Managing Compliance in Healthcare


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Presentation from California Homecare Association 2013 Annual event. Technology brings additional resources to the fingertips of nurses and homecare professionals at the frontline to support their clinical decision-making and contribute to improved client outcomes. With day to day changing patient needs, there is increasing evidence that technology and applications will transform the industry and facilitate faster and better communications, prevent fraud, and proactively manage compliance requirements.

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Managing Compliance in Healthcare

  1. 1. Managing ComplianceRequirements while Pro-ActivelyLeveraging TechnologyMichael K. WonsPresident & CEOCellTrak Technologies, Inc.
  2. 2. Speaker BioMichael K. Wons is an experienced senior executive who is leading allaspects of CellTrak’s strategy and execution of its business plan. Withmore than 30 years of experience with leading healthcare andadvanced technology companies Mr. Wons brings a unique “customerfocused technology” perspective to lead CellTrak. Mr. Wons is theChairman of the Board at CellTrak and actively serves andparticipates in the National Association of Homecare and Hospice(NAHC), Canadian Homecare and Hospice Association (CHCA) and theNational Hospice and Palliative Care Organization (NHPCO) and theWireless Life Sciences Association (WLSA). Mr. Wons also serves inadvisory board roles for HealthCare and Capital Council (HCap), theElectronic Visit Verification (EVV) work group and the Service OrientedArchitecture Consortium (SOA-C). Mr. Wons is a noted industryvisionary who regularly speaks at events on behalf of the industry, isan author of over 25 published white papers and technical journalsfocused on security, privacy and industry platforms and is co-authorof the Complete IT Framework for Success Book.Michael K. WonsPresident & CEOCellTrak Technologies
  3. 3. Why are we here?Technology brings additional resources to the fingertipsof nurses and homecare professionals at the frontlineto support their clinical decision-making and contributeto improved client outcomes. With day to day changingpatient needs, there is increasing evidence thattechnology and applications will transform the industryand facilitate faster and better communications,prevent fraud, and proactively manage compliancerequirements.
  4. 4. Compliance Super Heroes• Can any agency become a Super Hero when it comes tocompliance?• Do you need radioactive strength to be proactively ready foran audit?Answer:All you need is to learnfrom our 3 objectives…An industry super hero empowering agencies.
  5. 5. Objectives• Understand how technology can assist in pro-activelymanaging compliance and risk• Understanding strategies required to manage compliancethrough indicators to ensure a successful compliant audit• Learn how an agency is embracing technology now and whatother added benefits they found
  6. 6. Macro Industry Trends• Healthcare costs are increasing faster than the GDP• Who owns the patient is still the battle• Move away from fee-for-service to more focus on integrated care• There will be fewer homecare companies in the future as the providerscontinue to consolidate…same expected for software vendors• The home is the center…it is where people want to be and where theywant to stay…technology and improved care models will improve results• Insurance companies are buying homecare providers• Government(s) are focused on reducing reimbursements• Healthcare moving from “population” to “individual”• Explosion in homecare staff• Technology Leaders are emerging…
  7. 7. Self Service
  8. 8. Educated Patients
  9. 9. • Mobile technology is now, and will continue to become morerelevant in every day activities in the healthcare continuum.• Information explosion has occurred and will continue• “Source of Truth” is limiting factor to Success• Providers looking for ways to become more efficient andeffective• Compliance, Efficiency, Productivity & Safety via a MobileDevice is a reality• Care convergence is occurring in the home; homecare,telehomecare and medical home Social Networks willImprove Healthcare• “Care anywhere” is what people want…Technology in Healthcare
  10. 10. 99% of non-compliantvisits can be avoided5% of all homecare visitsare not in complianceFraud mitigation canimprove accountability10% of all healthcaretransactions arefraudulentIndustry Challenges
  11. 11. Fraud and Compliance ChallengesProcessCare DeliveryStaffManagementReimbursementInformationHIPAAComplianceInteroperabilityEMR and HIETechnologyPHIBYODPrivacy andSecurity
  12. 12. Compliance Challenge
