GPS Cuts Fraud, Costs For Home Healthcare - InformationWeek
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11/5/2014
09:06 AM
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GPS Cuts Fraud, Costs For Home Healthcare

GPS-based electronic visit verification products such as Axxess and Celltrack help ensure caretakers actually visit patients' homes.

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Now that more sick and disabled Americans live at home, payers and operators of residential healthcare providers are increasingly turning to technology to reduce fraud and ensure patients receive the care they need.

Nationwide, medical fraud costs tens of billions of dollars -- and home health fraud drains billions from the country's economy, said John Olajide, CEO of Axxess, in an interview. He's not exaggerating: Fraud and abuse in healthcare cost about $75 billion annually, according to the Institute of Medicine. The cost to untended patients can be immeasurable.

In 2012, Dr. Jacques Roy was charged with reportedly bilking $375 million from Medicare, in part by certifying more than 5,000 patients unnecessarily required home healthcare compared with the average of 104 for most physicians. About a year ago, Roberto Marrero pleaded guilty to, among other things, billing Medicare for therapy and other services that home-health patients did not need or receive, the IRS reported. In September, six south Florida residents were indicted for allegedly soliciting and receiving kickbacks from a now shuttered home-health agency.

[Read how tech is attacking Ebola: Real-Time Analytics Can Help Stop Ebola.]

Sometimes, it's individual employees, not organizations, who commit fraud, said Olajide, whose company develops electronic visit verification (EVV) solutions.

"These are all individuals taking advantage of lapses in the system. It's people taking advantage of loopholes in the system," he said. "They see opportunities to exploit..."

Government anti-fraud initiatives, task forces, and well-publicized campaigns that generated more than 1,000 convictions and $2 billion in recovered payments are cutting into fraud, said Olajide. And technologies that allow home health agencies to electronically monitor remote staff ensure better patient care, accurate billing, and compliance with payers' request for proof of service, he added.

That's why states like Texas and Illinois now mandate the use of electronic visit verification (EVV). The Illinois Department of Human Services Division of Rehabilitation Services, for example, began using EVV for its Home Services Program in January 2014. About 30,000 personal assistants will use the system, developed by Sandata, to serve 28,000 people with severe disabilities, the state said. In addition to tracking caregivers' location, it integrates with payroll and flags supervisors in cases of suspected neglect or abuse.

(Image: Alyssa L. Miller/Flickr)
(Image: Alyssa L. Miller/Flickr)

GPS-based electronic visit verification that integrates with payroll software quickly and automatically allows agencies to determine nurses' paychecks, Marvin Javellana, chief operating officer at Better Care Home Health, told InformationWeek. The four-year-old agency specializes in high-acuity patients, meaning daily care is critical to their health, he said. At a time when more patients are being treated at home, Medicare began lowering reimbursements, further spurring Better Care's interest in EVV, said Javallana.

"Now, when Medicare lowers your reimbursements you start to look at how to become more efficient," he said. "We really need to squeeze every single cent of what we're reimbursed. The adoption of this technology is not just about compliance. It's about survival. How are you going to survive in this industry right now if you're not efficient?"

GPS products also reduce caregivers' mileage, according to EVV developer Celltrak. After implementing CellTrak VisitManager, the Hospice of Cincinnati's staff managed more visits per location and staff safety improved, said Jeri York, master scheduler, in a statement.

Before Better Care used Axxess' EVV, nurses carried a timesheet for each patient, who was then asked to sign daily to confirm the nurse's visit. Nurses could, however, get patients to sign multiple days simultaneously, said Javallana. And caretakers could use voice over IP (VoIP) lines to pretend they were at a patient's home -- when they were actually far away, he noted.

The agency's EVV system, which runs as an app on an iPhone or Android, lets nurses log on only when they are near the patient. It's part of Axxess' electronic health record (EHR) and portal, so it automatically updates clients' vital statistics, photos, medications, signatures, and notes, further proving the nurse's presence, said Javallana.

"With a GPS solution, if you are not in that front door or a few hundred feet of that address, you cannot log in," he said.

The owners of electronic health records aren't necessarily the patients. How much control should they have? Get the new Who Owns Patient Data? issue of InformationWeek Healthcare today.

