Member Update - Operational

VNAA Member Update

For the week of 03/07/2005

VNA/Texas CEO Reflects on Devastating Fire 

This past Monday seemed like any other Monday for the patients of VNA of Texas. More than 6,200 Meals on Wheels were delivered that day, and 2,600 homecare, hospice and long term care patients were treated.  However, for VNA CEO Robert Brit Carpenter, that Monday was anything but business-as-usual. Just 24 hours before the first “meals on wheels” hit the streets that morning, the VNA was devastated by a 6 alarm fire, gutting their building and forcing the staff into a makeshift office four blocks away.  With nothing but cell phones in hand, Carpenter and his staff went right to work, determined not to miss a single patient visit.  

In their efforts to rebuild, Carpenter pointed to technology as the key to VNA’s rapid recovery.  Fortuitously, the VNA had recently hired an outside IT firm and had their servers moved to a secure off-site location.  “Simply backing up doesn’t cut it,” says Carpenter. “You’ve got to have [the servers] at another location to fully protect your agency.”  Because the servers were off-site, the VNA’s system was fully operational a mere four hours after the fire. “Going electronic with our patient data proved to be crucial.  The more you use paper, the more information you’ll lose in a disaster.  It was electronic records that allowed us to continue our patient visits.”

Brit also acknowledged the importance of careful insurance planning, thanks to VNA’s General Counsel Tom Ricciardelli.  “Thanks to Tom, we had made meaningful decisions about insurance options – the kind you only realize at times like this.”  When making coverage decisions like replacement value vs. original cost, Brit advises other CEOs to think about the kind of coverage you will want after a fire has claimed everything.  “Don’t be penny-wise and pound-foolish,” he cautions, “and be certain that someone reads the policy fine print.  Know if you need to have every electronic devise listed separately on riders.” Due to careful attention to issues like this, more than $300,000 worth of HomeMed devices will be covered by VNA’s insurance policy.

“We have a crisis plan, but plans don’t even begin to prepare you for something like this,”  Brit ruminated. However, you won’t find this CEO stopping to catch his breath.  He’s already fine-tuning his long term operational plans based upon this weekend’s experiences.  “We are going full bore with electronic records,” Carpenter said after learning that the fire was literally fueled by the VNA's document storage area. “We thought we were already paperless, but we still have over 3,000 boxes of paper to evaluate after they are sanitized, deodorized and cleaned.”

Despite his attention to operations and logistics, when asked to identify the greatest lesson learned, Brit quietly replied, “A VNA is not a building or a location - it’s the dedication of people providing care to their community.”  

And just how did Brit and his staff find the emotional strength to prevail throughout this crisis?  Some simple but powerful words from Brit Carpenter, “The key is to focus on your mission and not on your problems.”

CMS Publishes Changes in Medicare Appeals Process 

CMS has announced that it is publishing new Medicare appeals regulations in the Federal Register on Tuesday March 8th. An advance copy is available on line (see below. Key features include: reduced decision-making timelines, the right to escalate an appeal to the next level if the current level is not decided on time, the use of a new entity “Qualified Independent Contractors (QICs) to reconsider denials by intermediaries and by Quality Improvement Contractors (QIOs), the use of QIC review panels that include medical professionals to reconsider medical necessity issues, and the transfer of Medicare Administrative Law Judges from the Social Secutity Administration to the Department of Health and Human Services.  The rule is final but subject to public comment and will take effect for home health agencies on May 1, 2005.  A Summary of the rule are available at:

The full text of the rule in final draft form (prior to final edits at the Federal Register) is now available at: it is 511 pages, the last hundred or so pages reflect the new rules themselves.)

AARP, VNAA Join Forces at VNAA 23rd Annual Meeting 

During VNAA's upcoming 23rd Annual Meeting, don't miss the chance to learn from AARP and VNAA about a critical new wave in today's healthcare marketplace, Consumer-Directed Health Care.  

The program, offered on Friday, April 29, will be lead by Joanne Handy, President & CEO, VNA of Boston, Bob Wardwell, VP of Regulatory Affairs for VNAA, and Jennie Chin Hansen, a member of the AARP Board of Directors, Class of 2008.

Don't miss this chance to learn about the AARP's concept of Consumer-Directed Care and how it may differ from the provider perspective. Hear how AARP services, programs, and advocacy reflect its views on consumer direction, both now and in the future. VNA of Boston will discuss their consumer direction, and how identify ways that VNAs can prepare and respond to this latest healthcare force.

Ms. Hansen is past director of On-Lok,Inc, a non-profit family of organizations providing comprehensive primary, acute, and long-term care community-based services to nearly 950 frail seniors and 5,000 well seniors throughout San Francisco. On-Lok is the prototype for PACE (Program of All-Inclusive Care for the Elderly). Ms. Hansen began her career in community and public health nursing so comes to this subject from a very strong background in community health.

