April 2014
When the Unexpected Happened: The Coding Conundrum of ICD-10! By Jan Spears
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he U.S. House of Representatives was once again working feverishly on March 27 to pass legislation to address the Medicare physician fee payment reduction of 24% effective April 1, 2014. The bill, H.R. 4302 “Protecting Access to Medicare” offered a last minute patch introduced by Representative Joe Pitt (R-PA), containing these simple seven lines: “The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD10 code set as the standards for code sets under section 117(c)
In This Issue: ALJ Delay Will Result in Eradication of Home Health Agencies- Pg. 2-3 An Advocate in MA: Representative Alan Silvia Pg. 4 Using Your Vision to Recruit Top Talent: Jonathon Kovar- Pg. 5 The American Nurse A Documentary Pg. 6-7 Goodbye to Windows XP and Office Pg. 8 Hall of Inspiration Pg. 9 Highlight on an Excellent Home Healthcare Owner: Amy Nelson Pg. 10-11 Still No Free Market for EVV Pg. 12
of the 13 Social Security Act (42 expended U.S.C. 1320d-2(c)) and section into 14 162.1002 of title 45, Code getting of Federal Regulations.” Passed ready without a roll call vote in the for the House, the Senate took up the transition. measure on Monday, March 31, Pushed again at late date and with a by CMS timelines and transition primary aim to get the physician markers, many agencies fix in before the Medicare cuts re-worked referral intake to physician payments were processes, sent coding and implemented. leadership By a 64-35 teams to ICDPreparation for its vote, the 10 training implementation must still Senate passed programs, HR 4302 with go forward. Don’t put your brought the ICD-10 training inhopes in another delay delay left next year. And don’t lose house to their intact. Thus, clinicians, your investments already worked with the frenzy expended by shelving for ICD-10 vendors on enforcement, your ICD-10 manual and software slated to begin filing away your coding modifications, October 1, and set their knowledge. 2014, came to readiness a screeching clock well halt. The conundrum of what to ahead of what was expected to do has just begun to set in. be the “final delay.” The new delay actually penalizes those CMS estimates the one who prepared timely while year delay for implementing rewarding those who were less ICD-10 could cost the health diligent. So, how should the care industry and related home health agency solve the stakeholders between $1 and coding dilemma before them $6 billion. The degree to which now? an individual home health or Most industry stakeholders hospice provider is financially are encouraging those agencies impacted is directly proportional that are ICD-10 ready to to the work the entity has Cont. on page 8
ALJ Delay Will Result In Eradication of Home Health Agencies
By Edward Vishnevetsky
Several weeks ago, Nancy J. Griswold, Chief Administrative Law Judge at the Office of Medicare Hearings and Appeals (“OMHA”), sent a memorandum to various providers warning that Administrative Law Judge (“ALJ”) assignments would be delayed for at least twenty-four (24) months. Judge Griswold stated that she also expects post-assignment hearing waittimes to continue to exceed six (6) months. In total, some cases may linger three (3) years or more before an ALJ hearing occurs and an adjudication is issued. The effect of this decision is that it is retroactive to claims that were filed on or after July 15, 2013. Aside from the potential constitutional violations (which require an entirely separate article to discuss), a delay may not seem that significant: it’s just a longer time to wait, right? WRONG! Many Medicare Part B providers and suppliers, like home health agencies (cumulatively, “HHAs”), remain unaware of the tools that the United States Government has at its disposal to collect Medicare overpayments. This article uses a hypothetical scenario to summarize the Medicare recoupment process to ensure your awareness of the exacting methods the Government can take to collect from providers. The consequences of a delay ALJ assignment, hearing, and adjudication are substantial. Even a cursory investigation of the latest developments make it patently clear that these delays may put more Medicare providers, like HHAs, out of business than any other issue facing healthcare companies today. 2
