Care at home organizations continue to search for ways to navigate industry changes and reimbursement cuts. Home care organizations can lean on the nuances of their industry to expand and diversify their business and increase revenue.

In an education session at the 2023 小猪视频, Growth, Innovation and Leadership Experience (小猪视频), Zaundra Ellis, Vice President of Hospice Professional Services at 小猪视频, and Guy Tommasi, Jr., Director of , explained how home care leaders who wish to diversify their revenue streams should focus on adopting strong leadership strategies and partnering with other care at home and community organizations.

The Role of Leadership in Diversification

During the session, Tommasi advised home care leaders to concentrate on making home care valuable and local, focusing on the strengths of the industry and the needs of the specific community the organization serves. Leaders should avoid trying to compete with neighboring states and communities.

Ellis and Tommasi also encouraged care at home leaders to lean into innovation, partnerships and new initiatives. They believe adopting and maintaining a partner-focused and innovative mindset is the key to surviving in an ever-changing industry.

鈥淚n our industry, we need to get that partnership mentality,鈥� Tommasi said. 鈥淚t鈥檚 [really] hard to do anything alone today. And if you want to build scale, you build scale based on partnerships, because that then allows you to build those new programs.鈥�

Ellis added that those partnerships can also help leaders address any gaps in their organization or services.

鈥淸When] you鈥檙e thinking about being a disruptor, know your strengths and bring people along with you who balance things that maybe you鈥檙e not amazing at,鈥� Ellis said.

Scale Operations With Partnerships

Ellis and Tommasi provided several examples of ways home care leaders can create partnerships to scale their business. While home care often focuses on skilled and non-medical care, organizations can partner with hospitals in their communities to help reduce readmissions, improve and maintain compliance with .

Tommasi advised home care leaders looking to partner with home health organizations to appeal to and needs. Leaders should lean on how home care helps improve patient satisfaction and functional impairment.

鈥淚f you step up and you go to a home health agency and you tell them, 鈥業 can help you with your value-based purchasing, I can help you with PDGM, I can give you examples if you鈥檇 like,鈥� you will see them sit up because they haven鈥檛 heard it,鈥� Tommasi said.

Organizations should also use data to appeal to potential partners, focusing on the quality measures and performance data to be a differentiator in the industry.

鈥淭his [quadruple aim] isn鈥檛 really difficult but it is a differentiator,鈥� Tommasi said. 鈥淭his will add money to the bottom line, this will help you step up as a leader in your region and then you can scale it.鈥�

With more than 250 attendees, more than 40 sponsors and countless connections made, 小猪视频 2023 was a massive success for everyone. and mark your calendar for 小猪视频 2024, April 21-24 in Dallas.

Between reimbursement cuts and regulatory changes, the care at home industry faces many challenges. While these issues must stay top-of-mind for organizations, industry leaders should also begin to focus on developing the next generation. Ryan Klaustermeier, MSN, RN, Vice President of Professional Services for 小猪视频 and Chair of the National Hospice and Palliative Care Organization (NHPCO) , shared why developing the next generation of leaders is crucial to the care at home industry.

Developing the Next Generation of Leaders

Developing the next generation of leaders is essential to ensuring the survival and progression of the care at home industry. As staffing issues and turnover rates increase in the industry, leaders must ensure that they are attracting new people, resulting in a more sustainable leadership pipeline.

Klaustermeier noted that more senior leaders who are gearing up for the end of their careers don鈥檛 always take time to grow younger colleagues. 鈥淚 think there鈥檚 been a lack of intention and ensuring that there is a smooth and successful transition of power within the industry,鈥� Klaustermeier said, 鈥渨hich I feel is a disservice to the people we serve in our communities.鈥�

According to Klaustermeier, the best way to be intentional with leader development and create an intergenerational culture is through active engagement, focusing on sharing practices, knowledge and experience.

鈥淸Leaders should] leverage their expertise and knowledge to ensure that this industry continues to flourish for years and years to come.鈥� Klaustermeier said.

Bridging the Gap Between Generations

Leaders set the tone on acceptable forms of communication and should individualize those needs based on their staff. For leaders looking for tangible ways to close the generational gap, Klaustermeier suggested looking into succession planning and mentoring toolkits. 鈥淓veryone in a leadership position should have a succession plan, in my opinion.鈥� Klaustermeier said.

When building out a mentorship program, Klaustermeier stressed these programs should require contracts and set time limits so that participants experience the full benefits of the relationship.

鈥淚 think intentional and formal [mentorship programs] with guidance and boundaries will create more successful mentoring opportunities than random, informal ones, because accountability is important.鈥� Klaustermeier said.

