In the News

The Bottom Line: Top Billing, Financial Mistakes Responsible for Home Health Agency Struggles

Home Health Care News / By Joyce Famakinwa
Home health providers often make mistakes that leave money on the table at best, and at 
worst, lead to financial ruin. 
However, providers that learn to avoid these stumbling blocks will be better positioned to achieve longevity and financial stability. 
In general, the home health consulting firm SimiTree has noticed an increase in the amount of providers that have been struggling with things like unbilled claims, inaccurate primary payer selection and more, according to Lynn Labarta, vice president of post-acute revenue cycle management at SimiTree. 
In fact, Labarta recently wrote about this very topic for SimiTree. 
“SimiTree has thousands of customers in the home health and hospice space all over the country, and we have been seeing an uptick in these issues and agencies struggling or feeling that they may not survive,” she told Home Health Care News. 
Labarta believes that not staying on top of unbilled claims is the No. 1 issue that providers are currently struggling with. It’s an issue that pops up at companies of all sizes.
“We see this unbilled claims issue with all sorts of agencies — all the way from startups to mid-size agencies, even some of the largest agencies in the country struggle with this for different reasons,” she said.
Broadly, most providers’ EMR has a section in the software where all of the unbilled claims are housed. These are claims that can’t be billed because there is some type of hold on them. Typically it’s a clinical hold, or regulatory issue that prevents the claim from being billed. 
For many providers, this is where most of the revenue lives. 
“We’ve seen agencies that have thousands of claims sitting in the unbilled claims list,” Labarta said. “When you translate the thousands of claims sitting in that bucket, depending on the size of the agency, you’re talking about hundreds of thousands of dollars. Of course, if you’re dealing with a smaller agency it could be smaller dollars, but it still impacts cash flow. This makes agencies feel like they’re seeing patients and working very hard, but not seeing the money coming through the door.”…

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‘Not About A Shiny New Toy’: How Home Health Providers Are Succeeding With More Complex Patients

Home Health Care News / By Patrick Filbin
As home health patients become sicker and more complex, providers have been forced to find ways to keep their care models financially viable.
In order to combat some of those “acuity creep” challenges, industry leaders are leaning on technology, data-driven decision making and more value-based care.
“We continue to navigate through a very regulated industry,” Janice Riggins, chief clinical officer at VitalCaring, told Home Health Care News. “That continues to pose issues for us, in addition to expenses for training and education. The recruitment and retention of qualified staff that have that clinical expertise is a financial implication. All of these aspects are at a very heightened level. Now more so than ever.”
The Dallas-based VitalCaring provides home health and hospice services across six Southeastern states.
Staffing costs and physician engagement
When taking care of the sickest and most complicated patients, it’s imperative that clinicians and caregivers are properly trained and that staff resources are optimized.
“Training and education is an investment that needs to be considered,” Riggins said. “It’s really important for our staff to have continuous training in order to handle these complexities of the sicker patients, which add to that overall operational cost.”
In this care environment, clinicians must be operating at the top of their licenses, McBee Associates President Mike Dordick told HHCN.
“Unlike going in and changing a wound or basic injections, you’re going to the sicker patients where there’s a lot more that clinicians have to be able to to deal with,” Dordick said. “Your resource allocation and your staffing strategy has to be at a higher level than if it was a lower-acuity patient.”
McBee Associates is a consulting firm that works with hospitals and post-acute care providers.
Maintaining an adequate staffing level will always be a struggle for providers. The same goes for covering the costs that are necessary to take care of new-age patients.

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2024 Predictions: Three applications for AI in Home Healthcare

McKnight’s Home Care / By Preeti Kaur
Business is booming in the healthcare generative AI market. The sector is projected to reach a staggering $22 billion by 2032 — enabling technology providers, health systems, payers and others in the ecosystem to develop game-changing capabilities that are reshaping the field. 
Frankly, the timing couldn’t be better for the home healthcare sector, an area that is  particularly ripe for transformation. Variable schedules, provider shortages and a vulnerable aging population make managing logistics and providing care uniquely complex. In the face of these challenges, AI offers a compelling solution to streamline back-end tasks and enhance the patient-provider relationship.
So, while 2023 may have been the year of AI awareness, 2024 is set to be the year of AI advancement and widespread adoption. Although I’m encouraged by what we’ve already achieved, I’m more excited about the coming benefits that adoption at scale will provide both home care operators and patients.
Specifically, I envision AI revolutionizing the home healthcare industry in several important ways in 2024:
1. Improving personalization at scale
With nearly 3 million home healthcare patients across the nation, personalizing their individual experiences is a time-consuming and complex undertaking. However, AI excels at this task. It’s capable of analyzing vast amounts of data to identify individual preferences, behaviors, and patterns much more quickly and accurately than human workers.
Expect certain applications that are already in use to achieve more widespread adoption by home healthcare agencies in the next year, including:

  • Streamlining care plan creation: With AI, providers can quickly generate personalized care plans based on the patient intake call, health records, and knowledge of similar patient profiles. AI-generated plans may include granular details like care reminders, medication schedules, and even activity recommendations.