Hypothetical Scenario HHA receives a letter from CMS (through the local Medicare Administrative Contractor) stating that 40% of the HHA’s claims for certain HCPC codes (under consolidated billing) were improper in the past year, translating to an overpayment amount of $150,000. CMS then extrapolates the denial percentage to all of the HHA’s claims for those certain HCPC codes within the past 5 years, leading CMS to demand the HHA pay $4.5 million for overpayments. I. Extended Repayment First, the HHA must decide whether to submit a request for an Extended Repayment Schedule (“ERS”). Below are some (general) facts about the ERS process: 1. The ERS process changed in 2013. 2. The Government will approve an ERS if the total amount of all outstanding overpayments is 10% or greater than the total Medicare payments made for the previous
calendar year. 3. The longest time period an ERS can last, if approved, is 60 months (or 5 years), from the date of the Initial Demand Letter. 4. The interest rate associated with an ERS is statutorily set at 10.875%. 5. Payments recouped during ERS processing will not be refunded to the HHA. 6. HHAs that submit a request for an ERS lasting greater than 6 months must submit a multitude of financial documentation, including a letter from a bank denying a request for a loan in the amount of the alleged overpayment. 7. Just because an ERS request was made for a specific amount of time does not mean CMS will approve the ERS for that time period. In the hypothetical example listed above, assuming a maximum ERS approval of 60 months: 1. The HHA must pay $97,560.61 in principal and interest each month. 2. Based on the 3-year delay outlined in Judge Griswold’s memorandum (above), the HHA will pay $3,512,181.96 before an ALJ adjudicates the claim. II. Interest and Recoupment During the Appeals Process A. Interest Interest, at a rate of 10.125%, begins to accrue on all unpaid overpayments within 30 days of the HHA’s receipt of the Initial Demand Letter until the overpayment is repaid in full.
B. Redetermination approximately $2,768,343.75 after collection efforts include rights to The first level of appeal is Redeterthe Reconsideration decision is collect on all of a HHA’s assets— mination. Although a HHA has issued. not simply the Medicare funds at 120 days after receipt of an Initial issue—allowing a collection from Determination notice to submit an III. Treasury Offset Program all of the following sources: appeal for Redetermination, unless If the HHA fails to make pay1. All accounts receivable (from one of the following occurs, CMS ment arrangements with CMS or Medicaid, private insurance, or will start recouping the overpayCMS is unable is to recoup the retail). ment following the 41st day after entire alleged overpayment debt 2. Bank accounts. the date of the Initial Demand within 180 days, the debt becomes 3. Real estate interests. Letter: “delinquent.” Upon delinquency, 4. Administrative wage garnish1. HHA timely submits a reCMS refers the debt to the United ments. quest for ERS. States Department of Treasury for IV. HHAs with the Same Tax Iden2. HHA timely submits a rebutfurther collection under the Treatification Number tal statement. sury Offset Program (“TOP”). Section 6401 of the Affordable 3. HHA timely submits a reUnder the TOP, the Department Care Act added the option to quest for Redetermination. of Treasury can collect debt from collect overpayments from entities C. Reconsideration the HHA (“Debtor”) by collectsharing a tax identification number The second level of appeal is Reing funds directly from any of the (“TIN”). Specifically: consideration. Although a HHA below federal sources of Debtor (6) AUTHORITY TO ADJUST has 180 days after the Redeterincome: PAYMENTS OF PROVIDERS mination decision date to submit 1. Debtor’s income tax return. OF SERVICES AND SUPPLIERS a Reconsideration appeal, unless 2. Social Security, Black Lung, WITH THE SAME TAX IDENthe HHA timely submits a TIFICATION NUMrequest for Reconsideration, Even a cursory investigation of the BER FOR PAST-DUE CMS will start recouping the — (A) latest developments make it patently OBLIGATIONS. overpayment from: IN GENERAL. — Notclear that these delays may put more withstanding any other 1. The 60th calendar day after the Redetermination provision of this title, in Medicare providers, like HHAs, out notice date if the Redetermithe case of an applicable of business than any other issue fac- provider of services or nation decision affirms the entire overpayment in quessupplier, the Secretary ing healthcare companies today. tion. may make any necessary 2. The 60th calendar day adjustments to payafter the Redetermination deciand Railroad Retirement proment to the applicable provider sion date, if the Redetermination grams. of services or supplier under the decision affirms, in part, the over3. Federal salary payments. program under this title in order payment in question. 