My Experienced-based Cultural Truths About Robots

 When I demonstrate robots the most frequent question I am asked is: “What does it do?”

My – admittedly, my somewhat flippant answer is: “What would you like it to do?”

The time has come to recognize that the advance of humanoid robots while presently still only at a nascent stage, has already achieved amazingly great things. Clearly though, people are trying to understand and grapple with the very idea of robots as a reality. Not just where do they fit in society? But where will they fit in my life? How will I end up interacting with them? Will I be forced to interact with them? Are they nice to be around? What role will they play in my life?  Will they take my job? What does it mean to own and use one? 

Most of the questions I get quickly arrive at the same personal level that I remember surrounded the reactions and responses to the advent of personal computers. But this go around with robots as the next new interface to knowledge, information and services has a different edge to it.

It seems that with robots we tend to want to test and probe more about the humanized traits they display. We didn’t do this so much with personal computers. They were quickly seen as friendly and as an ally and in the end a machine. And, they were deemed controllable. Robots stir up a different reaction. Does it think by itself? Does it feel the emotion it senses? Can it run off and do its own thing? Does it know what I am thinking? I was once even asked if one felt sad being left alone?

The reasons these reactions are different from the initial personal computer experience is driven by the fact that robots are intentionally designed to evoke a human-like quality. And yes, they can become engaging, empathetic and endearing. But perhaps most unsettling to some, is that robots have mobility and a certain display of autonomy. They can move about and navigate their surroundings. They turn their heads and look at you when you speak, and move their arms and hands and fingers. Some individuals I have met feel that maybe this ‘thing’ can and might ‘chase them down’. “Can I hide from it?” they ask. At the core of most of this cultural and social formulation attitudes about robots is the sense of the foreboding by many that surrounds robots in that they will be replacing people in many roles and jobs.

A lot of this emotive reaction has already given rise in Europe with the Economic Union (EU) developing ‘civil law rules for robotics’. This is of course in anticipation of the impact of and the quantity of robots we will encounter in our future society. While in and of itself a good idea to think about and consider such policies, it tends to contribute to the general uneasiness about robots in that they seemingly have already achieved a ‘lobbying status’ in governmental bodies.

In debates and discussions about these issues I inevitably return to my actual experience. When you see a child suffer less pain and stress when facing medical procedures because they are accompanied by a medical assistant robot that they trust; when you see seniors becoming actively engaged via a tele-presence robot reducing the life-threatening impact of loneliness and isolation; when you see young students in a classroom becoming excited and engaged with learning new math and science concepts and skills; when you see the elderly in a skilled nursing facility become animated over attending an exercise session led by a robot; when you see a robot contribute to enhanced care decisions and performance results in a hospital labor ward; when you see an autistic child achieve lasting social improvement progress you begin to sense the true cultural and social impact of robots…and it is good.

MACs, RACs, ZPICs and Home Care Services

Navigating the audit gauntlet in CMS billing is getting more challenging by the week and recently, it seems, by the day. Two things are becoming abundantly clear. First, and no matter how well intentioned and honest, the old methods of claims preparation and submissions no longer work. Second, and more than ever, you must avoid submitting what you can’t defend.

The first line of the gauntlet is firmly in place.

MACs – Medicaid Administrative Contractors

RACs –  Recovery Audit Contractors

ZPICs - Zone Program Integrity Contractors

Each of the above hired, licensed, paid and deployed throughout the country to oversee, review, process and question each and every claim you submit.

As challenging as understanding, complying and staying current with the medical and health care aspects of providing home care is and the proper ‘care coding’ and claims submission documentation is, the challenge of navigating and avoiding the deepening scrutiny of these multiple audit weapons that CMS has operational to oversee fraud, waste and abuse (FWA) is equally challenging. The ROI for CMS is provably simple. CMS spent $450 million on FWA programs and re-gained $42 billion. Without a blink they just announced a $11 billion charge back to hospitals for past over payments. So don’t expect the pressure to lessen any time soon. The authorities granted these contractors extends to being able to refer home care agencies to the DOJ or OIG for investigation and potential prosecution.

Quality assessment and control (QA) over claims documentation has now become a mandatory staffing and skill set requirement for home care services.

As Michael McGowan an experienced auditor now leading OPERACARE stated, “Poor documentation that doesn't show necessity, skill, or documentation to standards of CoP can all down grade a visit.  Or, visits are easily deemed non billable due to no orders to support the claim or even improper supervision.   So it is no longer a matter of RAP vs reality of how many, but so many other factors can down grade your therapy counts.  Even a whole chart with MUE can negate all therapy visits before they occur.  Only proper OASIS scrutiny in real time at SOC to plan for necessity and efficient treatment followed up by rock solid documentation can help you get the payment you think you are going to get.”

