Delta Connect Blog

Expanding Home Care Service Lines

Posted by Crystal Parks on Jan 27, 2015 8:30:00 AM

In part 2 of our Guide to the Growing Long Term Post-Acute Care market, we ask if your agency is ready to expand into other service lines. 

The evolution of the long term post-acute care (LTPAC) market means that it is more important than ever to be competitive. Your primary goal is to care for your patients to the best of your ability. However, the only way to acquire more patients is to outperform your competition. 

Home care providers must do the following to stay competitive:

  • Expand into different service lines
  • Implement a risk share business model and strategic alignment across care segments
    • Bundled payments for all services required for completing a patient's episode of care
    • Find the right partners
  • Benchmarking your agencies performance at both a national and community level


Stay tuned for more infographics related to the growing LTPAC market. 


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Topics: Post Acute Care, home care, Private Duty, Hospice, Home Health

NAHC Summarizes What Home Care Providers Need to Know After Lawsuit Win

Posted by Rachel Alden on Jan 22, 2015 2:26:37 PM

In a NAHC Report released today, NAHC provided a very helpful article entitled "NAHC Wins Lawsuit: What Home Care Providers Need to Know Now." The article discusses the implications and next steps following the court's invalidation of the Department of Labor's overtime rule.

We are providing a key excerpt from the article below for your information.

What Does the Decision Mean?

The rulings “vacate” two regulations that the DoL promulgated in an attempt to eliminate any application of minimum wage or overtime exemptions in home care services. The decisions of the court restore the exemptions of “companionship services” and “live-in domestic services” to what had been in place essentially since 1975.  That means that personal care services provided in the home by home care agencies are not subject to minimum wage and overtime requirements unless there is a state law providing for such. The decisions block the new rules from taking effect on January 1, 2015. In other words, a home care agency can continue its compensation practices for personal care aides that had been in place in 2014, assuming those practices were compliant then.

What Happens Next?

The DoL through its attorneys have asked the Court to issue a Final Judgment consistent with the rulings. That is a strong signal that DoL wants to prepare the case for an appeal as the rulings issued to date themselves are not appealable. Once the Final Judgment is issued, DoL has 60 days to appeal the case to the U.S. Court of Appeals for the District of Columbia Circuit. The appeals court is one step below the U.S. Supreme Court.

NAHC believes that the chances of an appeal are high given the rarity that federal regulations are invalidated, along with DoL’s publicly expressed dissatisfaction with the court rulings.

The path taken in any appeal can vary widely. If DoL wants to stay (suspend) the district court ruling it must first ask the judge to approve a stay. Judge Leon strongly hinted that he would deny such a request by DoL. If he denies a stay request, DoL can then ask the Court of Appeals to issue an emergency stay. The process in an emergency stay can take mere days or it may extend for months. Generally, it is not a quick process. If a stay is granted, the rules challenged in the lawsuit will go into effect. Since that result is a change in the “status quo,” the Court of Appeals may be disinclined to issue a stay.

Whether or not DoL seeks a stay of the district court rulings, the Court of Appeals will ultimately reach a decision on the merits of the case. The Court of Appeals has the power to review the lower court ruling as a “de novo” matter, meaning it is a fresh and full review  not affected by the district court decisions. These reviews now take one to one and a half years typically in DC. If no stay has been issued, the district judges rulings remain in effect, permitting the use and application of the longstanding overtime exemptions.

If the Court of Appeals affirms or reverses the district judge, the next stop is the U.S. Supreme Court. Previously, NAHC successfully litigated issues related to the “companionship exemption” at the Supreme Court in 2005 and 2007. 

What Should Home Care Agencies Do?

  1. An employer’s compensation practices must be consistent with both state and federal law. If you have any question as to whether your state requires overtime for personal care aides, you should consult local legal counsel skilled in employment law. Otherwise, you have many business options to consider, including whether you want to pay overtime even if is not required.
  2. NAHC believes that advocates for changes in overtime rights will continue the battle at the federal level, but that they will also shift efforts to include state law advocacy. For example, in 2014, California law was changed to establish some rights to overtime for personal care and home care aides. Home care companies should watch for similar efforts in their states.
  3. Even with the favorable rulings in the lawsuit, it would be prudent for home care companies to evaluate whether their compensation practices are compliant with the FLSA. One area of risk is applying the companionship services exemption to Medicare-type home health aides who may provide health care related services to patients that goes beyond personal care.  While DoL has not issued explicit guidance regarding what does and does not constitute “personal care,” the rulemaking challenged in the lawsuit offered hints that the DoL may consider blood pressure testing, wound care, medication administration, and therapeutic exercises to be outside the exemption.
  4. Follow any emerging developments in the ongoing litigation. A court ruling does not usually give businesses a warning that requirements are changed. A decision of the Court of Appeals would take effect the day it is issued. NAHC will provide its members with up-to-the-minute reports on any such developments through its various media including the listserves, NAHC Report, and its website.


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Topics: Private Duty industry

A Guide to the Growing Long Term Post-Acute Care Market

Posted by Crystal Parks on Jan 20, 2015 11:46:17 AM

As the population of American's age, the number of people receiving long-term and post-acute care services will grow rapidly. Is your home care agency prepared to expand to service lines that address the entire Long Term Post-Acute Care (LTPAC) landscape for managing patient population?