4. State payment offset. to satisfy any past-due obligations If the Reconsideration deci5. Other federal offsets (i.e. vendescribed in subparagraph (B)(ii) sion does not overturn all of the dor payments; military retirement of an obligated provider of services alleged overpayments, CMS will pay, etc.). or supplier... start recouping the remaining In addition to the TOP, CMS overpayment amount upon sendhas the prerogative to refer debt Based on the above statute, a ing the Reconsideration decision collection activity to: (i) another HHA needs to be aware that if to the HHA. debt collection center; (ii) a private it owes a debt to Medicare, the Based on the hypothetical excollection contractor; or (iii) the Department of Health and Human ample listed above, if the HHA did Department of Justice, under a Services may withhold or recoup not submit an ERS and wins 40% process called “Cross-Servicing.” any payments made under Title of the claims at the RedeterminaBy law, these entities may initiate 42 of the United States Code (i.e. tion and Reconsideration levels, lawsuits against the HHA for the Medicare, Medicaid) to any other then CMS will begin recouping remainder of the debt. Lawsuit Cont. on pg. 7
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$1400 a day for hospitalization compared to $137 per day when you look at home health costs….and nursing homes cost $325 per day on average. He also quoted a study by Avalere Health which estimates that skilled home health care saved Medicare $1.71 billion State Rep. Alan Silvia over two years, $216 represents the 7th Bristol million of which was District in MA where he is through reduced hospia member of the Joint Com- talizations. mittee on Elder Affairs. That same study goes on those. We should be doto estimate an additional ing everything we can do $30 billion savings if to keep people at home.” home health care were meds are distributed to available to more people with very little superviSilvia says other law with chronic illnesses. sion. They put them on makers are beginning to The statistics are there a cocktail of meds that listen not only to the and at least some lawchanges their personhorror stories but to the makers are listening, but alities so that they are common sense of makSilvia says the public’s sleeping at 6pm. It reing homecare a more perception of home care duces the nursing home’s viable option. In a story must begin to change. costs because they don’t for the Herald News in “We have to somehow have to hire as much staff Boston, Silvia referred corral home health agenbecies to promote this very cause issue of quality home you are “We should be care. There is a large part chemof our population that doing everything we ically has no idea what home recan do to keep people healthcare agencies acstraintually do.” People are not at home.” ing aware that home care, peoas Jonathon Kovar often ple! I says, “is the only entity was so upset that I have to the latest study by The which has the ability begun to pray that God Agency for Healthcare to facilitate a person’s takes me in my sleep Research and Quality complete care, to tie all so I never end up in a that found that one out the systems back togethposition like that. It’s of every 10 U.S. hoser for that patient: social just a disaster when you pitalizations could be services, skilled nursing, think of it. What we prevented with approwound care, the physicould provide in somepriate outpatient care. cian, nurse practitioners, one’s home verses that 40 million people are therapists.” Both men situation where we keep hospitalized each year. cont. on next page people in a facility like It costs an average of
An Advocate in Massachusetts A perfect storm usually connotates disaster… But according to Massachusetts House Representative Alan Silvia, this storm should bode well for home healthcare
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think people are beginning to listen. I have been sitting (in the legislature) for hours listening to testimony of folks who have benefited from home healthcare. It’s usually better for the patient and when we look at the dollars it only makes sense!”