With the new pre authorization claim review, and with MACs, RACs and ZPICs and all the other audit teams out there, it is best to be sure of what you are doing and why, and make sure it all follows through.

So what can be done to lessen audit risk? To prevent being audited into bankruptcy? Use software that lets you see what CMS sees before they see it and don’t submit what you can’t defend.

The best I have seen is OPERACARE. But don’t only take my word for it.

Ben Galin of Galin Consulting after reviewing OPERACARE said “It is the only tool I have seen that automates some of these first steps to let you see your chart from a macro and micro and agency macro view simultaneously, in seconds, where it can take an entire QA team to do this in hours.”

The true bottom line is this: It is a new world, a new age and a new era for home care, one where your bank accounts now have large exit doors. It is time to step up to these new challenges with advanced weaponry of your own, show your worth and lessen your worries about MACs, RACs and ZPICs knocking at your door. OPERACARE can help you do that.

10 Strategic Imperatives for Home Care Services In The New Era

The avalanche of changes impacting home care services can only be described as dramatic. Home care leaders are now pressingly faced with addressing an entirely new era. A new landscape has been created that demands a new approach to protecting revenues, ensuring business sustainability, thus survivability, and the recasting of operational methods and processes that meet the needs of patients…and the business.

What defines this new era?

CMS: $42 billion dollars saved via its fraud prevention programs

The primary impetus is of course CMS. New regulations, reporting, coding, quality benchmarks, bundled payments are just a few to be highlighted. The heightened attention and regulatory oversight given to payment penalties, re-admissions, claims reviews and audits are CMS policies that stimulate the establishment of the new culture. One can only assume that this regulatory and heightened audit cultural impact will continue.

Underlying all of these actions and more is of course, the implied belief by CMS derived from the state of the industry, that there are too many home care services, serving too small a client base, that are under performing and are operationally, poorly managed. CMS wants fewer home care agencies serving larger client bases having financial stability. In addition is the ever deepening CMS/MAC oversight that seeks to ferret out fraud, waste and abuse. The consensus is that the number of home care agencies while having increased dramatically will enter a period of CMS motivated decline with 12,000+ agencies today becoming ~ 8,000 in just a few years.

Bottom line: all major categories of financial performance are under pressure. According to one recent industry survey source, “cash on hand” to operate has dropped to 33 days; median revenues have fallen; accounts receivable has slowed from 44 days to 68 days. Current asset to current liability ratio is worsening making borrowing problematic. Unless cash flow cycles can be improved the outlook can only get dimmer.

Everything taken together it is indeed, a new era.

The home care industry has been slow to recognize and follow the lead of hospitals and SNFs for example in successfully making operational quality and efficiency gains through automation. Hospitals and SNFs understood that outdated polices and paper based processes were not going to enable them to produce the efficiency gains and achieve the quality objectives that their new environment (and CMS) demanded. Being slow to adopt automation methods designed for the new era in home care is no longer an option given that surviving in the new era is important.

The issue is not just about running a home care business more efficiently and effectively. While adopting to the new era process may seem like added costs, industry research indicates that agencies with higher visit costs were also more likely to have high quality and satisfaction scores and be among the top performers. The new processes done correctly points to actually freeing capacity to serve more clients.

Payment Error rates (PERM) are the highest since CMS tracking began

New on-boarding methods utilizing automation can actually contribute to increased revenues. Using automated home care QA and UR pre-claims automated methods can deliver up to 50% better profit margins in many cases and actually increase the capacity of the business to serve more clients with the same staff levels.

Dealing with compliance audits and ADR requests is simply a very expensive waste of time and staff resources. Technology should be and can be the targeted solution strategy.

  

Let’s look at the new paradigm with Ten Strategic Imperatives as Guideposts:

#1 STAR Ratings are the new driver. Bench-marking outcomes are now less relevant. STARS outcomes need to be managed in real time prior to their submission to CMS.

#2 OASIS care plans have typically been written up hours or days post visit.  All care plans and service utilization decisions need to be done on site during the OASIS visits. RAP submissions should be made within 2 -3 hours of the OASIS visit.

#3 Over Utilization visits from one episode to the next need to be reduced. OASIS based data needs to drive staffing. Home care needs to use OASIS data the same way hospitals use DRG data.

