2011 Annual Meeting
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Annual Meeting a "Home Run;” Features New Practice Management Products and Services

by Jessica E. Quintilian, Assistant Executive Director

You asked we listened! This year’s annual meeting reflected changes that you, our members, requested: An entire day on practice management preceded the annual scientific meeting, at which new practice management and technical assistance services were debuted. Many more vendors attended to explain new products to Academy members, and there was much more networking time and group interaction than had been the case previously. Home care medicine is coming of age and this year’s conference called "Health Care is Going Home: The Future is Now” clearly showed the rapid progression of this field.

The Academy is growing and there was no better evidence than at this year’s annual meeting, held at the Gaylord Resort & Convention Center in National Harbor, Maryland on May 10-11, 2011. Featuring a full day on "Successful Management of the House Call/Home Care Medical Practice,” including new products and services such as Home Care Medicine: A field guide to developing successful practices and programs, day one of the meeting focused on documentation, coding, legal and contractual aspects, practice development and marketing, practice and provider metrics, and management, with plenty of time built in for discussion and networking. Many members took advantage of the Academy’s new subscription offers to join the home care medicine learning community and receive practice management and technical assistance services. If you weren’t able to attend the meeting, see our website to sign up for these exciting offers!

Day two, "Health Care is Going Home: The Future is Now,” featured a panel discussion on the changing home care neighborhood, keynote speaker Eric Dishman, Director of Health Innovation at Intel Corporation, emerging technologies, an IAH panel discussion, and three concurrent breakout tracks focusing on clinical, education and regulatory issues. Both days featured networking breakfasts and saw record attendance for an Academy meeting. For the first time ever, our annual meeting was video recorded! You will be able to download the video presentation sync directly to your computer. See our website for details.

Successful Management of the House Call-Home Care Medical Practice

Documentation and Coding

Past President Dr. Gresham Bayne’s presentation "Medically Reasonable and Necessary: The Case for Integrated Housecalls" addressed members as "the most important clinicians on the planet" and encouraged them to imagine a word of self-contained house call physicians operating out of their homes and all patient care centered around the concept of Independence at Home. Dr. Bayne's presentation highlighted the problem of house calls HIT, coding, point of care tools today and for the future. Dr. Bayne included steps on what members can do today to get increased reimbursement. These included five ways to get paid using the CKD new CPT for patient education, home sleep testing, specimen transport fees, taking advantage of the PQRI and eRx bonuses and contracting with transitional care and dual eligible programs. Dr. Bayne also described five ways to keep your payments and ways to save money. He concluded with an experiment illustrating the problem with documentation, data management and the EMR concept.

Dr. Alan Kronhaus continued the discussion of documentation and coding, cautioning members to never "game the system,” and further defining the key words "medically reasonable and necessary” and "ongoing evaluation and management.” Dr. Kronhaus described in depth how and why house call providers can be targets for audits, terms to ban from your lexicon, and key goals of documentation such as documenting at the highest level appropriate. Full of practical documentation pearls, Dr. Kronhaus’ presentation also covered the "treating physician rule,” billing based on time versus level of service, criteria to support billing based on time, key drivers that determine level of service, and tips and tricks such as "magic words.” Other issues such as trip charges were also addressed.

Legal and Contractual Aspects of Practice

Robert Clark, JD kicked off the Legal and Contractual Aspects of Practice discussion, summarizing characteristics of different types of legal entities including LLCs, professional corporations, general partnerships, PLLCs and nonprofits. Issues such as taxation, differences in state statutes and laws prohibiting the corporate practice of medicine were discussed, as were common exceptions and what to do if the use of a permitted entity is not viable. The "friendly” PC/Management Service Organization structure was presented.

Carla Murphy, JD followed with a continuation of legal aspects focusing on employees versus independent contractors, how to properly classify workers, wage and hour guidelines and the most generally applicable exemptions. Ms. Murphy’s presentation concluded with tips on physician employment contracts.

Practice Development

Following lunch and discussion time, Dr. Kronhaus began the afternoon with a Practice Development and Marketing presentation that focused on choosing a vision for your practice and defining success, defining your target and your unique selling proposition, crafting your marketing message, selecting marketing strategies and domains to consider when characterizing your practice. Dr. Kronhaus used valuable examples from his own practice to illustrate these concepts.