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Speaking with HealthTrust CEO Jonathon Kovar, and Tiki Perkins, HealthTrust Director of Public Relations, Silvia said that one thing that is bolstering his already strongly positive view of home health is what he is seeing happen in many nursing homes. “I have listened to hours of disaster stories about the numbers of people in nursing homes that are receiving anti-psychotic medicines. I couldn’t believe the percentages of patients (75%) these
Using Your Vision to
Recruit Top Talent TOP TALENT is a lot like mon-
ey. It is not easy to come by if you don’t already have some of it. Like money, top talent seems to naturally flow to the companies that already have it. The rich get richer and the poor get poorer. Google has top talent begging to work there, while other Silicon Valley firms are spending millions on recruiting with no results. How does that happen? And more importantly, how can your company attract top talent like Google without breaking the bank? You absolutely must start with a clear vision. Top talent is motivated more by their ability to make a difference than they are by money. If your company doesn’t have a clear vision for how it is changing the world, then world-changers will not be attracted to it. Make a detailed plan for what you want your, company to look like in two years, what services it will offer, where it is located, even how employees feel about their jobs. You can’t make the company what you want until you first know what you want. Start by writing down your vision. All recruiting will be based on that vision.
By Jonathon Kovar
Next, define the roles that need to be completed to make that vision a reality. Reverse-engineer your vision by defining what jobs need to be done. Be specific and write job descriptions for each of those roles. Decide what type of person is needed for each role. At a minimum (and this is harder than it sounds), each person must know and believe in the vision you have for your company. Don’t waste time with anyone else.
want someone who just wants money, advertise money. If you want someone with vision, advertise vision.
Once you know what roles you need filled and the kind of person you need to fill them, you must prepare as if that person was already hired. What training programs, equipment, space, etc. will be needed for them to come on board and be useful as quickly as possible? Make it happen before you start recruiting.
Like all aspects of the Compliance Complex, after the process is over, you will need to evaluate and refine it. How can it be more efficient? How can you scale this process if you needed to hire ten more people tomorrow? Learn how to make the process better and you will be able to hire more and grow faster – all the while maintaining the highest levels of quality and compliance.
Now, you are ready to recruit using your vision. Use every tool at your disposal (online ads, networking, social media, etc.) to advertise the position. Always, ALWAYS, make sure to advertise the vision as the first requirement for the job. If you
Jonathon Kovar is CEO of HealthTrust Software, an author, speaker, and Healthcare Attorney. His company, HealthTrust Software, has seen a 200 percent growth every year since its inception in 2009. Kovar is the author of “The Compliance Complex,” an operational guide for home health agencies.
Advocate: Cont. from pg. 4
that makes it harder for agencies to thrive.
agree that the marketing of that information is very important…and something that is sorely lacking. On the legislative side, Silvia says he is always looking for new legislation that he can write in order to promote home healthcare and eliminate many regulations
With this in mind he said he looks forward to joining Jonathon and the Home care Expansion Advisory Committee with HealthTrust Software. 5
“The American Nurse” Coming to Theatres Near You She was once a fashion photographer. Now she is a nationally acclaimed photojournalist who is writing and shooting the stories of the lives of American Nurses. Carolyn Jones has been interviewed by the New York Times, The Washington Post, and PBS News Hour (just to name a few), and of all the subjects discussed, the one that intrigues everyone the most is "The American Nurse." It is a project that has gone from website to print, and in May, will be released in theatres as a full length documentary during National Nurses Week. Carolyn came to national prominence at the height of the AIDS epidemic. Driven by the AIDS related death of
AIDS." “It was a dark time… before the AIDS cocktail was available,” Carolyn said. “A lot of people were dying of AIDS and all the material you read was about death… There was nothing on the market that showed you how to live with AIDS.” After this project, she never went back to her former career as a fashion photographer but continued to work on projects that showed people putting their best foot forward; stories of courage, love, and strength that best represented the human race.
for me,” she said. “But that nurse never knew what a difference she Photojournalist made. After Carolyn Jones that experience, I felt I needed to delve into this and see what these people were all about. It’s the kind of thing that just grabs you.” In over 120 full-scale interviews, Carolyn has used nursing to explore some of the most serious issues our country is facing, including poverty, returning war veterans, and a growing elderly population. She has also covered a diverse group of nurses, including a helicopter pilot, emergency nurses, a roller derby nurse, and a Daytona Race Track nurse.
