Voices: Nick Knowlton, Vice President of Strategic Initiatives, ResMed

This article is sponsored by MatrixCare. In this
interview, Home Health Care News sits down with ResMed Vice President of
Strategic Initiatives Nick Knowlton to learn why one of his driving mottos is
“Do right,” how interoperability is helping home health operators provide
better patient care during COVID-19 and how the pandemic has changed the
industry’s need for interoperability. [Disclosure: Knowlton is also the board
chairman of CommonWell Health Alliance.]

HHCN: You’ve had a deep and varied career. What are the most important lessons you’ve carried to MatrixCare, and what do you do here?

Knowlton: I’ve been with the Brightree and MatrixCare team for almost six years now, and I lead a lot of our strategic partnerships, and a great deal of our interoperability strategy as well. The most important lesson I’ve carried to this position is always do the right thing for your customers. We really believe that interoperability done right is a key to home health agencies and other post-acute providers being successful in a rapidly changing health care world.

A former CEO I worked for had a rule for working at the company: “Do right.” If you do the right thing for your customers and for their patients, you’ll be able to figure everything else out.

second lesson I carry is a little more technical: If you want to do
interoperability right, you do things that empower your clinicians and not
distract them. The idea of going the extra mile and building good interop
workflows into the product in a fashion that clinicians want to engage in and
use is absolutely critical. If you don’t do that, you lose them before you even
launch the product or service.

MatrixCare is heavily investing in
enabling clients to connect better with their referral sources. It’s not just
the initial care transition. How do you get actionable insight on your

As the interoperability world evolves, we are going to get a lot more granular about what a proper initial care transition into home health looks like. Today, you see everything from an e-fax that just has a patient’s name and what they are supposed to be treated for, to a full-blown electronic chart with loads of discrete data that can be digested to help empower clinicians to more easily take care of patients.

when you think about the power that you can unlock with these interoperability
modalities, the content is not just a PDF. The content and the standards that
we try to push for are based on the concept that a human should be able to read
it, but a machine should also be able to read it. We want to make sure that we
don’t degrade the content that we’re transporting. By doing this the right way
out of the gate, we can establish links with the patient identity in the
referral source system to enable better follow on interoperability.

in the home health world, this is becoming increasingly important. I think
everybody’s aware of the reimbursement impacts of PDGM (Patient-Driven
Groupings Model). But I think that the two key things for why interop is more
important now would be the compression of the revenue cycle into a much shorter
timeframe than pre-PDGM, and also the direct tie between reimbursement and
having a full history of the patient including all of their disease states and

Do those referral sources
typically know everything that a home health agency needs to know about a

Typically they don’t. There certainly are some
patients in the home health realm who have relatively simple care histories and
simple needs, but let’s be honest: Our industry also sees patients who have the
most complex disease states, the most number of diagnostic codes associated
with them, and also high levels of comorbidities for those disease states.

The practical implications are that a patient might
have been discharged from a hospital for a rehabilitation purpose but they are
increasingly being seen in other care settings. The referral source may not
know that the patient also has other chronic disease states associated with them,
and they may not know the full complexity of that patient’s care history.

Once you have the initial referral
and actionable insights on patients, how do you cast a wider net to learn more?

When we think about how to accomplish the ultimate
interoperability mission for our customers and for their patients, it’s more
than just that initial referral. Because these patients are often seen by
multiple specialists and have multiple comorbidities and disease states
associated with them, it’s important for us to reach out to others who have
seen that patient and try to find their complete care history. That way, our
providers can have a 360-degree view of the patient before they treat them.

We have been pioneering a lot of work through
CommonWell Health Alliance and also connecting with Carequality and connecting
with Surescripts medication history network to really flesh out what else might
be going on with a patient. Some of these things could be identifying recent
encounters with specialists and grabbing the patient’s chart from that
location, or reaching out to Surescripts to find out what other medications
have been filled on behalf of the patient. But the idea is to cast as wide of a
net as possible, so that during that initial encounter with the patient, the
clinicians run into as few surprises as possible.