Career Planning for the Next Generation

Younger employees who are looking for ways to move through leadership hurdles should focus on career mapping and planning. Like their more senior leaders, Klaustermeier suggests young leaders invest in a career pathing toolkit and tailor it to their desired position or discipline. Klaustermeier pointed out that the NHPCO Next Generation Leadership Council is currently working on this type of resource.

鈥淚f you were to start a hospice tomorrow, you could take our templates, have job descriptions pre-made, and have career pathing ready to go.鈥� Klaustermeier said.

Younger employees can also lean on professional development resources like the 小猪视频 Training and Certification Program, which provides industry-specific training to help users perform their duties at the highest level.

Ultimately, though, young leaders need to take their careers into their own hands. Klaustermeier advises young employees to continue learning and not be afraid to disrupt current systems. Young employees should also diversify their mentorship opportunities, connecting with peers as well as C-suite leaders.

鈥淒on鈥檛 expect leaders to take you under their wing and help you grow,鈥� Klaustermeier said. 鈥淵ou have to openly ask for that need and express your desire to grow within your organization or profession because if you don鈥檛 tell someone that and keep telling them, it鈥檚 just not going to happen.鈥�

Anyone can create an 小猪视频 Training and Certification Program account, giving them access to all certifications, continuing education and training courses across service lines. Together we will elevate care at home.

Diversity in the care at home industry is continuing to grow in importance. Organizations that promote diversity, equity and inclusion (DEI) can see benefits ranging from increased employee engagement to improved patient care.

Tom Codd, Chief People Officer at 小猪视频, joined Sonnie Linebarger, Co-Founder of and CEO of , to discuss the importance of DEI at the 2023 小猪视频 Growth, Innovation and Leadership Experience (小猪视频). Codd and Linebarger shared actionable ways care at home organizations can create and foster a diverse, equitable and inclusive culture.

Organizational Culture and Success

Codd noted there has been a cultural shift in focus from tolerance and multiculturalism to equity, inclusion and belonging. The addition of belonging to DEI stresses the importance of how people feel at work.

鈥淔itting in is about assessing a situation and becoming who you need to be to be accepted,鈥� Codd said. 鈥淥n the other hand, belonging doesn’t require us to change who we are; it requires us to be who we are.鈥�

Many organizations with successful DEI programs have their framework built on three core pillars:

• Clearly defined and disseminated stance on DEI. Diversity, equity, inclusion and belonging permeate the company鈥檚 mission, strategies and practices in visible ways.
• Specific plans and programs to support DEI. This can include hiring and onboarding practices, DEI steering committees and cultural programs.
• Measuring and regular reporting on performance.

Organizations should not view DEI as just another program, but it should be part of the organization鈥檚 culture. Organizations must also consider whether their employees reflect the communities where they live and work. Linebarger underlined the need to represent diverse groups at all levels of an organization and address barriers that could hinder an inclusive work environment.

鈥淒espite significant promotion of diversity, so many companies really don鈥檛 put that into play,鈥� Linebarger said. 鈥淭he idea is not to do the tick box. The idea is to really implement it richly in the fiber of the company.鈥�

Actionable Steps for Organizations

Codd and Linebarger highlighted several actionable solutions care at home organizations can implement to create and grow DEI programs in their organization.

• Benchmark DEI and human resources data against industry peers.
• Provide a career development program for everyone in the organization, such as mentorship and training opportunities.
• Promote pay equity.
• Report DEI data within the organization.
• Leadership accountability for DEI initiatives.

Monitoring and Reporting on DEI Initiatives

Leadership accountability is essential for the success of DEI programs, and internal reporting on those programs can ensure progress and accountability across the organization.

“Beyond having ideas and launching DEI programs, mature companies have robust means for measuring and monitoring the performance of these programs, including supporting software and regular reporting,” Codd said.

Linebarger stressed the need for organizations to not only gather data but to also use it to drive actionable solutions and improvements within their organizations.

鈥淲hen you think about measuring reports, what you measure, you move,鈥� Linebarger said. 鈥淒riving sustainable changes requires effective monitoring.鈥�

With more than 250 attendees, more than 40 sponsors and countless connections made, 小猪视频 2023 was a massive success for everyone. and register now for 小猪视频 2024, April 21-24 in Dallas.

Many care at home organizations, especially hospice providers, are considering adding palliative care services as a separate business line. Community-based palliative care programs can address gaps in care for patients with a serious illness and serve as a referral source for other services.

小猪视频 hosted a recent webinar with Hospice News as part of the . Amy Rose, 小猪视频鈥� palliative care product director, led a session on leveraging palliative care for seamless care transitions. Sarah Payne, medical director for Banner Hospice, and Rory Farrand, vice president of palliative care for the National Hospice and Palliative Care Organization (NHPCO), contributed their insights to the conversation.