  13. 13. A Pill that Treats-n-Tells• Pill is swallowed.• When pill gets wet it triggers acircuit between coatings ofcopper and magnesiumgenerating a tiny electric voltagefor a few minutes.• Skin patch records the digitalmessage along with patientsheart rate, body angle andactivity and sends the data to ablue-tooth enabled device.• Data is available for viewing bypatients, caregivers andphysicians.• Users can set alarms to remindthem to take medicines or issuean alert if a patient is inactive fora period of time.Proteus Digital Health Solution
  14. 14. State of the Industry• Fraud and abuse costs payers and taxpayers billions of dollarsannually.• The benefits of home-based care delivery are extreme, fromboth a cost savings and a patient results perspectives.• Fraud mitigation can significantly improve accountability toassure that services are being delivered to care recipientswhen and where providers claim they are.• Fraud mitigation can set the foundation for improvedoutcomes across the healthcare continuum.
  15. 15. • More Responsibility with Less Resources• Improve Compliance• Increase Productivity• Improve Communications and Provide Field StaffSafety• Reduced Operating Expenses (Proven ROI)Healthcare Delivery Challenges
  16. 16. Typical Challenges in Homecare• Bloated Mileage and Travel Costs• High Scheduling Overhead• High Payroll Overhead• Backend Billing Adjustments• Missed Visits• Late Visits• No Visit Verification
  17. 17. Technology to ManageCompliance ChallengesTelephony based solutionsCell phones or mobile devicesemploying GPS technologyTablet based digital signaturecapture devicesBiometric recognitiontechnologiesElectronic random numbermatch devices
  18. 18. Connectivity is the “Key” tothe Future of Healthcare2. This will likely include greaterconnectivity and collaborationamong providers, payers and otherhealthcare participants.3. More expansive use of socialnetworking, and improvements inhome-based services and healthmonitoring using mobile technologyare expected…1. With the rapid evolution of technology, healthcareproviders will continue to look to software and devices toconnect to patients, families and other providers.
  19. 19. Healthcare is changing
  20. 20. HomecareTele-HomeCareMedicalHomeCareTeam• Currently 18 million patientsand more than 500 millionpatient visits each year• Total Field Staff of 5.2 million(including long term care)• Home Healthcare providersdrove more than 5 billion milesin 2012• By 2014, 50% growth amongemployees is expected• The Technology Needs areevolvingCare Convergence in the Home
  21. 21. Compliance Solutions RequirementsProcess• Electronically record the exact date services are delivered• Electronically record the exact time the services begin andexact time the services end• Electronically verify the location from which the services areprovided• Electronically verify the services provided via patient specificcare plan• Include a mechanism to verify whether their employees arepresent at the location and time where services are to beprovided for recipient• Require a personal identification number unique to eachcaregiver and, if appropriate, a unique password establishedby said caregiver• The system must be HIPAA compliant;• The system must insure daily back-up of all data collected
  22. 22. Compliance Solutions RequirementsInformation• Information includes photo, video, and voice in addition toelectronic text based information• Published policies for use of patient information• Continuous HIPAA education• HITech policy alignment• Separation of duties• 256 Bit encryption• Secured pipes• Intrusion detection• Breach management policies• SAS 70 Type II data center certification for cloud services• Preparation for personal health records
  23. 23. Compliance Solutions RequirementsTechnology• Published information policies• Independent security review of processing and hostingenvironments• 256 Bit encryption of information• Virus / Intrusion detection and mitigation tools• Bring your own device (BYOD)• Usage policy• Mobile device management solution• Remote wiping of device• Loss / Leave policy• Separation of duties
  24. 24. Additional Agency benefits ofCompliance Solutions• Electronic documentation tools enforce required informationand provide feedback ensuring the record is complete.• Accuracy of the information is increased reducing the amountof rejected submissions due to incorrect information.• Reduced Travel time and Mileage Reimbursement• Reduced Missed and Late Visits• Streamlined communication• Document and sign at the point of care• Quicken reimbursement by payor network• See where your care staff is• Quicker Referral Servicing and Increased Census• Paperless Timesheets24
  25. 25. Faculty Contact InfoMichael K. WonsPresident & CEOCellTrak Technologies, Inc.1051 Perimeter Drive, Suite 950Schaumburg, IL