Metrics & Management – Quality and Cost of Care

Dr. June Leland presented Metrics and Management: Quality and Cost of Care, briefly summarizing the characteristics of quality as identified by CMS, OASIS, items of home health compare and questions to consider when assessing your quality of care. Dr. Leland presented patient data on home based primary care respiratory infection and showed how the VA tracks primary care performance measures. A transitional care proposal was also presented, followed by a question and discussion period. The Academy’s new field guide (mentioned in the first paragraph of this article) was introduced by Executive Director Constance Row and Associate Executive Director Gary Swartz.

Practice and Provider Metrics & Management

Maureen McCarthy, CPA wrapped up the day with her presentation on Practice and Provider Metrics and Management. Monthly billing essentials that each provider should know were covered, as were internal control measures and ways to measure productivity. Ms. McCarthy stressed the importance of providers knowing their business statistics monthly, use of internal benchmarking to identify what is or is not working for a practice, familiarity with state law and the advice of a healthcare attorney. Contracting with Medicare and negotiating with other carriers was another valuable piece of the discussion.

Health Care is Going Home: The Future is Now

A networking breakfast featured discussion tables on medical education, research, managed care, starting and selling a practice, practice management and hospice and palliative medicine.

Academy President Dr. Thomas Edes welcomed nearly 250 attendees and thanked the Board and staff, particularly Associate Executive Director Gary Swartz, who brings new expertise in practice management and technical assistance. Dr. Edes also thanked this year’s exhibitors and sponsors: Amaji Health Information Systems, ExpressMD Solutions, Gerontological Advanced Practice Nurses Association, Hopkins Medical Products, InTouch Health, Invacare Corporation, Nightingale Home Healthcare/Techs to Suit, Omni Medical Supply, Oncology Care Home Health Specialists, Sterling Medical Services, Sunovion Pharmaceuticals, WellDoc and Wyatt Matas & Associates. Special thanks went to Dr. Alan Kronhaus for coordinating the practice management program and to this year’s Program Chair, Dr. Steven Landers, who presented the opening remarks on "Why Health Care is Going Home.”

The Changing Home Care Neighborhood

A panel discussion on "The Changing Home Care Neighborhood” followed, moderated by Dr. Landers and featuring A. Malachi (Mal) Mixon, Chairman of the Board for Invacare Corporation; William Borne, CEO and Chairman of the Board for Amedisys; Andrea Devoti, President and CEO of Neighborhood Health Agencies; Christie Franklin, President and CEO of Bristol Hospice; and Beth Hennessey, Executive Director of Sutter VNA and Hospice. The shared future of home care was discussed and ways home care providers can better work together to achieve this future.

Keynote: Innovation in Health Care, Eric Dishman

A global leader in healthcare innovation, our keynote speaker Eric Dishman founded Intel’s first health research and innovations lab in 1999, and worked to spearhead Intel’s digital health group in 2005, which recently formed a joint venture called Care Innovations - an Intel/GE company. Embracing a global perspective, Intel has been engaged in field work over the past 12 years and has now studied 1,000 patient households in 20 countries and 250 care facilities across the continuum of care. A social scientist and behavioral researcher, Mr. Dishman had a 20-year career in Silicon Valley companies and built personal health technology prototypes for the "nursing home of the future.” Mr. Dishman brought his specific expertise in home and community based technologies and services for chronic disease management and independent living to the Academy with his presentation "Changing Practices: Innovating Home-Based Care Models and the Personal Health Technologies to Help Us Get There.” He presented results from a five-year cohort study on how to monitor and help with activities of daily living using environmental and other kinds of sensing technologies. Mr. Dishman also provided an entrepreneurial and historical perspective on technology and our modern "mainframe system of healthcare,” discussing the problems with this system going forward and the world forces at work to shift the mainframe. He described house call providers as "pioneers for what is going to become the norm.” His presentation highlighted global aging, health care reform and care models, health IT, sample technology prototypes and the megatrends, or 4 "Cs", of global healthcare reform--complexity, coordination, collectivity and community. Mr. Dishman then expanded on each of these concepts by discussing the necessity of building a complexity-ready health IT infrastructure and using data to personalize treatment in new ways, moving to team based care models and including families and patients as part of those care teams, paying groups of providers in collective ways and moving care into communities. Dr. Dishman's inspirational keynote concluded with calls to action for the Academy and its members including driving a vision and national plan and partnering with like-minded organizations. Said Mr. Dishman, "Health care at home may be our Sputnik moment."