#4 Outcomes data needs to be distributed to field clinicians via tools that make each field clinician accountable for the results (data) they produce.

#5 Claims submission error rate of + 40% (current average) needs to be sub 15%

#6 Hospital Re-admission rates at +27% (current average) needs to be sub 10%

What is clear from the above is that a new approach for the new era is not just needed, it is demanded. This means that new processes supported with new supportive automation methods is required.

Legacy systems built for the old era requirements of PPS will no longer meet future needs.

#7 Avoid Being Audited into Bankruptcy

If you see what MAC sees what would you do differently?

First and most essential is the ability to avoid costly and time consuming audits. It is far too easy to be ‘audited into bankruptcy’ resulting from inaccurate, or clinically inconsistent claims. Do this enough and you are on the MAC radar screen. Having software that uses the audit analytics that MAC uses aids you in not submitting what you can’t defend.

#8 Don’t Miss Securing Additional Justifiable Revenues

Missed revenues is significantly more prevalent than most home care service providers realize. Having software that can align claims with additional, justifiable revenues is critical to survival and stability.

#9 Transition to a New Era Repeatable Process

Getting ‘real time’ claims feedback enables improved, speedier claims filing without a seeming unending cycle of ADRs. Cash flow cycles improve.

Establishing new process methods that binds field clinicians with QA staff lessens inaccuracies, speeds accurate claims and will in the end lessen staff requirements and improve capacity to handle more clients. This is a key factor as having definable repeatable on-boarding processes if the foundation that underlies stability.

#10 Win New Business Based on Facts and Data – Win with Strong ‘Value-based Purchasing’

Being able to generate outcome analytics that supports quality claims becomes the basis for new business marketing that differentiates your service and attracts new business.

The re-design of home care delivery is real. The numbers of the growing elderly population with expanding care needs is real. CMS’ new regulations and ‘submission demonstrations’ are real. Increased MAC audit pressures are real. True home care service leaders will advance to meet these realities -- the opportunity to survive and excel is real.

Michael McGowan is President of OperaCare Inc. | Michael Radice is Chairman, Technology Advisory Board, ChartaCloud Technologies LLC | PHOTO Credit: lehrmach2.blogspot.com

Copyright 2016 ChartaCloud Technologies/OperaCare. All Worldwide Rights Reserved.

CMS Clearly Knows What It Is Doing. Do You?

Nine states are now subject to Value Based Payment modeling; five states are subject to the pre-claim submission demonstration; CMS spent $450m on building tools and staff to chase fraud, waste and abuse (key in on “waste”); aggressive CMS/MAC audits are the policy du-jour; DOJ prosecutes 300 in a nationwide health care abuse round up; round two of the OCR HIPAA audits are now underway. It would be difficult to see these actions as unrelated or random. Even more difficult not to see the writing on the wall.

Clearly, CMS believes that there are too many home care service businesses. Too many that are under-capitalized; too many that are not profitable; too many that are serving too small a patient base; too many that are operationally, weakly managed; too many that can’t make the necessary leap to technology advances and yes, too many that submit unjustifiable or inconsistent claims, purposeful or not.

It can’t be lost on the home care industry that CMS is accumulating empirical evidence that quality of care can and does improve and at a lower cost when the industry is forced to a value based payments model and STAR ratings. I would blame the capacity to be able to now demonstrate care improvements on the industry…how did the industry end up in that circumstance? Results are showing that there existed and there is room for improvement. It seemingly needed to be externally driven.

So what is the CMS strategy? Reduce the number of home care services so that fewer are serving a bigger census and doing a better job of it. The question quickly becomes strategic for industry players. Become a new era player, survive and grow or get audited or bureaucratized into bankruptcy.

The consensus forecast is that the ~ 12,000 home care agencies will end up being around ~6,000.

The four operational axioms I would focus upon to survive in this new era are:

1.       Don’t submit to CMS/MAC what you can’t defend

2.       Know your OASIS outcome analytics – deeply

3.       Be sure care plans are done actively and not at some later point in the day or week.

4.       Anticipate the re-certification hurdles

Seeing the benefits of these four axioms is not conjecture it is based on experience. If you would like to discuss that experience, please do let me know. I’d be happy to do so.