I was struck over and over particularly with the nurses who were doing home health because of the level of intimacy. It’s unusual…first of all you are in someone’s home so it is intimate already but where the nurses get the skill to be able to do this while maintaining the dignity of each and every patient...it was such a beautiful lesson for me to learn.” Then, just as "Living Proof " was born through compassion for her dying friend, her very personal story of fighting breast cancer and the nurse who helped her through it inspired her to begin the adventurous "American Nurse Home health nurse Jason Short Project." traverses roads washed away by
mud slides just to get to his patients deap in the Appalachian Mountains. a dear friend in 1992, she produced "Living Proof – Courage in the Midst of
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Carolyn said after her last chemo treatment that she walked out of the door and didn’t look back, hardly thanking the nurse who had helped her so much. “It was a profound experience
Carolyn said she was very impressed with the degree of care and professionalism in all the nurses she interviewed but it was perhaps the home health nurses that made the greatest impact on her. “If there is one thing that we heard over and over, it’s that the future of nursing was in home healthcare… It is a vital and important part of that industry. The level of care is amazing… They are caring for their body and soul and emotions. It is really beautiful… and very unusual work and we need to support it in every way we
possibly can.”
health because of the level of intimacy. It’s unusual… First of all, you are in Traveling to the Appalachian someone’s home so it is intimate already, Mountains, Carolyn shadowed Jason but where the nurses get the skill to be Short, a home health nurse who able to do this while maintaining the fearlessly drove up creek beds just dignity of each and every patient… It to get to people living in the most was such a beautiful lesson for me to remote areas of the Appalachians. She learn.” described Jason as a She followed colorful character; May 8 is the national premier another a garage mechanic nurse to a showing in many Digiplex turned nurse after a home where motorcycle accident theatres. You can find these the level of left him incapacitated poverty was venues by going to the for over a year. so bad that Carolyn said she was americannurseproject.com / she did not very uncomfortable screenings. Individual groups know if she at times with the could go and nursing schools are also overwhelming smells in. Carolyn and the squalor of said that getting permission to have a the homes of Jason’s Robin, the private screening. Whether patients, but Jason nurse, “waltzed in the theatre or later when was above all that. in like that “He would cruise released on DVD, nurses may man was her into that room and oldest friend get continuing education credit make a sterile area in the world, by watching the film. so he could take shook hands, care of the patient. I said hello, and was struck over and over, particularly took care of him with great dignity and with the nurses who were doing home respect.”
ALJ Delay: Cont. from pg. 3
HHA or location of an HHA that shares the same TIN, regardless of a difference in NPI or billing numbers. V. Auditors and Appeals The Government does not allow a HHA to appeal a claim at any level of the administrative appeals process, including the ALJ, if that HHA does fails to comply with any Medicare Conditions of Participation (i.e. accreditation, licensure). Consequently, even if a HHA has millions of dollars subject to appeal at the ALJ level, but the HHA cannot afford to stay in business (because its payments have been recouped), the HHA loses its ability to appeal the claims at the ALJ level as soon as the HHA fails to comply with any Medicare Conditions of Participation. This is particularly worrisome given the manner in which auditors are compensated. For example, RACs are compensated based on a percentage of claims they win. As such, it is in the RACs’ finan-
She said every home health nurse showed this kind of compassion. "One nurse I followed went into a home where the patient hadn’t seen anyone
Book cover of “The American Nurse” else in a week. When the nurse left, she said, ‘I love you, you know.’ The woman got choked up and said, ‘I love you too.’ And I am walking out of there, weeping because of the beauty of it all.”
cial interest to audit and extrapolate overpayments from as many HHAs as possible given that the RACs: (a) know that most of the HHA’s payments will have been recouped by the time the ALJ hearing occurs; and (b) if the HHAs have no payments coming in, they cannot afford to comply with the mandatory Conditions of Participation; and (c) HHAs that cannot comply with the mandatory Conditions of Participation have no right to appeal those claims at the ALJ level! The RACs will end up initiating thousands of audits with the knowledge that the HHAs will be unable to appeal the audits at the ALJ level (where most claims are overturned), thus allowing the RACs to collect a commission on the recouped overpayment. HealthTrust Global guest writer Edward Vishnevetsky is an associate at Munsch Hardt Kopf & Harr. His focus is on health law and commerical litigation. Edward is the recipiant of the "Legal Leaders on the Rise" award provided by "Texas Lawyer Magazine," recognizing him as one of the top 25 lawyers in Texas under 40.
