new regulations affecting home health care. As always, Mary was wonderful in helping us understanding the regulations that will be affecting us. Here's a brief list of the regulatory issues the Mary covered, and a link to her handout materials for this presentation. A short report on each element will follow in future blog postings.

http://www.nahc.org/Meetings/AM/09/Handouts/513.pdf

Regulatory Update Items*

* Medicare Administrative Contractors
* Recovery Audit Contractors
* Survey & Certification Future Considerations
* Post-Acute Care Demonstration
* Home Health Quality
* CHAMP - Collaboratin for Homecare Advances in Management Practice
* Red Flag Rule
* Medicare Home Health PPS Rule
* Case Mix Creep
* Outlier Policy Change
* Proposed Coverage Standards
* Provider Enrollment
* Physician Certification and Recertification
* Oasis Compliance and OASIS-C
* CAHPS - Consumer Assessment of Health Providers and Systems
* Delta OASIS-C Best Practices Project

There's clearly a lot of valuable information here, and you'll want to learn as much as you can about each of these items. Stay tuned for more details.

We appreciate your comments. If you were in Mary's session, what was most important for you?

Injury And Hazards In Home Health Care Nursing Are A Growing Concern

noreply@blogger.com (Stephen Tweed) — Sat, 10 Oct 2009 12:43:00 +0000

Patients continue to enter home healthcare ''sicker and quicker," often with complex health problems that may require extensive nursing care. This increases the risk of needlestick injuries in home healthcare nurses. While very few studies have focused on the risks of home healthcare, it is the fastest growing healthcare sector in the U.S. In a recent study, led by researchers at Columbia University Mailman School of Public Health, the rate of needlestick-type injuries was 7.6 per 100 nurses.

At this rate, the scientists estimate that there are nearly 10,000 such injuries each year in home care nurses.

The findings were published in the September 2009 issue of American Journal of Infection Control.

Future Technology May Help Keep Seniors Safe

noreply@blogger.com (Mandy Besek) — Wed, 12 Aug 2009 15:23:00 +0000

Check out the newest post on Private Duty Today for an insight on new robotic research projects aimed to keep seniors safe.

CNN Survey on President Obama's Health Care Reform

noreply@blogger.com (Mandy Besek) — Wed, 05 Aug 2009 15:09:00 +0000

Recently released this morning was an opinion survey on President Obama's Health Care Reform from CNN. The survey questioned over a thousand individuals, mostly non-hispanic whites, about whether they approved of or opposed the current reform. Research found that half of those surveyed were in favor of the reform, while 45% were opposed. Only 5% stated that they had no opinion.

When questioned further, of those that favored the reform, only 23% said that they felt strongly about it. In contrast, of those that opposed the reform, 33%, a 10% increase, stated that they felt strongly about their opinion.

You can learn more about this poll and statistics compared to President Clinton's reform here.

Statistics on Home Health Care Growth

noreply@blogger.com (Mandy Besek) — Wed, 15 Jul 2009 13:19:00 +0000

New jobs for health aides, such as caregivers, will outweigh other positions in the health field such as doctors or nurses according to Obama’s Council of Economic Advisers.

Compared to other non-health related occupations, health related fields have seen a 12% increase since 2000, of which 48% came from health care support such as home health care aides.

As the aging population continues to increase, there will no doubt be more home health care aide positions available to be filled.

Boomers Boost Web Traffic

noreply@blogger.com (Mandy Besek) — Tue, 14 Jul 2009 16:39:00 +0000

A web traffic study by Neilson Online proved there are growing numbers of seniors seeking information online, particularly health related information. In fact, people 55 years and older accounted for nearly one third of the online traffic in late 2008.

The Pew Internet and American Life Project has shown that 91% of internet users between the ages of 64-72 also use email. Additionally, 85% of this age group uses search engines and 70% are seeking health related information.

Home health care companies can benefit from these numbers by providing additional online services on their websites such as email contact information, search bars, and other health related information.

M.M.S. Study on Home Health Care from a Doctor's Viewpoint

noreply@blogger.com (Mandy Besek) — Thu, 09 Jul 2009 14:15:00 +0000

A recent research collaboration between the Massachusetts Medical Society and Home Care Alliance of Massachusetts found that doctors supported the benefits of home health care, but found that there were problems within the medical system for wide spread referrals.