Emerging Technologies in Home Care

Dr. Anand Iyer and Timothy Wright followed with their presentations on emerging technologies in home care. Dr. Iyer began with "mPowering Home Health Care: Changing the Rules of the Game," which focused on how mobile solutions transform the chronic care environment. He addressed the question of whether this can be adopted not just at an organizational level, but at a societal level. Dr. Iyer discussed macro trends in healthcare, why current methods fail and key success factors, describing wireless as the "golden thread" that links these success factors and a solution to support and bridge the patient-provider relationship. He concluded with four key operational success factors--outcomes, regulatory compliance, accessibility and integration. Timothy Wright then presented "Design and Evaluation of Portable Telemedicine Systems." Mr. Wright's presentation focused on the promise of telemedicine and concepts driving change, and the part technology will play in redesigning how care is delivered, improving access across the continuum. Mr. Wright concluded by presenting portable telemedicine market research findings.

An expert panel featuring Mr. Dishman, Dr. Iyer and Mr. Wright followed, fielding audience questions.

Annual Meeting features awards, Board re-election and Bylaws modification

Dr. Edes reported in his "State of the Academy” address the many ways we have expanded and improved service to members based on last summer’s strategic planning process. Dr. Edes’ comments included how the Academy has delivered on communications through new technology, practice management and member feature columns in Frontiers; and a weekly e-newsletter giving members the latest updates in public policy and practice management issues. We can now be found on all the social media—Facebook, Twitter and LinkedIn. We have delivered on practice management through our new website and technical assistance offerings, ranging from free to tailored efforts, including the subscription to the first offering of the Home Care Medicine "U” initiative of the Academy – Home Care Medicine: A field guide to developing successful practices and programs. Members can also take advantage of low-fee-based Practice Management and Technical Assistance services available now under the direction of Gary Swartz, who will be advised by Board members with a combined house call experience exceeding 100 years! (See our website for more information).

Dr. Edes reported on the Academy’s involvement in resolving audit issues and in addressing travel time reimbursement issues, as well as in fostering successful implementation of IAH. A webinar is planned once the specifications are released.

With the Academy ready to stand and work with members to take home care medicine to the next level, Dr. Edes emphasized that we cannot do this without your support. The Academy is implementing a slight dues increase, and Dr. Edes urged members to support the Academy through individual and group flat rate memberships for everyone in their practices. More information is coming soon. He also sent out a call for volunteers to work on committees and task forces. Please let us know which efforts interest you!

Members were asked to re-elect Board members due for reappointment and to vote on a Bylaws change giving all dues paying members the right to vote at any annual or special meeting of members.

This year’s new Awards Committee Chair, Dr. Theresa Soriano, presented two Academy members with our highest honor. The 2011 Eric Baron House Call Doctor of the Year was awarded to Dr. Stephanie Bruce, Medical Director of the Medical House Call program at Washington Hospital Center. Since 2006, Dr. Bruce has led the successful implementation of the program’s mobile electronic health record, a wireless real-time EHR that has elevated the quality of their clinical services. She leads a team of 16 house call staff that make over 8,000 house calls annually in Washington, D.C. Since 2004, Dr. Bruce has devoted her career to home care medicine and colleagues describe her as an extraordinary physician, wise leader and remarkable teacher. Dr. Bruce epitomizes the rare physician leader who respects and defers to her NP, social work and support staff colleagues. In addition to making house calls, she manages a daily panel of hospital patients and leads a home hospice service and inpatient geriatrics service. Dr. Bruce is also a renowned educator, receiving rave reviews from residents and house call staff. Under her leadership, the Medical House Call program has thrived and is one of the leading models of home based primary care in the U.S.