A good example of this would be what we commonly
refer to as “The Shoebox Problem,” where a clinician shows up at the patient’s
house and there’s a shoebox full of medications waiting for them, and they
don’t know what is the current and best active med list for that patient. They
waste a lot of time and energy calling the provider who prescribed it or
working with their home office to find out what amongst that shoebox is still
supposed to be there and what might be missing from it.

We know that by enabling better interoperability
from the referral source and by casting a wider net for these providers, we’re
going to minimize the amount of work a clinician has to do chasing down the
patient care history, and they will arrive much more comfortable knowing that
they’re going to have a much more complete and accurate picture of what they
will encounter with the patient. It makes them a lot more efficient, and
enables them to spend more time on other tasks such as communicating with the
patient’s family members about what’s going on and what the next steps would

How are referral sources thinking
about interoperability and reacting to these capabilities?

We started pondering this question a couple of years
ago. We felt that we had really good, anecdotal stories from customers and
other care providers, but we conducted a survey in concert with Porter Research
to find out exactly where referral source pain points were and how they felt
about interoperability and its impact with post-acute care providers.

The results, which we released last year, were
actually quite astounding.

Sixty percent of referral sources who refer patients
into home health and other post-acute care environments indicated that they
would be willing to switch their post-acute care partners if they were able to
interoperate with them effectively. Being able to automate a referral to the
post-acute care provider was listed as the number one thing they wanted to

The pain points they’d like to avoid are some of
those phone calls back and forth. Like when we discussed “the shoebox problem”
— just as much as the clinicians in home health don’t like having to make all
those phone calls, the referral sources don’t like answering them because they
know that those medication lists exist within their system and they know they
have the capability to transport to other care domains. Home health should not
be any different.

What else are referral sources
asking for?

Insight into the patient care journey. We knew this
anecdotally and it was brought out in our research study as well. Referral
sources have referred to this as the black hole phenomenon. They refer a
patient to home health and they have no idea how that patient’s care

In a value-based reimbursement world where providers
are increasingly asked to take financial responsibility for the care
progression of their patients, not being able to have insight into how those
patients are progressing is unacceptable. We’ve seen numerous proof points that
the ability to provide on-demand insight into what’s happening with those
patients is of tremendous value to not just the referral source, but hence
their relationship with their post-acute care network.

How has the COVID-19 pandemic
changed the need for and value of interoperability?

COVID-19 has been amplifying the trends that have
been emerging for the past few years. As not just the staff of a home health
agency, but also the referring physicians and their staff have been driven to
remote workforce situations, interoperability has become increasingly
important, and in some cases almost impossible to do without. If you don’t know
how to get ahold of a referral source to track down additional information over
the phone, or if nobody’s monitoring a fax line, doing it from an EHR system to
another EHR system is a great way to circumvent that obstacle because these
system by and large are always on now.

What do you see growing out of
this increased interoperability?

Number one, there will be a much expanded use of
remote patient monitoring and telemedicine technologies. The genie is not going
to go back in the bottle. The other issue that might be a little less clear to
a lot of folks is as soon as providers start adopting interoperability
technologies, they really see the power of it and they really believe that it
is real and that it needs to be further unlocked.

What we see all the time now is providers who were
skeptical, and moved forward with some basic interoperability modalities, and
have now become champions for using the technology. Frankly, they have become
the biggest proponents of asking for more.

So there is a snowball effect for the adoption of
interoperability in the industry. And I think COVID-19 has led to the
recognition of the power and the value of multiple technologies from
interoperability to remote patient monitoring to telehealth.

Editor’s note: This interview has been edited for length
and clarity.

MatrixCare, provides
innovative software-as-a-service solutions for home health, hospice, palliative
care and private duty providers. To learn more about how MatrixCare can help
your organization,
visit MatrixCare.com.