From a randomized sample of 3,000 Massachusetts licensed doctors, there were 248 responses from 12 specialties. Over half of the responses were from primary care physicians.

The majority agreed that these services allowed them to better manage their patients’ care, prevented emergency room visits, and reduced family stress.

Around half of the doctors said that paperwork, payment, and access problems interfered with home health services for their patients. Half stated that they had to keep patients in the hospital for a longer period simply because there was difficulty finding home health services.

I would like to thank The Boston Globe for providing much of the information. You can read their article here.

North Carolina Nurses Educate Legistlators About Effects of Medicaid Cuts

noreply@blogger.com (Mandy Besek) — Fri, 03 Jul 2009 12:33:00 +0000

The state senate has recently approved a $55 million dollar budget cut to the Medicaid Personal Care Services (PCS) program. More than 36,000 elderly and children with mental/physical disabilities in North Carolina rely on these services as a part of their daily lives.

The North Carolina Association for Home and Hospice Care (AHHC) and its 900 agency membership have made efforts to educate the state legislators and communities about the devastating effects. The team points out a significant economic loss if the state forces many of these elderly patients into nursing homes, where care costs can nearly quadruple.

Encouraging Communication with Alzheimer's Patients

noreply@blogger.com (Mandy Besek) — Thu, 02 Jul 2009 12:41:00 +0000

Caregivers need to understand how to listen to and communicate with their Alzheimer’s patients. This is essential for understanding their needs and developing a friendly relationship between caregiver and client. Make your caregivers aware of these simple steps.

Be Patient. Alzheimer’s patients may have difficulty finding the right words to describe what they are thinking. They may stay silent when they are trying to organize the words in their head.
Eliminate Distractions. The tv, phone, magazines, etc. may be inappropriate to use when conversing with your client. If your client is talking during a movie, turn the volume down. If you are on the phone, tell the person to hold for a couple of minutes.
Agree to Disagree. Expect that the opinions, habits, and interests of your client will be vastly different from yourself.
Be Reassuring. Alzheimer’s patients may be tempted to give up on communicating because of frustration or anxiety. Encourage your clients to speak their mind in their own words and that what they have to say is important to you.
Be Positive. Remember to smile when you listen to your clients! Expand on positive statements that your clients bring up.
Take Interest in Feelings. Emotions may be some of the easiest subjects for a client to express because they experience them daily. Highlight a good day or when you catch your client smiling or laughing.

New Gadgets for Senior Assistance and Entertainment

noreply@blogger.com (Mandy Besek) — Tue, 23 Jun 2009 17:44:00 +0000

Lure crowds during your next health fair by offering a free raffle on some fun and functional electronics for seniors. Listed below are brief descriptions of some products available for the elderly in your community.

Jitterbug™
Easy-to-read simple cell phone for seniors to help them keep in touch with friends and family.

Kindle™
Electronic library that holds downloadable e-books. This product comes with a variety of built-in audio options that may help visually impaired seniors enjoy book reading.

GrandCare™
This electronic day planner lets busy family members upload photographs, check appointments, and messages at the touch of a button.

SeniorPC™
These senior friendly computers, a product of HP and Microsoft, are designed to make everyday computer tasks easier. They also come with a variety of memory games and a prescription planner.

7 Ways for Caregivers to Improve Senior Quality of Life (attached link)

noreply@blogger.com (Mandy Besek) — Fri, 19 Jun 2009 13:03:00 +0000

This is a post that will help all caregivers build meaningful relationships with their clients.

Check it out

Boomers May Face Bankruptcy and Long-Term Care Collapse

noreply@blogger.com (Mandy Besek) — Wed, 17 Jun 2009 19:11:00 +0000

Check out a related article, posted on Private Duty Today, that explains more.

Newly Named Healthcare Faculty Regulation

noreply@blogger.com (Mandy Besek) — Mon, 15 Jun 2009 18:28:00 +0000

The Healthcare Faculty Regulation (HFR), lead by division chief Doug Colburn, will be the new name for the former Georgia Dept. of Community Health as of the first of July. This will be a division of the Georgia Office of Regulatory Services.