Alison Diana has written about technology and business for more than 20 years. She was editor, contributors, at Internet Evolution; editor-in-chief of 21st Century IT; and managing editor, sections, at CRN. She has also written for eWeek, Baseline Magazine, Redmond Channel ... View Full Bio

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Ariella
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Ariella,
User Rank: Author
11/5/2014 | 2:33:01 PM
Re: Hmm
@Alison we've now had some experience with visiting nurses on the receiving end.  My concern about having things set too much in such a system is that the nurses wouldn't have the flexibility to add on a patient as needed. The nurses we've used seem to have the ability to set their own schedule and so adapt to come when patients ask for them.  For example, we've requested that nurse come in the morning some days but in the afternoon on others, and she does without having to get some external approval.  We were even able to get add on a visit that wasn't previously scheduled for a Sunday when we needed another component to drain a valve.  The nurse was able to add this visit on, so she should get paid for it (she said weekend rates are higher), and we will be billed for our share via our insurance.
Alison_Diana
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Alison_Diana,
User Rank: Author
11/5/2014 | 2:16:46 PM
Re: Hmm
As I wrote in the article, many places still do use paper systems with patient verification: Patients sign an Excel sheet each time a nurse comes to visit. The problem is, sometimes nurses ask patients to sign for multiple visits at one time, so it looks -- on paper at least -- that a nurse has visited every day that week when, in fact, s/he has only been there a few times. And if a nurse is tending to a patient who can nornally live alone but is mentally challenged and needs a nurse for a physical illness, then they may fall prey to fraud. 

Also, these EVV systems automate the collection of timesheet data into payroll, so from what I gathered from user organizations, the process of tracking nurses' timesheets is streamlined and much, much faster -- and more accurate -- since the back office no longer has to manually input hours from potentially hundreds of nurses. It's also safer for nurses, who are traveling into residential neighborhoods of all kinds. I know my friends who are home health nurses have had a few horror stories about some of their clients' neighborhoods, especially one friend who prefers night duty. While GPS won't save her life, at least her office knows her location at all times that she's working, should the unimaginable happen.
Ariella
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Ariella,
User Rank: Author
11/5/2014 | 1:27:54 PM
Re: Hmm
I know that we like technological solutions, but wouldn't it be simpler to have the patients verify that they were visited? Or is this to be used for patients who are so out of it that they can't be relied on for verification?
Alison_Diana
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Alison_Diana,
User Rank: Author
11/5/2014 | 11:44:51 AM
Re: Hmm
That is a terrific point, @Whoopty! It's very easy to blindly and immediately blame a nurse, especially when there's technology "evidence" to support his/her apparent no-show, without even asking for a reason. In no case should GPS be viewed as reason for punishment, any more than it should be used that way in any other industry. But just as we've seen Nannycams often show touching moments between caregivers and their charges, GPS can help reward the (as i said before) very many dedicated women and men who tend to the elderly and sick while weeding out the handful who neglect, steal from, or abuse them.

Living in Florida -- where I have several good friends who are home-health nurses -- we hear a lot about both great and awful cases of elder care, in both residential and institutional homes. I know if one of my loved ones needed tending to by a team of people and they wouldn't be okay if one of those folk didn't show up, I'd feel better knowing there was something -- human or technological -- monitoring attendance. Whether for a valid or invalid reason (car accident vs. goof-off), if that nurse was a no-show, at least then the caregiver organization could soon send a replacement. And in the case of fraud, taxgivers just can't afford to keep paying thieves for services and goods they're not providing or aren't needing. It's unfair to those, like your wife, who ARE providng these invaluable services and then find cuts across their industry. 
Whoopty
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Whoopty,
User Rank: Ninja
11/5/2014 | 11:31:01 AM
Hmm
I'm a little wary of so much onus being put on nurses for late or missed calls. In my experience (wife was a carer for 10 months) it was regularly the fault of the caring organisation. She would often be given calls that coincided with others, with no time allowance for travel time in between. 

If GPS is indeed added to a nurse's mandatory carry list, I would like to see a pledge for their employers that they will give them a realistic schedule and not blame them for being late while giving them impossible tto complete timetables. 
Alison_Diana
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Alison_Diana,
User Rank: Author
11/5/2014 | 9:43:11 AM
Love This Tech
I heard about this technology before my family's medical emergency made users of a visiting nurse. In all the emotional upheaval, I never asked Gayle whether she was connected to her service via GPS, although she did receive many calls and texts while at the patient's home -- and we all know your service provider can track you down that way! In our patient's case, there was plenty of family to follow up, if necessary (it wasn't). Sadly, especially in instances of permanently required care, there are no loved ones or friendly neighbors to make sure nurses show up on time, that meds are taken/not stolen/needed, and that patients do their necessary exercises. To be sure, the vast majority of home nurses are wonderful, dedicated people. But sadly, there are some who view lack of supervision as a license to cheat or steal.

By going a step further and integrating EVV into payroll, these solutions remove another expense and time-consuming task from cash-strapped home-health providers.
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