Humanoid Robots in Assistive Health Care

  Guest Post: Lauryn Schimmel, Managing Director, ChartaCloud Technologies

While many are aware of the uses of advanced surgical robots that perform precise roles during surgery, I wanted to take this opportunity to highlight and share some of the other currently active roles that humanoid robots are taking in healthcare today! Words cannot express the joy experienced when a robot can become a distraction, educator, and a friend to children in frightening hospital corridors. In addition, witnessing a robot bring seniors to their feet and smiles to their faces during what started as just another day in a senior living community is powerfully meaningful and illustrative of the amazing world of technological innovation that we live in.  I invite you to take a look at some of the exciting things that are happening in the world of humanoid robotics!

Pediatric Healthcare & Dentistry

Humanoid Robots equipped with proprietary RxApplications^TM are clinically proven to reduce children’s pain by 50% and increase vaccination rates by 10%. The humanoid robot in pediatric care settings acts as a pain coach, physical companion, and motivator. RxApplications^TM control the humanoid robots behaviors during a specific medical procedure. These behaviors are sequenced to work at the same pace as the healthcare professional who is conducting the medical procedure. The humanoid robot coaches, educates and provides companionship before, during, and after procedures using research-based cognitive-behavioral interventions. RxApplications^TM are customized for each hospital and allow the hospital to innovate their use of the humanoid robot. Templates are used to create RxApplications^TM when available, otherwise it is possible to develop new medical and dental procedures from scratch.

Current RxApplications^TM in use include:

□        Blood Test □        Breathing Coaching □        Dental Cleaning □        Dental Local Anesthetic □        Dental Nitrous Oxide □        Dressing Changes □        EEG □        Foley Catheter Removal

□        Induction □        IV Start □        Medical Play □        Orthodontist Greeting □        Oxygen Tube Insertion □        Port Access □        Vaccination □        Videofluoroscopic Swallow Study

In the Pediatric Healthcare setting, the humanoid robot provides benefit to every clinic as well as for hospice care. The robot was able to increase vaccination rates by 10% during a clinical study by calming children that were kicking, punching, and biting the nurses beforehand. The robot provides relief to children as young as two and as old as sixteen years old.

Senior Living

NAO, the humanoid robot developed and designed by Aldebaran Robotics, is currently located in over 200 assisted living communities around the world. Its first purpose to was demonstrate some exercise to the residents and have the residents imitate NAO doing the same movement to help them move and stretch. This enabled caregivers to really be by the resident’s side and help those who needed movement correction or assistance, while NAO led the show. With this great success, more and more caregivers are asking for other behaviors and applications. The elderly see NAO as a little child and often, when NAO is introduced to them, they take him in their arms like a baby and start to baby him.

One day, during a presentation, one resident named Marcel, began to talk with NAO. Using the ZORA platform, it was possible to answer through the robot to Marcel. They spoke together nearly 20 minutes. This was awesome because Marcel typically was a withdrawn resident and during these 20 minutes he spoke more than what he had done for 4 years during his life at the retirement home.

NAO can be remotely controlled by the staff; this way the robot can walk into a room “by itself” instead of being carried in by a caregiver. This way, the resident can naturally discuss with NAO and have the feeling of being “alone” with him. Of course, the whole situation is monitored thanks to video and audio streaming and the caregivers can supervise and interact through NAO. NAO helps the caregivers support residents, alleviate loneliness, and make them interact in a natural way.

In addition, NAO is able to assist the caregivers. There are a lot of “cold tasks” meaning that there are some duties such as answering to frequent questions of the residents, that take a lot of time and aren’t ‘as important’ as other tasks. So the caregivers often neglect them. For instance, every day, every resident asks (and sometimes more than once): “What are we eating today?”. The caregivers haven’t enough time to answer to everyone. So, they had the idea of using NAO to do it. The robot stays on a table each morning and tells the daily menu when a resident pushes one of its foot’s bumpers. The other foot allows the resident to hear the main news of the day. This simple application makes both the residents and the caregivers very happy.

Autism Special Education

The humanoid robot can engage children with applications designed for special education. The NAO robot is especially suited to interact with autistic children because the NAO robot is interactive and fun, engaging and captivating, and adaptive to the needs of the classroom from individuals to groups. It is a great help for teachers that really appreciate eliminating monotonous tasks. The NAO robot has a pack of applications inspired by commonly practiced special education teaching methods (ABA, PECS, TEACCH, DENVER, SCERTS) to unlock deeper learning in the classroom. The applications are mult-educational and focus on educational lessons, communication skills, and daily life knowledge. The applications are structured to make children with disabilities comfortable and confident and they can be adapted to individual motivators, internal states, and personality to create the perfect match.