Communication in Palliative Care

Communication is a central tenant of palliative care delivery, and it鈥檚 critical for continuity of care.

鈥淚n palliative care, we鈥檙e one piece of a very complex puzzle that is the care delivery for a patient,鈥� Rose said. 鈥淚t鈥檚 so important not only for our referral pipeline and making sure that our community is comfortable referring to us, but also just general care coordination and transition, to maintain really deep relationships and communication channels.鈥�

Farrand noted that telehealth can provide an additional connection between providers, the patient and the family. However, telehealth use needs to be based on the needs of the community and the team providing care.

鈥淸Telehealth] helps improve access and equity, especially for rural or other marginalized populations in general,鈥� Farrand said. 鈥淚n areas that are resource scarce, [telehealth] helps extend those palliative care services where folks may not have a local provider鈥f you have a significant coverage area, you don鈥檛 want to have your expensive, smart, wonderful clinicians behind the wheel of a car all the time.鈥�

Internal communication among the provider team is also critical. Many palliative care providers use the hospice interdisciplinary group (IDG) approach of bringing the team together for regular meetings about patients.

鈥淭he care team has to be connecting regularly,鈥� Payne said. 鈥淚f they don鈥檛, nuances get lost along the way, the communication starts to break down. So bringing that internal team together at least biweekly is important.鈥�

Leveraging technology can enable more clinicians to come together easily and share information with the team.

鈥淚n this space, we tend to be just a little bit walled off technologically,鈥� Rose said. 鈥淔inding a tech partner that can speak that language and send and receive information in a way that makes your job so much easier is really integral.鈥�

Patient Transitions Between Palliative Care and Hospice

Palliative care’s focus on symptom management and patient goals lends itself to discussions about next steps for the patient, such as hospice. With consistent and accurate communication, palliative care teams can ease those transitions of care.

鈥淎 thing that I see a lot are silos between how the hospice team operates and how the palliative team operates,鈥� Rose said. 鈥淎s we transition patients, [we need to make] sure that we’re on the exact same page about what those teams are doing. That communication can be a challenge, especially if you’re working on different systems that aren’t communicating with one another.鈥�

Patients receiving hospice care may improve and no longer meet eligibility criteria for hospice, but they will still need continued healthcare support.

鈥淚f we don鈥檛 have a safety net for [patients transitioning out of hospice], and hopefully that鈥檚 community-based palliative care or some other way to address those needs, they get lost and they鈥檙e going to have a lot of trouble,鈥� Farrand said. 鈥淢aking sure that person has a path back to palliative is really critical.鈥�

Education and Support

Early education on the resources and services available to the patient and family can also support transitions. Farrand encouraged providers to use simple language, talk up the benefits of palliative care, explain that patients have a choice at every step and connect using stories rather than statistics.

鈥淭his is really just humanizing that discussion,鈥� Payne added. 鈥淚t鈥檚 humanizing the experience throughout while also making it very custom and using language that鈥檚 digestible to patients and families rather than coming to the table with our own intention.鈥�

Educating referral sources, especially front office staff who have direct communication with patients who are struggling, can also be helpful.

鈥淚f [referral sources] can tell me that the patients have symptom burden or caregiver strain, then those are the low hanging fruit right out of the gate that we should be talking to for palliative care,鈥� Farrand said.

Payne agreed, adding, 鈥淲henever someone has a serious illness, it would be very prudent to involve palliative. Palliative will wrap their arms around that individual [and] help support them through the journey, no matter the outcome.鈥�

小猪视频 Palliative Care, a cloud-based palliative care software, was built for flexibility with streamlined workflows from intake to claim submission.

Over the past two years, we have seen a dramatic increase in the use of remote care technology in clinical practices of all kinds. With recent reports that the cost of COVID-19 social isolation has reached nearly $7 billion, we may soon see remote care monitoring (RCM) in the home expand exponentially. RCM may soon be considered the 鈥渟eventh discipline鈥� on many home health plans of care.

Face-to-Face Compliance with Remote Care Monitoring

In home health, we must secure documentation of a face-to-face physician visit with the patient for the same reason we are seeing the patient in the home. The documentation secured that describes how the patient鈥檚 clinical condition, as seen during that encounter, supports the patient鈥檚 homebound status and need for skilled services.

How can an organization comply with this requirement when patients are unable to, or refuse to, leave the home due to fear of contracting the virus?

Remote care monitoring is a logical answer to this dilemma.

In fact, , indicating 鈥渢he face-to-face encounter can be performed via a telehealth service.鈥� For home health organizations struggling to comply with the face-to-face rule, it is in their best interest to make this technology available to all admitted patients who require clinical care and are unable or unwilling to leave their home.