To register visit

MedPAC Calls for HHMBI Freeze, Hints at Major PPS Reform Proposals 

The Medicare Payment Advisory Commission (MedPAC) last week submitted its March 2005 Medicare Payment Policy report to Congress, which includes a large section on Medicare home health payment policy.  Of graet interest to VNAs is MedPAC’s official recommendation to Congress to “eliminate the update to payment rates for home health care services for calendar year 2006.  

MedPAC cites the following rationale for the recommendation: “We find evidence that access to care for most beneficiaries is good. The numbers of users and episodes have risen, but the amount of service within an episode continues to fall. Quality has risen slightly. There are more certified agencies now than there were one year ago. These factors, along with more-than-adequate margins, suggest that agencies should be able to accommodate cost increases over the coming year without an increase in base payments.”  

If Congress adopts this recommendation, HHAs would not receive the 2.5% cost of living increase (3.3% minus 0.8% as mandated by MMA) scheduled for January 1, 2006. According to MedPAC, “This recommendation decreases federal program spending relative to current law by between $200 million and $600 million in one year and $1 billion and $5 billion over five years.” Congress will probably consider Medicare legislation this year; therefore, the chance that this recommendation would be included in a Medicare bill is high.

In addition, MedPAC finds so many shortcomings with the current Home Health PPS that the report goes as far as to say, “Furthermore, additional research is needed to understand cost variations and the efficacy of the PPS as a whole.  That research could suggest replacing the PPS altogether, rather than making incremental changes to its existing structure.”

Other MedPAC findings:

  • Home health spending is projected to have grown 12.6% in 2005 and is expected to grow at approximately 10% each year for the next five years.
  • The expiration of the Medicare home health rural add-on between April 2003 and April 2004 lowered the margins of rural home health agencies but did not have an impact on beneficiaries’ access to care.
  • Visits per episode continue to drop; in 2003, the average number of visits per episode was 17.3 (a 8.5% decrease from 2001).
  • The number of Medicare-certified home health agencies went from 6,888 in 2002 to 7,530 in 2003.
  • Among Medicare-certified HHAs, 70% of patients are Medicare fee-for-service.  Medicare managed care patients, Medicaid patients, and private pay patients are each roughly 10% of the aggregate patient population.
  • In 2005, the average projected Medicare margin for all HHAs is 12.1%.  The average projected Medicare margin for voluntary HHAs is 9.1% and 14.3% for private HHAs.  The projected rural margin for 2005 is 6.1% (which includes the expiration of the 5% rural add-on on April 1, 2005) and 13.2% for urban HHAs.
  • The largest HHAs decreased their per-episode costs by 6% between 2001 and 2003, while the smallest HHAs’ costs rose by 4% during that time.
  • Additional payment for technology is not needed because “PPS provides an incentive and reward for the adoption of technologies that reduce the number of visits necessary to deliver care.”

The report included information about how the current PPS system is operating, its shortcomings, and suggested changes.  VNAs should review the part of the report that begins, “Should the prospective payment system’s structure change?,” which is found on pages 113-115.  MedPAC will most likely recommend Home Health PPS reforms in its June 2005 report. VNAA has met with MedPAC’s Executive Director Mark Miller to share our PPS data and what reforms are needed to ensure that costs are adequately covered in each of the 80 HHRG case-mix groups.

The full report can be obtained by clicking the link below

New Demo on Home Health and Medical Adult Day Care 

CMS has rolled out information about the implementation of the home health and adult day care demonstration mandated by the MMA of 2004. Under this demonstration a home health agency will offer services both in the normal manner and in a medical adult day care (MADC) setting that it either owns or with which it has a contractual relationship.  

The HHA is then paid 95% of the PPS rate and expects to achieve savings of that much or more through the economies of substituting some visits in the MADC setting of those in persons’ homes. The legislation proposing this demonstration was initiated by a proprietary chain that operates both MADC and home health agencies. It was supported in Congress by the Adult Day Care community. However, CMS is opening the participation in the demonstration to 15,000 patients in 5 demonstration sites.  

Since operating an adult day care program in concert with a home health program can create economies and synergies, this offers an opportunity for VNAs to be on the cutting edge by demonstrating the viability of this kind of arrangement.  There will be an open solicitation announced to solicit proposals from sites to participate in the demonstration. If you are interested, some additional details are available at the links below.

VNA Florida Acquires Jupiter Home Health Services 

JUPITER, Fla. – The Visiting Nurse Association of Florida, Inc. has acquired Jupiter Medical Center’s Home Health and Supportive Care Services in an effort to combine the expertise and high-quality care of both organizations into a single entity.  Beginning Feb. 28, 2005, Jupiter Medical Center’s Home Health and Supportive Care Services will become a part of the VNA.