  • Optimizing care matching: AI handles the complex process of matching care providers with patients based on factors like scheduling needs, travel times, personality and skills, helping create more effective provider-patient assignments.

  • Coaching providers: Using call recordings and transcripts, AI can offer recommendations for care providers. This could include general areas of improvement (e.g., areas where additional training is needed) as well as recommendations that are specific to the patient-provider relationship (e.g., future conversation topics).

2. Supporting task prioritization
By 2025, the U.S. is expected to face a shortage of over 400,000 home health aides. As the aging population continues to increase, AI offers home healthcare providers the ability to alleviate time-consuming tasks, streamline provider workflows, and reduce costs. One such application includes task prioritization and reorganization to help providers and administrators navigate an overwhelming list of to-dos. This use case is currently in development and will hopefully make its way into home healthcare in 2024:

  • Optimizing task management: AI can analyze patient needs, biometric data, urgency and potential risks to create a daily list of to-dos for providers. Consider a patient who requires immediate attention due to a sudden change in their condition. AI can help restructure a provider’s daily schedule and find coverage if necessary, to ensure the patient receives prompt care. This capability isn’t just helpful for providers; it can also offer benefits for operators and desk-based administrative health workers.

  • Generating communications: While AI is already widely used to generate communications, this capability becomes even more valuable when used alongside task prioritization. If a provider needs to rearrange the order in which they visit patients, AI can provide a script to quickly communicate with patients. In the event of a provider change. It can also communicate thorough notes on the patient’s needs to substitute providers.

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New Evidence Suggests Long COVID Could Be a Brain Injury

Medscape Medical News / By Sara Novak

Brain fog is one of the most common, persistent complaints in patients with long COVID. It affects as many as 46% of patients who also deal with other cognitive concerns like memory loss and difficulty concentrating. 

Now, researchers believe they know why. A new study has found that these symptoms may be the result of a viral-borne brain injury that may cause cognitive and mental health issues that persist for years.

Researchers found that 351 patients hospitalized with severe COVID-19 had evidence of a long-term brain injury a year after contracting the SARS-CoV-2 virus. The findings were based on a series of cognitive tests, self-reported symptoms, brain scans, and biomarkers. 

Brain Deficits Equal to 20 Years of Brain Aging

As part of the preprint study, participants took a cognition test with their scores age-matched to those who had not suffered a serious bout of COVID-19. Then a blood sample was taken to look for specific biomarkers, showing that elevated levels of certain biomarkers were consistent with a brain injury. Using brain scans, researchers also found that certain regions of the brain associated with attention were reduced in volume.

Patients who participated in the study were "less accurate and slower" in their cognition, and suffered from at least one mental health condition, such as depression, anxiety, or posttraumatic stress disorder, according to researchers.

The brain deficits found in COVID-19 patients were equivalent to 20 years of brain aging and provided proof of what doctors have feared: that this virus can damage the brain and result in ongoing mental health issues. 

"We found global deficits across cognition," said lead study author Benedict Michael, PhD, director of the Infection Neuroscience Lab at the University of Liverpool in Liverpool, England. "The cognitive and memory problems that patients complained of were associated with neuroanatomical changes to the brain." 

Proof That Symptoms Aren't 'Figment' of Patients' Imaginations

Cognitive deficits were common among all patients, but the researchers said they don't yet know whether the brain damage causes permanent cognitive decline. But the research provides patients who have been overlooked by some clinicians with proof that their conditions aren't a figment of their imaginations, said Karla L. Thompson, PhD, lead neuropsychologist at the University of North Carolina School of Medicine's COVID Recovery Clinic. 

"Even though we're several years into this pandemic, there are still a lot of providers who don't believe that their patients are experiencing these residual symptoms," said Thompson, "That's why the use of biomarkers is important, because it provides an objective indication that the brain has been compromised in some way."

Some patients with long COVID have said that getting their doctors to believe they have a physical ailment has been a persistent problem throughout the pandemic and especially as it relates to the sometimes-vague collection of symptoms associated with brain fog. One study found that as many as 79% of study respondents reported negative interactions with their healthcare providers when they sought treatment for their long-COVID symptoms.

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Medicare Advantage Headwinds Didn't Prevent Payers from Turning a Profit in 2023

Fierce Healthcare / By Paige Minemyer
Though a spike in utilization among seniors slammed payers last year, particularly in the fourth quarter, each of the six major national firms turned a profit in 2023.
Leading the way, as per the norm, was UnitedHealth Group, which brought in $22.4 billion in profit for the year. Its closest rival, CVS Health, earned $8.3 billion in 2023 profit, according to a Fierce Healthcare review of quarterly earnings reports.
Both of these firms represent major players in Medicare Advantage (MA): UnitedHealthcare and Aetna, respectively. And both felt the impacts of the higher-than-expected care use in the back half of the year, with CVS cutting its outlook for 2024 to compensate.
Humana, another of the largest MA plans in the country, was the most acutely effected by the utilization increase, given that the bulk of its insurance business is in the Medicare space. While it was profitable for the year, posting $2.5 billion, it reported a $541 million loss in the fourth quarter and set conservative guidance for 2024 amid "greater inherent uncertainty" in MA.

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