Lifelong Learning and Leadership

As the holidays come about in the late fall of 2019, I have come to know a most remarkable lady.

She celebrated her 100^th birthday in October.

Her name is Loretta Meyers.

She is a Chicagoland native, a retired businesswoman, a wife, now a widow, a mother, grandmother and great grandmother, and is a successful teacher. And, simply put, a leader in her own right.  Loretta gets around with the use of a wheelchair and a walker. She resides in a wonderful, cozy retirement center in Wilmette, IL. Our agency, BRC Access Care, is privileged to provide loving caregivers for Mrs. Meyers during each week. (Thanks to Bel and Helen).

As a token of our love and admiration for her, I was fortunate to go see her on Sunday afternoon along with a couple of kind teenagers who have dubbed their visitation ministry “Cardinal Cares”, using the metaphor of the cardinal as a symbol of God’s attendance and care for us just when we need it.

Pictured with Loretta is the sponsor of Cardinal Cares, Kym Malkin, and her daughter Mimi and friend Daisy. Also pictured, behind Mrs. Meyers, is our loving caregiver, Helen, holding the poinsettia we brought to Loretta.

While we were visiting Loretta, we happened upon a Christmas caroling program that she was attending. While visiting with her after the program, we encountered a few of her friends who are also residing at the center. One of them was Mr. Richard Baer, another of our wonderful clients who resides at the center. He is 90+ years young. Mr. Baer is an avid reader and is an enthusiastic and kind man. He loved the attention of the teens who shared their ministry of presence.

Mr. Baer with Mimi and Daisy and “the cardinal”

Mr. Baer told us an interesting tidbit about Loretta Meyers. For the past several months, beginning this past year, she has begun a program at the Center called “The Great Courses”.

[https://www.thegreatcourses.com/]

 It is a gathering of course materials from several excellent sources, such as universities, National Geographic and others. Beginning in 2019, Loretta began offering this course material at the Center where they reside. Initially, they had 20 or so of Loretta’s friends in attendance. As the months went by, and the courses were offered, the numbers for this lifelong learning course increased, to where, nowadays, they have had to move the gathering to a larger space, since the gathering is garnering over 50 in attendance.

It occurred to me that Mrs. Meyers is a wonderful example for us all.

At age 100, she is initiating and offering a lifelong learning experience for her cohort there at the Center, encouraging others to join her as a lifelong learner.

Again, what a marvelous example for us all.

I admire Loretta Meyers so much that I just had to share this story about her.

What a great lady and outstanding leader she is!

A leadership vignette

Vignettes of Leadership  

"Anyone can be a critic. What takes guts is to see the best in people." -Robin Sharma 

There is great value in seeing people through the lens of humanity.  Seeing our colleagues as people who are doing their best keeps us from falling into the trap of viewing people through a lens of judgment.  Sitting in judgment of our team members causes frustration, disappointment and resentment.  Truly effective leaders desire to lead from a perspective of calm.  Keeping in mind that we do not lead "team members," "employees," or "staff," but rather human beings, helps us to stay grounded in our own humanity. 

As humans we put down roots and grow in the desire to be all about people -

 "It's all about helping people."   

We must be careful not to see our colleagues as a means to an end, but rather as people who need to know we are human, too!  Great leaders take the time to stop and interact on a human level with the people they lead. 

THIS IS SERVANT LEADERSHIP

These exceptional leaders take time for others and go the extra mile for them.  Seeing the best in our colleagues does not excuse them from being accountable or give them a free pass when they are not performing up to par. 

Consequences naturally flow from our actions, but having a positive perspective toward our colleagues and their performance engenders positive work ethic.  

Taking the time to learn how our people feel gives us the ability to understand their thinking and to get inside their perspectives.  There are few things more important in affecting our leadership ability or producing bigger dividends than knowing our people and seeing what is best in them. This perspective enables the full potential of the individuals on our team.  

Every one of our colleagues is different, with their own skill levels, experiences, values, backgrounds, influences and beliefs.  

It is our duty, as leaders to identify and appreciate the best in each one of our people and put that best to full use for the benefit of our team as a whole, each individual who is a part of our team, and the many patients, families and communities we are privileged to serve.

"When we seek to discover the best in others, we somehow bring out the best in ourselves."

                                                                               ——-William Arthur Ward

‘Borrowed’ from a thought leader in the healthcare industry...Keith Myers of LHC Group.

Delivery System Reform: The Time Has Come

from HealthAffairs.com/4/23/2017---

The below summary(in Helvetica font) of the healthcare system's endemic problems is indicative of both what is happening in the sphere of home based care, and what is most attractive about home based care: Lower cost healthcare service delivery.

"Delivery System Reform In Context
There is widespread agreement that the provision of health services in the United States suffers from high levels of waste and inefficiency. A 2012 report from the Institute of Medicine (IOM) estimated that about 30 percent of health spending was wasted on unnecessary services, excessive administrative costs, fraud, and other problems. Although the IOM stated that the US health system has become too complex and costly to continue business as usual, we are far from resolving these problems.