LTPAC services have a wide range of conditions and more complex, chronic care needs that result in frequent transitions for patients between their homes as well as acute, post-acute and long-term care settings. The range of LTPAC providers and care settings with frequent movement of patients amongst them necessitates the exchange of relevant and accurate care documentation. Coordination of care is essential as is the need for systems to support the capturing, use and exchange of patient information.


Stay tuned for more infographics related to the growing LTPAC market. 

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Topics: Post Acute Care, home care, Private Duty, Hospice, Home Health

How One Home Care Provider is Preparing for 2015

Posted by Ellen Bolch on Jan 13, 2015 8:51:35 AM

What are new leadership characteristics needed for a transforming healthcare delivery system?

The healthcare delivery system is transforming from an institutional acute care based model to a community post acute, and even pre-acute, population health based model. But the transformation is moreellen_bolch_headshot_web complex than that. When there are value shifts in any economic sector, certain assumptions can be made and applied to healthcare.

  1. When risk shifts from the payer to the provider, a cycle begins that shifts power from the provider to the customer.
  2. With such a shift, the Value Chain is reengineered, accompanied by mergers, acquisitions, divestitures, closures, and rising customer expectations of service.
  3. As this occurs, standardizing clinical processes necessitates the responsibility for health care to be downloaded: doctors to nurses, nurses to technicians, technicians to paraprofessionals, etc.
  4. New Information Technology continues to generate rapidly expanding quantities of data which, coupled with advancements in data analysis, allow for identification of patterns of disease, gauging efficacy of treatments, and spotting links between causes and symptoms.(BIG DATA)
  5. Advances in Technology represent the “breakthroughs” in cost and quality which occur when the value-added chain is restructured, leading to innovative, elegant changes which create a new paradigm where existing methodologies become superfluous.

So, how to lead through the economic deregulation of healthcare? What leader characteristics are required to “pull it off”?

Economics 101: those who benefited most from the old order are the slowest to adapt. The home care provider leader of tomorrow must:

  1. Have Vision; be able to paint the picture of the new hardscape of healthcare for the organization while dealing with the realities of today – the proverbial one foot in the present and one foot in the future.
  2. Be a Paradigm Buster; don’t wait for a shift to react. Stay ahead. As hockey great Wayne Gretsky said, “Skate to where the puck will be”.
  3. Be Customer Focused and Patient Centered; it is more important to own the customer than the product.
  4. Now, More Than Ever, Maintain Focus on Reducing Costs while Increasing Quality Outcomes.
  5. Create the Leverage to Forge Strong Partnerships for Fitting into a Chain of Value and a Distribution System.
  6. Be Data Driven and Invested in Technology; watch where value is shifting and shift with it.
  7. Have Faith in the Future and be Willing to Challenge the Status Quo.

How should home health providers prepare for 2015?

Organizations should prepare for 2015 by retooling themselves into a partner whose performance characteristics make it sought after by Bundled Payment projects, Accountable Care Organizations, Transitional Care Models for Value Based Purchasing and Chronic Disease Care Management, etc. That means developing and delivering the care programs of the future today. This translates into the following mandates:

  • Demonstrate Outcomes via transparent data specific to the potential partnership
  • Develop a Utilization Review Approach to Care Modeling for Home Care – Proportional and Acuity Safety Based
  • Employ Data Integration and collaboration across the partnership
  • Ensure Dynamic Patient Risk Stratification with associated algorithms for care management
  • Shift Care Focus from Patient Dependence to Self Management
  • Emphasize Population Health Management – Chronic Disease Transitional Care

The Chinese curse, “May you live in interesting times”, certainly applies to health care today. These are the most interesting and exciting of times. A new generation of health care professionals and leaders have been handed the challenge of a lifetime. They just might pull it off!

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Topics: home healthcare

Zero Update for Hospice Recommended by MedPAC for FY2016

Posted by Crystal Parks on Jan 9, 2015 2:06:11 PM

The Medicare Payment Advisory Commission (MedPAC) met in late December to discuss Medicare payment policy recommendations for inclusion in its forthcoming annual March Report to Congress. The Commission uses a standard framework to assess payment adequacy, including provider access to capital, financial margins, access to care - including numbers and growth in providers, as well as growth in utilization - and quality when making recommendations. In addition to preliminary approval that the Report recommend elimination of the update for hospice payments in Fiscal Year (FY) 2016, Commissioners supported reprinting of previous MedPAC recommendations that have not yet been implemented.

Specifically, those recommendations state that the hospice payment system be reformed to better reflect the costs of hospice care over the course of the episode and that CMS conduct medical review of hospice providers that have a high proportion of long-stay patients. It should be noted that the latter recommendation (related to medical review) had not been implemented by CMS due to a legislative drafting error; that error was corrected as part of the IMPACT Act, which was signed into law in October.

Presentation slides and a transcript of the discussion are available online. MedPAC’s next meeting, at which final votes will be taken on payment recommendations for FY2016, will be held on Jan. 15-16, 2015.

Read more in the NAHC Report


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Topics: Hospice Payments, Hospice

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