The move was in response to Senate Bill 433, which has forced the Dept. of Human Resources to transfer responsibility for licensure and regulation of hospitals and other health related institutions.

HFR will enforce licensing and regulate nursing homes, home health agencies, private duty home care, personal care institutions, and personal care home employee record checks.

Medical ID Theft

noreply@blogger.com (Jason Tweed) — Thu, 11 Jun 2009 13:00:00 +0000

Many of your clients that do not check their medical records closely may be at risk of medical identity theft. According to the World Privacy Forum, as many as 500,000 Americans have been the victims of medical identity theft, most of which don’t even realize until it is too late. Recovery from identity theft can take years at the expense of the victim’s bank account, health plan, and dignity.

Surprisingly, a vast majority of the thieves are corrupt doctors, nurses, and other health care professionals that know their way around medical billing systems. A thief can ruin credit history, medical history records, and can even put the victim at risk of lost insurance coverage.

You can encourage your clients to be more aware of their medical record history by having them follow these simple steps:

• Always review your explanation of benefits (EOB) that is sent in through your medical insurer. Notify personnel if you see changes that do not correlate to your history.
• Monitor your insurance benefits
• Keep a copy of your medical records on hand. In case you would become a victim of medical identity theft, these important documents act as evidence.
• Correct inaccurate medical record immediately. Even minor mistakes need to be corrected to ensure accuracy.

By providing some basic information about medical identity theft prevention, your clients will respect your company for protecting their dignity and be more responsive to your services.

Nursing Home Negligence and Prevention

noreply@blogger.com (Jason Tweed) — Tue, 09 Jun 2009 13:43:00 +0000

Court systems statewide are noticing increasing rates of nursing home negligence and elder abuse. The economic crisis is tempting too many caregivers to take advantage of these sensitive individuals.

The jump in abuse is creating an ever more competitive environment for nursing homes. Families are double checking safety and negligence records of nursing homes to ensure that such abuse doesn’t happen to their loved one.

Even if the nursing home does have a reliable record, it does not guarantee your family member will not be abused. Such unfortunate events are rarely to be blamed on supervisors, managers, and other higher level staff, rather they are simply the symptoms of an unjust caregiver.

If abuse is suspected and has supporting evidence, an elder abuse lawyer, nursing home abuse lawyer, or a nursing home negligence attorney can assist in obtaining compensation. Different cases receive varying levels of compensation. In some instances, a situation may be settled out of court.

Cases of elder abuse, not matter how small, can be a huge setback for any home health care business trying to entice new customers. To prevent such situations, provide incentives for experienced caregivers. Maintain yearly and quarterly caregiver training meetings. Require background checks for caregiver applicants and invest in random drug screening. Those not able to deal with the stress of caring for another individual may react inadvertently. Caregivers that are educated about dealing with stress and are provided with outlet options will be less likely to abuse their clients.

Hospitals losing Money. What will be the impact on Home Health Care?

noreply@blogger.com (Stephen Tweed) — Tue, 10 Mar 2009 05:00:00 +0000

According to a report from Thomson Reuters, U.S. hospitals maintained their operating margins through the third quarter of 2008. But steep investment losses pushed 50 percent of them into the red for 2008, resulting in a “near-zero” median margin for the industry. The bottom quartile of hospitals posted average losses of 7 percent or more for the year.

Meanwhile, the recession-fueled increase in the numbers of uninsured and Medicaid patients is making hospitals’ financial position worse this year. The rout has been compounded by a drop in the number of surgeries, which have affected 44 percent of the hospitals in the survey.

What are you seeing with hospitals in your marketplace? How will this impact home health care?

One trend we observe is that when hospital census is down, home health referrals drop off as well. Are you seeing a decline in your hospital referrals?

Another trend we have seen in the past is that when financial performance lags, hospital executives decide to exit the home health business. With many hospital based home health agencies losing money anyway, look for some executives to cut their losses and get out of the business. If so, this will be a great time to pick up some market share. It will also be a time for strategic buyers to move into your marketplace, acquire the hospital based agency, and become your new competitor.

What are you seeing? Give us your comments below.