Despite numerous initiatives undertaken by providers and health care organizations to improve care coordination, the degree of fragmentation is striking. Redundancy and excessive use of services is common, as is lack of communication and data sharing among providers. In too many instances, the result is poor quality and high-cost care.

The goal of improved efficiency in health care should be a central feature of any reform effort. The key is to set in motion changes that lead to continuous improvement in the productivity of the care delivery process, which could slow the pace of rising costs without diminishing the quality of care.

While the goal of better and more efficient care is widely shared among those advocating various approaches to health reform, there is far less agreement about the federal government’s role in that effort. The approach taken by the ACA and MACRA assumes that the federal government has the know-how and administrative capacity to set the terms for what would constitute higher-value care—and, in the process, redesign the way providers care for patients. Indeed, the federal government’s role in delivery system reform—and health care in general—is central to the disagreement about the ACA: Proponents of the ACA are relatively confident in the federal government’s ability to lead a delivery system reform effort, while opponents believe more room should be made for private initiative."**

SS: No matter of the reform efforts emanate from the private sector or the government sector, it is a foregone conclusion that Home Based Care(Home Health/Medicare and Medicaid, Personal Assistance Services, and Hospice) is not only the low cost provider in the healthcare continuum, but also is preferred by the patient. 

It is the time to reiterate and reinforce the overwhelming value of Healthcare in the Home.

**The Future Of Delivery System Reform. by Joseph Antos and James Capretta, April 20, 2017

Rachel Hammon: Texas own "warrior maiden"!

Rachel Hammon: Texas’ own “Warrior Maiden” 

-- by Sam Smith*

I confess, I am a binge watcher of videos/movies/TV programs on Netflix and Amazon.

One of my favorite series is Vikings, on the History Channel. It is the story of Ragnar Lothbruk, the legendary Viking leader in the 7th century. The medieval Vikings had a role within their culture they call the Warrior Maiden--it is a woman who takes up the battle ax, spear and shield and fights battles along with the Vikings’ marauding male warriors. Ragnar’s wife, Raghida, is a character in the series who is an example of a warrior maiden.

Her role on Vikings reminds me of Rachel Hammon, a woman who absolutely fulfills the role of the ‘Warrior Maiden’. She is valiant and stands up to our home care ‘opponents’ in the Texas legislature and in Washington, DC. She is an independent voice when negotiating and collaborating with NAHC, VNAA, The Partnership and The Alliance.

At Axxess, we are very proud of the work she does for our industry. She is truly a courageous leader.

She has, for five years now, been the Executive Director of the Texas Association for Home Care and Hospice. She came to her present position with big shoes to fill. Anita Bradberry was her predecessor and literally set the standard for the sustained professional association operations at the Texas Association for Home Care and Hospice. Rachel, a Masters degreed Nurse, and a University of Texas alumnus with home health experience, served the association as the legislative and regulatory director for 15 years. All these years were spent as an apprentice, as it were, under Anita Bradberry, who is a wonderful role model. Anita surely was a fabulous mentor with whom to have worked.

Anita is surely very proud of how well Rachel has performed in her role. I know I am.

Now, for the past 5 years, Rachel has become a force to be reckoned with, in Austin, and in Washington, DC. As a registered lobbyist and well known Healthcare at Home advocate in Congress, and CMS, she leads not only TAHCH but also the Council of State Associations with her independent and courageous voice in Washington, and is an active advocate for the home care industry in the halls of state in Austin.

We are so pleased and privileged to have our very own ‘warrior maiden’, Rachel, leading our efforts to make sure our collective voice is strong and consistent in the halls of state.  She is a tireless patient advocate and a true champion for all of us in our industry. Rachel consistently and powerfully shares her thoughts and impressions of regulators and other association leaders within our healthcare at home industry in a very dynamic environment.

Now --let’s just say, go get ‘em, Rachel...let ‘em have it about PreClaim Review, and thanks for applying yourself with focused energy as our very own ‘warrior’ in Austin and Washington, doing your very important job with excellence as the Executive Director of the Texas Association for Home Care and Hospice.

*Sam Smith is the Senior Vice President of Business Development for Axxess. Axxess is a technology company that provides software, services and solutions that empower healthcare organizations to deliver the best quality care to patients in their homes.

Update on Reducing Hospital Readmissions- by Elizabeth Hogue

Wisdom from an expert in the field---Elizabeth Hogue, Esq.-noted legal expert in Home Care

Most hospitals nationwide face substantial penalties from the Medicare Program because discharged patients are readmitted within thirty days of discharge.  Hospitals subject to penalties for readmissions are actively seeking assistance to reduce or eliminate penalties that may be as high as 3% because they amount to millions of dollars in lost revenue.  Post-acute providers of all types, including home health agencies, private duty agencies, hospices and home medical equipment (HME) suppliers, and assisted living facilities (ALFs) are ideal partners for hospitals in their quest to avoid penalties for readmissions.  Now is the time for providers and discharge planners/case managers at hospitals to collaborate to reduce these rates through the use of Preferred Provider Agreements and/or Care Transitions Agreements. 