“This is an exciting time for us because two great home healthcare organizations are coming together,” said Donald R. Crow, chief executive officer of the VNA.  “[We] are excited to bring the VNA’s expertise and innovative practices into this community to serve south Martin County, north Palm Beach County and Wellington.”

With this new acquisition, Jupiter Medical Center’s Home Health Services will now be known as the VNA.  Its Supportive Care Services, including private duty home health aides, companion and nursing services, will be known as Visiting Nurse Services – the sister agency to the VNA.  All employees and patients of Jupiter Home Health and Supportive Services have the opportunity to continue with the VNA and are wholeheartedly welcome.

Established in 1976, the VNA is a non-profit, community-based healthcare agency offering complete home health services. The VNA’s services are available in Martin, St. Lucie, Palm Beach, Okeechobee, Polk, Pinellas, Pasco, Sarasota, Hillsborough, Hernando and Manatee counties. Care is provided to patients regardless of age, sex, race, creed, disease process or ability to pay, as funds will allow. For more information about this VNA, please call (772) 286-1844 or visit the Web site at

VNAA Welcomes Elect Two New National Board Members 

The VNAA welcomes Linda Maurano and Scott Gardner, both recently selected to serve on the VNAA Board of Directors. Linda is President of the homecare division of MedStar Health (Claverton, MD) and Scott, a partner at Hobbins & Gardner law firm (Saco, ME), serves as vice chair of the board of Home Health, a home health provider, and a Trustee on the Board of Maine Health.  

With more than thirty years of home health experience, Ms. Maurano has been involved in all sections of homecare and has served in a leadership role for both a for-profit homecare company, a hospital-based nonprofit, and the voluntary VNA.  As President of the Homecare Division of Medstar Health, Ms. Maurano is involved in a large, 7-hospital, non-profit healthcare system servicing the Maryland, Washington and Northern Virginia area.  Currently, Ms. Maurano is an active member of The Washington Home and Hospice Board, a participant on the VNAA Government and Bioterrorism Committees, and home health lead for the Montgomery County Department of Health and Human Services Bioterrorism Task Force. She is one of the founding board members of the Capital Home Health Association and has served as Chairman. Ms. Maurano has also served on the JCAHO Standards and Survey Procedures Committee and on advisory committees for the District of Columbia Long Term Care Task Forces. Ms. Maurano holds a MS in Community Health Nursing from The Catholic University of America and BS in Nursing from Salve Regina University.

Mr. Gardner’s involvement with home health began in 1994 when he joined the board of the Visiting Nurse Service in Saco. He served two terms as board chair of the VNS, through the traumatic days of IPS and the start of PPS. He was chosen Board Member of the Year by the Maine Homecare Alliance in 2002. Mr. Gardner was part of the team that worked to bring about the merger of the VNS with the Portland homecare agency, Community Health Services last year, and is currently serving as Vice Chair of the merged entity, now called Home Health.  Scott Gardner is originally from Maine and currently lives in Portland with his wife Elizabeth and son, Cecil. Scott graduated from the Maine Maritime Academy in 1982 and sailed as a Deck Officer in the Merchant Marine for three years.  Scott graduated from Tulane Law School in 1988 and returned to Saco, Maine to start his own law practice, Hobbins & Gardner. Scott’s practice is mainly focused on trial work.

VNAA is currently holding elections for two seats on the Board of Directors, to be decided by a vote of VNAA member agency CEOs.  The newly elected positions will be announced at the VNAA Annual Meeting in San Diego from April 27-29.  To learn more about the VNAA Board of Directors, please visit the Board page at

Aspirus VNA Appoints New Executive Director 

Aspirus VNA Home Health and Extended Care, in Wausau Wisconsin, recently appointed Jean Burgener as the Executive Director.

You can contact Jean at Aspirus VNA, 520 N. 32nd Avenue, Wausau, Wisconsin  54401.

DVT Awareness Month Is Here 

Did you know up to 2 million Americans are affected annually by DVT? Increasing public education is an important factor in prevention, diagnosis and timely treatment of this potentially fatal condition.

The Coalition to Prevent Deep-Vein Thrombosis (DVT), comprised of some of the nation's leading organizations in the medical, public health and patient communities, has made great strides to help make DVT a national public health priority. Launched in March 2004, the first annual DVT Awareness Month successfully educated public and healthcare professional about DVT risk factors, signs and symptoms.

This year's awareness campaign promises to be even more effective. If DVT is part of your VNA's wellness programs or you work with local hospitals to provide services for DVT patients, visit the Coalition's web site at and click on Media Center to download a Coalition press kit.

For more information on DVT, visit


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