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Windows XP and Office 2003 Get the Boot out of Home Healthcare Hopefully your agency has already dumped every
system that has Windows XP and Office 2003, otherwise you are at risk of automatic HIPAA violations. Microsoft ended security updates and patches for Windows XP and Office 2003 on April 8 which have in the past protected patient information required by the HIPAA Security Rule. According to Mike Semel with Semel Consulting, just having a Windows XP computer on your network could be a time bomb that could easily cause a reportable and expensive breach of protected patient information. Getting rid of Windows XP means replacing both hardware and software with business-class operating systems. From the Department of Health and Human Services, 45 CFR parts 160, 162, and 164 of the Health Insurance Reform Security Standards, the Final Rule reads: "Section 1173(d) of the Act provides that covered entities that maintain or transmit health information are required to maintain reasonable and appropriate
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administrative, physical, and technical safeguards to ensure the integrity and confidentiality of the information and to protect against any reasonably anticipated threats or hazards to the security or integrity of the information and unauthorized use or disclosure of the information. These safeguards must also otherwise ensure compliance with the statute by the officers and employees of the covered entities."— HHS.gov According to Gartner, the global installed base of PCs, roughly 33 percent of the world’s PCs are still running Windows XP, totaling 500 million. It’s essential that every agency performs an end-to-end IT security audit on their entire infrastructure and compile a list of all the software and lab equipment that requires Windows XP to run.
ICD-10 Cont. from page 1
both code sets.
maintain their leverage by performing “dual coding.” This would require coding the OASIS using both ICD-9 and ICD-10 code sets. While only the ICD9 codes would be transmitted on OASIS and claim data, the clinician would not lose the ICD-10 coding knowledge recently obtained. In fact, he or she should be “old hat” with it by 2015! Detailed referral intakes and in-depth pathophysiological work-ups would not be diminished or lost due to the delay; rather, the knowledge gained with the more intensive ICD-10 history inquiry and physical assessment would greatly enhance ICD-9 coding efficacy right now. To implement dual coding, the agency would continue to use a referral form that may have been revised for ICD-10 and add a coding workup sheet with both ICD-9 and 10 coding lines. Coding reviewers would check for the accuracy of
As of publication date, CMS remains virtually silent on providing recommendations for how it will handle the delay. The congressional action delays mandatory enforcement of ICD10 until 2015. But, can providers who are ready, implement the code set on a voluntary basis? Will private insurers wait for CMS or go forward on their own? Or, will CMS scrap ICD-10 altogether and go with ICD-11 scheduled for release in 2017? These are important decisions that can affect how the home health industry responds. In the meantime, revised coding is a reality – just at a future date! Preparation for its implementation must still go forward. Don’t put your hopes in another delay next year. And don’t lose your investments already expended by shelving your ICD-10 manual and filing away your coding knowledge.
Guest writer Jan Spears is the founder and president of MJS and Associates, one of the top healthcare consulting firms in the nation. Mrs. Spears has more than 30 years experience in home health administration including ownership of a multi-million dollar home care operation in Texas during the mid 1990‘s that was the first agency to integrate the OASIS assessment tool into home care practice as a demonstration site for CMS. She worked closely with CMS in the development of the OASIS data collection format in preparation for the implementation of a prospective pay reimbursement program for Medicare. She has authored several publications including Home Health Agency — Policies and Procedures, ”Care Guides for Home Health Practice under PPS”, and “ Crosswalk for Compliance — An Effective Guide for Integrating OASIS Elements to Clinical Documentation”
Anna Rozell - Speech Language Pathologist North Texas Therapy and Homecare
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t was one of those moments that stick with you the rest of your life. Not because it was so unbelievable like winning the lottery, or so painful like breaking your leg, or so self-satisfying like receiving a great promotion, but because you made a difference - a big difference in the life of a little girl and her family. A life-changing difference.