A good starting point for providers and discharge planners/case managers to negotiate such Agreements is to identify the penalties incurred by the hospitals.  Although hospitals likely already know this information, home care providers can find it on the website of the Centers for Medicare and Medicaid Services (CMS) at www.cms.gov in preparation for discussions with hospitals. 

The next step is to identify those patients discharged from hospitals who are at high risk for readmissions.  A new study entitled “Patient Characteristics and Differences in Hospital Readmission Rates” that appeared in the Journal of the American Medical Association (JAMA)  Internal Medicine by Michael L. Barnett, John Hsu and J. Michael McWilliams on September 14, 2015, seems to be helpful. 

The purpose of the study was to assess the extent to which a comprehensive set of patient characteristics may account for differences in readmission rates to hospitals.  The study included 8,067 admissions to the hospital from 2009 to 2012.  Patients were selected based on survey data from the national Health and Retirement Study (HRS) that was linked for HRS participants enrolled in the Medicare Program.

A total of twenty-nine characteristics of patients were assessed from this data as potential predictors of readmissions to hospitals within thirty days of discharge when added to standard adjustments made by the Medicare Program to hospital readmission rates.  The authors then compared the distribution of the characteristics studied between patients admitted to hospitals with relatively higher or lower readmission rates as reported by Medicare.  Finally, the authors estimated differences in the probability of readmissions between groups of patients before and after adjusting for additional characteristics.  The main outcomes and measures were readmissions for all causes within thirty days of discharge.

Based on the study, researchers concluded that several dozen variables, including the factors listed below, accounted for almost half of the difference in readmission rates between the best and worst performing hospitals:

-          Patients’ level of education

-          Patients’ income

-          Patients’ ability to bathe, dress and feed themselves

This conclusion has led some commentators to suggest that Medicare’s program to reduce readmissions may unfairly penalize hospitals that serve poor patients.  This means that collaboration between providers and hospitals is even more important at hospitals that serve population of poor patients.

The variables described above also make it clear that providers and hospitals should focus on patients’ ability to bathe, dress and feed themselves in order to avoid readmissions.  This is important information for collaboration between hospitals and providers.

Hospitals and home care providers must, of course, also bear in mind that Preferred Provider Agreements and Care Transition Agreements cannot interfere with patients’ right to freedom of choice of providers.  Arrangements between providers and hospitals to provide care transition services must also be structured to avoid the provision of free services to hospitals and patients by providers.

The industry’s efforts to “wrestle this issue to the ground” have just begun, but collaboration between hospital discharge planners/case managers and providers is clearly a key to success.

© 2015 Elizabeth E. Hogue, Esq.  All rights reserved. 

No portion of this material may be reproduced in any form without the advance written permission of the author.

ICD-10 has thrown some of our competitors clients in a tizzy

October 9, 2015: Dallas, TX

Yesterday, I received a phone call/report from a key friend/business ally in Florida who owns a Billing Company, describing how distraught many of his billing clients are due to how their claims are being rejected by CMS since the conversion of the healthcare billing and coding to the October 1st conversion from ICD-9 to ICD-10.
For those who are not involved in Healthcare, ICD-10 refers to the International Classification of Diseases diagnostics codes which specifies which code needs to be used for the patient's diagnostics.The US converted to ICD-10 on Oct. 1, 2015, after it was approved by the World Health Organization in 1992.The rest of the world has been using ICD-10 since the mid 1990's.
( yes, we in the US are laggards, but that is the theme of another day's commentary.)
My work with Axxess has been going on for over 4 years, and I am the so proud of our Engineering Team... now---more than ever.
Our clients are billing and making money, since October 1st, 2nd, 3rd,5th, 6th, 7th, and 8th, and will be able to bill and get funds today and next week. 
Moreover, we have our Axxess DDE Revenue Cycle Management tools assisting our clients, so they can see their remittance flow on a day-to-day, moment to moment basis.

The panic and crying out amongst the clients of competitors is reaching our ears. Reports are coming in form all over the US.
Behold, it is time for harvest.

Our Axxess engineering team nailed the ICD-10 conversion. This underscores this  fact: At Axxess, we are all about helping our clients make money.
These Engineers at Axxess, all located as a team here in the United States, are led by our CIO and Mobile Application Team Lead, and our Core Management Team--every player on these teams each and all are very competent. This IS industry leadership. Not talking about it. Doing it.

Come one come all! Come to Axxess where your software vendor gets it right -- the first time.

Kaiser and JAMA Infographic: Men's healthcare is behind that for women