The NAO robot is very predictable and reduces natural anxiety, its tireless features repeat until a child understands, and it is judgment free which increases a child’s confidence. NAO is able to bridge the human and technological worlds, linking autistic children by encouraging social interaction, learning, confidence, and self-esteem. The NAO robot is able to build the following skills: time perception, imitation, theory of mind empathy, join attention, turn-taking, academic skills, body awareness, verbal communication object labeling, nonverbal communication, and eye contact.

Physical Therapy

Within the Department of Rehabilitation at the University Hospital Ghent, the robot is used to show what exercises a patient has to do, and with what number of repetitions. The NAO robot installed with the Zora solution, is a small and very mobile robot with a high feel-good factor, she gives repeated and verbal instructions, supported by music and sound. It is just this combination that encourages children and seniors to move and exercise. Custom exercise routines for Parkinson’s Physical Therapy and Cerebral Palsy are two applications that are currently being developed.

It is exciting to be able to share some of these current use cases with you all. Humanoid robots are already assisting in healthcare roles today!

For more information:

ChartaCloud Technologies

info@chartacloud.com

603-580-1088

It’s Time for Enlightened Corporations to Meet the Needs of Employee Caregivers

The National Alliance for Caregiving reports that caregivers who don’t receive support from employers experience a negative impact on their careers. 

In fact:

·         66% of caregiver employees have gone into work late, left early or taken time off during the day to deal with caregiving issues

·         20% of caregivers were forced to take a leave of absence from work

·         10% of caregiver employees quit or take early retirement

·         9% of caregivers reduce hours or take less demanding jobs

·         5% of caregiver employees turn down a promotion

The negative impact on the corporation itself is more staggering. “Absenteeism” and “Presenteeism” (when I am at work but not really working- I am caring) is costing corporations millions. Furthermore, unhealthy stress on caregivers trying to balance the demands of care giving and job responsibilities ultimately adds more expense to an employer’s health costs. The day is fast arriving when employee care giving support via an Employee Assistance Program (EAP) will be the rule. Unless corporations move swiftly to craft and adopt enlightened practices and policies we will see government mandated employee caregiver support laws emerge. The numbers of employee care givers are dramatically expanding as the ‘Boomer’ population ages and retires. Caregivers will become a yet another protected class by necessity and by law.

Technology can play a vital role in lowering costs, lessening stress and reducing hospital admissions by connecting care givers and their families so that everyone can be informed of the health status of their isolated or remote ‘parents’ on any given day. If Ian employee had this technology as a benefit option as care giver they could then can more easily decide whether they need to go to ’Mom’s home’ or can actually go on into work. Or, if an employee is on a business trip, having such connectivity would allow me to concentrate on the task at hand by knowing what is happening and if a pro-active care intervention is needed.

If you are considering ‘care giver technology’ as a corporate benefit (EAP) I would like to know your thoughts.

Home Care Technology's Third Wave

I believe that we can all agree that technology has and will continue to change the landscape of home care. Most of technologies’ initial wave was focused on making business operations more efficient. Cost based decisions. We are now well into the second phase - patient-centric technologies – technologies utilized to enhance monitoring, care adherence plans and behaviors and reduce re-admissions more cost based decisions. The third wave has started – health care technology as a revenue generating profit center.

The unique impact of this third wave is that it will transform technology driven enhanced care and the attendant quality outcomes into profit centers. Like previous technology waves it will start primarily in private care. Technology will be a significant client and partner attraction. See the handwriting on the ‘government’s CMS wall’. More visibility to STAR Ratings. More pressure to give patients a voice in care. More decisions being driven by value based marketing, that is being able to prove that your outcomes’ in care giving performance is better than that of others and the restructuring of payment models to enhance the use and adoption of technology. Technology creates better health outcomes.

I know that we have many ‘payment’ hurdles to overcome. But I believe that home care will have little choice but to get on technologies’ third wave and manage it not just as a cost center but also as a revenue center. So why wait. Today, many of the technologies can start out as self- funding profit centers. Offering such services and not only differentiates your service but can be crafted to earn a profit.

The balance is shifting to where home care services will need a robust IT inventory of customer oriented technology services and a concurrent delivery and support capability to remain competitive and profitable. My forecast is that the solutions/revisions to existing ‘payment hurdles’ will outpace home care’s ability to adopt, deploy and manage future technologies.

What do you think?

Mike Radice serves as Chairman of the Technology Advisory Boards for ChartaCares.com and Generationcares.com