The Voices Series is a sponsored content program featuring
leading executives discussing trends, topics and more shaping their industry in
a question-and-answer format. For more information on Voices, please contact
[email protected]

The post Voices: Nick Knowlton, Vice President of Strategic Initiatives, ResMed appeared first on Home Health Care News.

Coronavirus Daily Update: Senior Housing Occupancy Drops to Record Low; 1.3M Workers File for Unemployment

During this critical time, Home Health Care News remains committed to bringing you all the essential news related to home-based care operations. At the same time, we also recognize the seriousness of the COVID-19 pandemic. In addition to our regular content, we’ll continue to highlight industry-related developments and mitigation strategies in this rolling bulletin.

What you need to know from Thursday (July 9):

— Another 1.3 million people filed first-time claims for unemployment insurance last week, the U.S. Department of Labor reported Thursday. In total, about 50 million Americans have made initial jobless benefits claims in the past 16 weeks.

— As coronavirus cases surge, a growing number of Houston-area residents are dying at home, according to an NBC News and ProPublica review of Houston Fire Department data. In other Texas-related news, Gov. Greg Abbott announced Thursday that he was ordering an expansion of elective surgery suspensions in his state.

— Senior housing occupancy fell 2.8 percentage points in the second quarter of 2020 from 87.7% to 84.9%, according to new data from the National Investment Center for Seniors Housing & Care (NIC). The drop is the largest quarterly decline since data reporting began 14 years ago, making this quarter’s occupancy rate the lowest on record.

CMS announced that the Review Choice Demonstration (RCD) would be renewed for participating states beginning in August. “I’m not sure their timing could be any worse,” Linda Murphy, the founder and COO of Concierge Home Care in Florida, told HHCN.

— Another health system is opting to leverage external home health agencies for in-home care instead of its internal divisions. University of Kansas Health System’s St. Francis Campus announced it is moving patients from its care to the care of home health agencies or Midland Care Connection Inc., WIBW reports. Hospitals and health systems outsourcing their home health operations has been a growing trend dating back to last spring.

— As a reminder, HHS has delayed quarterly reports associated with CARES Act relief funding and the Paycheck Protection Program (PPP). Quarterly reports were initially due July 10.

What you need to know from Wednesday (July 8):

— The Trump administration has officially notified the United Nations of its withdrawal from the World Health Organization (WHO), although the pullout won’t take effect until next year, according to the Associated Press.

— Overall, Congress has appropriated $2.6 trillion in funding to help the nation recover from COVID-19 and its impact on the U.S. economy. A new report from the Government Accountability Office (GAO) analyzed how the funding has been distributed thus far. As of May 31, the government has distributed $1.2 trillion in relief to individuals, businesses, health care providers and governments agencies. Only a fraction of that amount has gone to home health and home care agencies.

— Occupancy at U.S. skilled nursing facilities (SNFs) slid to 78.9% during the first peak of the COVID-19 pandemic in April, according to recent data from the National Investment Center for Seniors Housing & Care (NIC). That figure compares to 84.4% occupancy in April 2019. The occupancy dip may continue for the foreseeable future, especially as home health care providers ramp up their SNF-to-home diversion efforts.

— An estimated 5.8 million Americans 65 and older are living with Alzheimer’s dementia in 2020. By 2050, that number is projected to grow to upwards of 13.8 million people. As COVID-19 spreads across the globe, Alzheimer’s research is being delayed or suspended, with some of the most promising studies being forced to a complete halt, according to the American Neurological Association.

— As coronavirus cases surge, hospitals, nursing homes and other health care providers continue to face a dire shortage of respirator masks, isolation gowns and disposable gloves, reports The New York Times.

What you need to know from Tuesday (July 7):

— Small businesses have another month to apply for loans under the Paycheck Protection Program (PPP). President Donald Trump extended the program deadline to August 8 over the weekend. There is still about $130 billion left in PPP funding available.