The 2011 House Call Clinician of the Year was awarded to Nurse Practitioner Kathryn Corbet. Ms. Corbet has over 20 years of nursing and healthcare experience and has served with Visiting Physician Services for the past nine years, treating elderly and homebound patients in Ocean County, NJ. Her past positions include Nurse Practitioner at the Veteran’s Affairs Administration and Kimball Corporate Care, and Adjunct Instructor of Nursing and Clinical Instructor of Nursing at Ocean County College. Ms. Corbet holds certification in wound care and provides in-service training to other Visiting Physician clinicians. She has also completed the Certificate Program in Bioethics and successfully passed the AAHCP home care exam in 2006. She serves as a preceptor, taking nurse practitioner students "on the road” and exposing them to the world of home care medicine. She was instrumental in furthering the reintroduction of the house call medical model and her impact on the lives of frail and ill homebound elderly is invaluable. Colleagues and patients alike describe her as kind, patient and competent. Whether providing compassionate home care, instructing others, or lending an ear to a concerned caregiver, Ms. Corbet possesses the extraordinary qualities of an outstanding home care medicine professional.

The 2011 Poster of the Year was again awarded to Dr. Bruce Kinosian for "Predicted and Observed Costs of Veterans receiving Home Based Primary Care Among 23 Veteran Integrated Service Networks (VISN).” Dr. Tom Edes was second author.

Congratulations to this year’s winners!

Afternoon features IAH panel and concurrent sessions

Dr. Landers moderated a panel featuring Dr. Julia Zucco, from the demonstration division at CMS responsible for IAH; Dr. J. Marvin McBride, Chief Medical Officer of Inspiris, Academy Past Presidents Dr. Peter Boling, Dr. George Taler and Executive Director Constance Row. Dr. Zucco presented the progress to date on developing IAH payment methodology and quality metrics. Specifications are targeted to be released in late summer. Dr. Boling encouraged members to think of IAH as both a legislatively mandated Federal Medicare demonstration project and a definition of a model that has been launched into public space. Ms. Row reported on tools the Academy wants to develop to help members get ready and be successful, such as a learning collaborative and the new field guide, which can help members determine whether they qualify and how to collect and analyze data. Dr. Taler emphasized the importance of an integrated fabric of organizations coming together for mutual benefit under IAH. The Academy will republish advice on how to develop relationships with key players in future newsletters.

Concurrent sessions followed for the remainder of the day. Dr. Tom Parker presented the State of the Art in Home Cardiovascular Medicine, which included styles of home cardiovascular practice, diagnostic tools and technology, types of CHF, treatment objectives, pearls of pharmacologic management and the future of home cardiovascular medicine.

Topics in Home Care Education: Curriculum and Teaching Skills Workshops were presented by Drs. Robert Kaiser, Linda DeCherrie, Rebecca Conant, Robert Jayes, Jennifer Hayashi, Sonika Pandey and Karen Blackstone. The sessions included an overview of key steps in developing a house call curriculum, focusing on evaluation of learners and programs, curriculum design and revision. Discussion tables led by facilitators provided opportunity for the audience to converse about common problems and issues.

Dr. William Zafirau presented State of the Art in Managing Complications of Dementia in the Home Care Setting. Dr. Zafirau covered new guidelines on the diagnosis of Alzheimer’s Disease, how dementia interacts with managing medical comorbidities, managing behavioral complications, addressing caregiver issues and social support, and managing end of life care as well as neglect, self-neglect and abuse in the home. Several case studies were also presented.

Dr. Gregory Compton presented The Home Care Provider’s Wound Care Tool Kit, which included a review of common wound types, risk assessment, characteristics of proper assessment, pressure ulcers, approach to wound healing, debridement methods and recommendations for wound bed preparation.

Regulatory Environment of Home Health Agencies was presented by Dr. Patricia Tomsko Nay and Bill Vaughan, RN, BSN. Issues discussed included Social Security, Medicare, Medicaid, survey of home health agencies, Level 1 standards, survey protocols and guidelines, levels of deficiencies and informal dispute resolution. Specific cases were also presented.

In conclusion, Dr. Edes gathered input from the membership on what the Academy can do for members going forward. Suggestions included working together on metrics, coding assistance and a grassroots public awareness campaign.

"This year’s meeting was a home run,” says Academy President-Elect and Past Program Chair, Dr. Bruce Leff, referring to the superb program and amazing progress the Academy has made on its strategic plan since last fall. Dr. Edes agrees that the ready-to-go practice management materials created a palpable vibrancy of the Academy. This year’s Program Chair and Board member Dr. Steven Landers responds, "If this meeting was a home run, we are just a few steps away from a ‘grand slam’ with the next meeting.”