who is unable to help their child is palpable. But Anna did not remain defeated. “Once I knew the diagnosis I knew I had to educate myself to help him alongside the other therapists working with him. So I went back to school to get my graduate degree in Speech Language Pathology so I could help my son say ‘momma’.” It wasn’t easy. For three years she was a full time teacher and went to grad school while being a mom and wife. But for a mom who had felt powerless to help her child, the payoff was immeasurable. “Now my son is very socialized. He is doing fantastic in the second grade and is truly the
an excellent job with her patients and goes above and beyond to insure that the entire family is receiving the resources that they need.”
Anna says that when the whole family gets involved, the child progresses much faster. “It takes a village to raise a child…and even more to raise a child with disabilities.” With this in mind, Anna holds many of her therapy sessions right in the kitchen. That way, a child can ask about the “pan” “cup” or “saucer” and the mom can see that her involvement in her typical surroundings is both natural and vital. If the grandparents are in the home, she will make the “I went back to school to child go interact with them while they are get my graduate degree in watching TV. That way the grandparents can Speech Language Patholo- realize how easy and fun it is to help. “Little by little, consistent interaction with their gy so I could help my son say child leads to great success,” says Anna.
Imagine a little girl, a baby really, in a poor Hispanic home who had not spoken her whole 3 ½ years of life. No one knows why. Then along comes a Speech Language Pathologist who speaks both fluent Spanish and English. After an evaluation, she encourages the little girl’s parents to have her hearing checked. They did, and found ‘Momma’.” out their daughter was severely hearing Anna calls her job the “best one in the world.” She loves the interaction with the impaired. Fast forward a few weeks. This same silent little girl gets her hearing client, “whether it is that 82 year old veteran young boy that I knew he could be.” aid and has been working with that same who just had a stroke, or an 18 month old Anna says the experience with her own speech pathologist….when she finally spoke that is struggling with communication.” child is what makes it easy to put herself in her first words. Celeste Pohl says she has an exuberance to the shoes of other mothers who are at a loss meet the needs of everyone around her. “She “Me China,” she said. as to how to help their own children. is the one we go to when we need something She wasn’t wanting to travel to Asia. She However, another factor that makes Anna extra. She is always willing to take on extra wasn’t a geography prodigy. She was trying feel such great compassion for her clients projects. She (helps with) other bilingual to say her speech pathologists name… “Mrs. is that she is from Honduras and knows therapist coming in to insure that their level Anna.” what poverty can do to a family. She works of fluency is appropriate to what we need.” mostly with the Hispanic population who, “To this day, ‘Me China’ is a very special Anna has even developed a continuing as she says, deals with disabilities differently memory. It keeps me going sometimes,” education course for North Texas Therapy than other American cultures. “At first it says Anna Rozell, of North Texas Therapy which they will be presenting in February. was a struggle to get the Spanish population and Homecare. Where does Anna turn when the going involved because some would let the kids It’s a great story. But perhaps an even gets rough? “To God,” she says, and to her go and simply live with their disability.” better one is Anna’s own reason for becomhusband who she describes as a “wonderful But her goal, and something Celeste Pohl – ing a speech pathologist. Her second child North Texas Therapy and Homecare Clinical support.” And she remembers the children was diagnosed with language delays at a Manager says Anna is very passionate about, like the little “Me China” girl, and she knows very young age and was unable to even say that without her there, that child may not is making sure Spanish speaking families “Mommy”. The heartbreak of any parent have a chance at life. get the very best quality of care. “She does
Anna Rozell
Anna and Family
Anna and her second son, Gabrielle.