— The Small Business Administration (SBA) and the Treasury Department released a list of more than 650,000 PPP loan recipients on Monday. However, the list was not exhaustive: It only included companies that received more than $150,000, accounting for less than 15% of all loan recipients. Among those included were Kanye West’s clothing and sneaker brand Yeezy, Ice Cube’s professional basketball league and a number of large fast food franchisees.

— While the SBA didn’t name all 5 million companies and organizations that have received PPP loans thus far, it did break down loan recipients by the numbers. Turns out, health care and social services businesses have been the top recipients so far, accounting for about 12.9% of the $591 billion in loans paid out.

— April — when the coronavirus was at its peak — was a banner month for telehealth usage. Telehealth claim lines increase 8,336% nationally from April 2019 to April 2020, according to FAIR Health’s Monthly Telehealth Regional Tracker. A claim line is an individual service listed on an insurance claim. The increase came after telehealth claim lines increased 4,347% from March 2019 to March 2020.

— Nursing homes workers were largely to blame for widespread facility outbreaks in New York, the state health department claimed in a report released Monday. The health department claimed facility staff — rather than residents — played the biggest role in spreading the virus throughout nursing homes.

What you need to know from Monday (July 6):

— The Trump Administration and CMS are taking additional steps to support access to home dialysis treatment, including newly proposed changes to the Medicare End-Stage Renal Disease (ESRD) Prospective Payment System (PPS). The proposed changes build on President Donlad Trump’s previous Advancing American Kidney Health executive order. Specifically, CMS is proposing that certain new and innovative equipment and supplies used for dialysis treatment of patients with ESRD in the home would qualify for an additional Medicare payment. Currently, more than 85% of Medicare fee-for-service beneficiaries with ESRD travel to a facility to receive their dialysis at least three times per week.

— Lawmakers in Colorado have approved a bill that will permanently expand telehealth coverage and access in the state, according to mHealthIntelligence. The bill requires the state Medicaid program to pay for telehealth services at rural health clinics, federally qualified health centers and the federal Indian Health Service at the same rate as in-person treatment. The bill also expands coverage to include home health and hospice care, among other services. The bill additionally allows home health care providers to supervise their own telehealth services.

— Due to the coronavirus, essentially all in-person outpatient visits were canceled in many parts of the U.S. between February and May. As a result of those cancellations, primary care practices are estimated to lose $67,774 in gross revenue per full time physician in calendar year 2020. The financial impact of COVID-19 on primary care practices is being highlighted in an upcoming Health Affairs piece.

— Despite the appearance of a new coronavirus wave sweeping the nation, infectious disease expert Dr. Anthony Fauci warned on Monday that the U.S. was still “knee-deep in the first wave.” Fauci’s remarks came in a conversation with Dr. Francis Collins, the director of the National Institutes of Health. A replay of that conversation is available here.

For daily updates from the week of June 29, click here.

For daily updates from the week of June 22, click here.

For daily updates from the week of June 15, click here.

For daily updates from the week of June 8, click here.

For daily updates from the week of June 1, click here.

For daily updates from the week of May 26, click here.

For daily updates from the week of May 18, click here.

For daily updates from the week of May 11, click here.

For daily updates from the week of May 4, click here.

For daily updates from the week of April 27, click here.

For daily updates from the week of April 20, click here.

For daily updates from the week of April 13, click here.

For daily updates from the week of April 6, click here.

For daily updates from the week of March 30, click here.

For daily updates from the week of March 23, click here.

For daily updates from the week of March 16, click here.

HHCN encourages you to reach out to us individually or at [email protected] for story ideas, tips or general feedback.

The post Coronavirus Daily Update: Senior Housing Occupancy Drops to Record Low; 1.3M Workers File for Unemployment appeared first on Home Health Care News.