Providers and multiple professional organizations, such as , the American Medical Association and the , are attempting to work with Congress to gain support for remote care monitoring reimbursement. Now that the is showing significant interest and , it would appear that we are getting closer to meeting that objective.

Remote Care Monitoring as the 鈥淪eventh Discipline鈥�

As we work through the process of using remote care monitoring for ordered virtual visits, we need to understand what is required when surveyors and other auditors review documentation.

We currently have little direction from CMS. However, we have experienced survey and auditor reviews requiring documentation that is strikingly similar to rules now existing for the current six billable disciplines of skilled nursing (SN), physical therapy (PT), occupational therapy (OT), speech therapy (ST), home health aide (HHA) service and medical social work (MSW).

By treating the use of remote care monitoring itself as the 鈥渟eventh discipline鈥� on the physician鈥檚 care plan, we can satisfy the requirements that we see evolving.

Three Tips for a Compliant RCM Plan of Care

1. Orders should be very specific in frequency, use and duration. For example, an order may look like this: Remote care monitoring by RN 2 x week x 9 weeks. Remote care monitoring to assess patient鈥檚 compliance with current medication regimen, evaluate reported pain level and log being kept by patient for tracking of blood sugars.
2. The quality assurance staff within the organization should track RCM visits the same as the frequency and content of other visits.
3. Work with your electronic medical record (EMR) vendor to ensure RCM visits are appropriately identified as such. At this point, we cannot bill for RCM visits. If billed, it could be considered fraudulent billing.

RCM is quickly becoming adopted by all healthcare organizations as an alternative treatment of choice in caring for patients in the home. More frequent touch points could significantly change reported outcomes, improving star ratings. Be certain to research the best RCM program for you and your organization.

小猪视频 Home Health, a cloud-based home health software, includes HIPAA-compliant documentation capabilities on all devices, even without internet access.

With the implementation of the Notice of Admission (NOA) at the beginning of 2022, we have seen some issues occur with each Medicare Administrative Contractor (MAC) and their acceptance of the NOA.

These issues should be reviewed at each of the MAC鈥檚 websites (, ) for continued tracking and updated instructions to alternative workflows.

As of today, we have seen three common issues occurring nationwide. Billers need to be aware of these known issues to ensure timely and accurate claim submission.

Reason Code 32114

First, providers were seeing reason code 32114 regarding missing ZIP codes for NOAs. The Centers for Medicare and Medicaid Services (CMS) is aware of this oversight, primarily affecting NOAs that were submitted in a batch (multiple NOAs in one electronic submission).

to enter NOAs manually in Direct Data Entry (DDE black screen) to ensure pending acceptance. In DDE black screen, providers can access the claim in the Claim Center by entering the nine-digit ZIP code and resubmit by hitting F9.

It is important to review the status of your NOAs daily. However, if an NOA is late because of this issue, use the Remarks section of your final claim to include: 鈥淛an 2022 Issue RE 32114.鈥�

Reason Code 19960

For reason code 19960, organizations were seeing their claims in TB9990 status/location with a condition code of 15 added to NOAs that were not entered by the organization. This issue occurred primarily for Palmetto GBA providers.

that there is no additional action needed to submit these NOAs and when the MAC removes the condition code, a new received date will be applied. Since this cannot be overridden, some NOAs may be considered late.

Just as with reason code 32114, if this issue causes an organization鈥檚 NOA to be untimely, the final claim associated with the NOA should include a KX modifier and remarks: 鈥淟ate due to CC 15 release.鈥�

Reason Code U537F

at the time of publication, reason code U537F is one to be reviewed closely as some NOAs may be correctly editing for this reason code. Organizations should ensure that the claim does not have an open home health episode on file from a different organization, regardless of billing period date.

If the previous organization has not closed billing (DOLBA is blank), your organization鈥檚 NOA should include condition code 47.

Another instance in which providers will see NOAs in Return to Provider (RTP) status is when duplicate NOAs are submitted. In this scenario, one of the duplicate NOAs will receive this reason code. In this instance, the NOA marked with U537F should be suppressed by the provider as no further action is taken.

If your NOA does not fall under these scenarios, Palmetto GBA and NGS have advised organizations to monitor their websites for additional information. There are currently no resolutions implemented, but a fix is in process.

小猪视频 has created a resource page where updated information will be housed for industry partners and 小猪视频 users to find more information on all things NOA. Be sure to continually review each MAC鈥檚 claims processing issues log for peace of mind and guidance directly from CMS.

小猪视频 Home Health, a cloud-based home health software, provides built-in billing updates for accurate claims, as well as a resource page with frequently asked questions on the NOA.