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When Amy Nelson ran for Mrs. Minnesota International this year, she had to do an on-stage interview. Our guess is that she left her judges a little star-struck. Mrs. Minnesota International
On March 15, 2014, Amy Nelson was crowned first runner-up in the pageant. “This pageant doesn’t just judge simply on beauty but focuses on having a platform that you’re passionate about,” she said. “It features very accomplished women. That’s what caught my attention.” The International pageant is unique in its focus on married women with personal achievements playing a dominant role in which candidate wins. In fact, 50 percent of the score goes to the on-stage interview.
The Miracle League
As part of the pageant, each contestant is given the opportunity to select a service platform to spend the year promoting. Amy chose Miracle League, an organization that offers children with special needs the opportunity to play baseball. “The kids with disabilities are given a special facility to play on and are paired with ‘Buddies’ to help them,” Amy said. “I’ve been with Miracle League for 5 years because in home health you meet people with highly complex medical needs and sometimes they’re not in the best mood or having the best day. But out on the field, they’re just being kids. They’re having fun.” In 2013, Amy launched her first fundraiser for the organization, bringing all Minnesota professional sports teams together to help support the cause. Over $20,000 was raised the first year. 10
Amy Nelson - CEO Accurate Home Health Entrepreneur of the Year
Work-Life Balance
Amy recently won the Impact Entrepreneur Award from the Entrepreneurs’ Organization’s Minnesota chapter. According to the Minneapolis/ St. Paul Business Journal, EO’s Impact Entrepreneur Award recognizes the state’s top entrepreneurs who are active in fostering a vibrant local entrepreneurial community. Amy's home health agency, Accurate Home Care, does business in three states, with more than 2,000 employees and $50 million in revenue. Amy also served as president of the Professional Home Care Coalition and chairwoman of the Council for Pediatric Home Care. She started her first home health agency when she was just 18.
Amy thanks her family and staff for making all her accomplishments possible. “I have a very supportive family. But you also have to have staff you can trust. You can’t be doing everything yourself. That took me a long time to figure out. I have a great team at Accurate Home Health to handle the day-to-day operations. I don’t have to worry about things at the office when I’m away.” 11
No Decision from the Texas HHSC Means
Still No Free Market For EVV
Bringing the angst and frustration of many EVV users and suppliers alike, the Texas Health and Human Services Commission has yet to post the award or any update to the Texas EVV program. They had promised to do so by the end of March.
The award, which would open
up competition amongst EVV vendors, provide better quality for providers and ultimately lower costs to taxpayers, has been delayed once again. We will continue to diligently petition HHSC to fix the EVV program that has cost providers so much time and expense. Allowing legitimate EVV vendors into the program instead of just the one with the best lobbyists is still the quickest way to accomplish that. Meanwhile, for those looking for an EVV solution, the following are some points to consider. EVV can be delivered through a range of methods such as: -Telephony products utilizing an existing landline in the patient’s home – the most foolproof, simple and cost-effective method with no hardware purchase required. -Mobile applications for
smartphones which scan a fixed seal or QR code placed in the patient’s home. -Fixed remote devices that reside in the patient’s home to verify time and attendance via SMS text message when no landline is available. When incorporating electronic visit verification as part of your agency’s best practices, it is important to look for an EVV solution that integrates with your scheduling and payroll systems and also logs tasks from a care plan. In addition to heightened communications among stakeholders, (EVV) solutions provide an added benefit of enabling homecare administrators to significantly reduce paperwork by eliminating manual timesheets and streamlining the payroll process. Consider creating an EVV checklist for your agency. For example, an EVV solution should provide your adminis-
trators with: * Real-time 24/7 visit verifica tion visibility * Task reporting and observa- tion notes * Up-to-the-minute schedule updates * Care worker performance analysis reports * On-demand compliance re- ports for payors * Broadcast messaging capabil- ities * No-show and safety alerts for both the care worker and patient The right EVV solution will have a lasting impact on streamlining your overall agency communication flows and operations, keeping your administrators connected and allowing your care workers to focus on what’s most important: servicing your client and improving patient outcomes.
Happy Spring from HealthTrust Global 12