Silver Award: Signature HealthCARE, of Louisville, KY, for a digital platform th...
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Signature HealthCARE is honored to earn the Silver Award in the McKnight’s Long-Term Care News Excellence in Technology award competition.
The award was earned in the High-Tech, High-Touch category, which honors communities who have implemented a technology that improves team interactions to enhance care of residents and patients. Signature HealthCARE was recognized for their digital platform, CareAscend.
CareAscend helps post-acute and long-term care providers engage with their medical directors to assure full compliance with various regulations. CareAscend is a collaboration between Signature HealthCARE and MavenSphere.
The digital application is the first in the industry to address the important issue of medical director engagement by setting systems for their seamless connection with facility leadership regarding key activities such as quality assurance, staff education, and many other critical tasks. The application provides medical director training resources including on-boarding and ongoing education.
“Engaging post-acute medical directors more, to enhance their partnerships with facility leaders is one area that just has not been addressed before,” Dr. Arif Nazir, Chief Medical Officer of Signature HealthCARE, said. “With CareAscend, we are seeing an improvement in medical directors’ involvement in skilled facilities’ strategic and quality improvement aspects, an approach which is a must for the value-based systems including PDPM.”
Signature HealthCARE is excited to earn an award in the McKnight’s Excellence in Technology Awards for the second year. In 2015, they were honored for their Spirituality pillar in the innovation category.
Silver Award: Signature HealthCARE, of Louisville, KY, for a digital platform that creates ongoing communication between medical directors, skilled nursing facilities and chief medical officers. The CareAscend app drives engagement between medical directors and SNFs and enables two-way communication for maintaining and improving the administrative, clinical and physician collaboration.
High-Tech, High-Touch award winner
I am excited to introduce you to Bharath B. Reddy Bynagari, an entrepreneur and innovator in the health care industry. Bharath has founded four technology companies that serve clients in the health care industry, from physicians to post-acute and long-term care facilities. His most recent company, CareAscend, LLC, focuses on helping medical directors and the facilities they serve to maintain compliance in key areas.
After reading the Compliance Checkup about medical directors several months ago, he contacted me. Since then, we’ve discussed many issues in the health care industry, like how technology will continue to affect the delivery of health care. I want to share with you an interview with Bharath that contains many insights into achieving compliance through technology.
Laura: What is your background and how did you become involved in the health care industry?
Bharath: I am trained in IT. I did my Masters in Computer Science at the University of Texas at Tyler. I wanted to be an entrepreneur for as long as I can remember.
During my last job, I was working as a manager for a product engineering team at a health care data company. My team’s job was to take ideas from our VP of Engineering and run with them to make a product to sell to our customers. I learned how to execute an idea and implement it in real life.
During this time, in 2007, one of my twins got sick in the evening. I talked to the after-hours on-call pediatrician and realized how disjointed the practice of medicine can be despite technological advances. The on-call pediatrician had no idea who my son was and what his medical history was. This incident made me realize that there is huge gap here. I came up with an idea for an app platform that provides on-call doctors with a snapshot of the patient’s history and a way for them to easily document the care provided. I partnered with Community Health Network in Indianapolis and created Diagnotes (www.Diagnotes.com), a secure communication platform for healthcare providers using voice, text, and video.
This is how I started my entrepreneurial career and foray into the health care industry.
Laura: That’s a great beginning to your career! Describe the companies that you’re involved in and what need they fulfill in the industry.
Bharath: After developing Diagnotes, pilot testing it, and implementing it at hospital systems, I became part of a team that developed a brand new care model to help patients with depression, dementia and early onset of Alzheimer's disease. We tested the new care model with 200 patients, and I designed and developed the software for this care model. We then applied for and were awarded a CMS Innovation grant to expand the care model to 2,000 patients.
During this time, I came to know Dr. Arif Nazir at the Indiana University School of Medicine. We became good friends as we both have the itch for innovation. We wanted to work together to solve several problems in health care.
In 2017, in his new job as a Chief Medical Director of a post-acute care facility company, he shared the challenges he faced in the long-term and post-acute care world. We created a prototype of an application to solve certain problems, and then we presented our creation at a meeting with AMDA – The Society for Post-Acute and Long-Term Care Medicine. The CMOs in attendance were very excited about our application platform, known as CareAscend.
CareAscend keeps all parties involved in the financial transactions with medical directors in compliance. Medical directors can add a task and time spent as they work at a nursing home facility and at the end of the month, we can link that time log to the accounts payable department for prompt payments to the medical director.
CareAscend also has free features where you can search for any facility and see the CMS 5-star ratings and quality metrics for that facility.
We have created several dashboards within CareAscend, one for a chief medical officer, one for compliance, and another for administrators. You can easily audit all tasks, time, and payments to medical directors.
In the post-acute and long-term care world, I’ve seen a need for the chief medical officer and medical director to be on same page with the quality of care to be delivered at the facility level, as most of the time a medical director works part-time at a facility. In CareAscend, we have created an Orientation Package for each medical director’s onboarding process. The chief medical officer can create and manage the training he/she wants to provide.
We also added a Facility Evaluation Report feature to CareAscend. The medical director, Director of Nursing or others can assess the facility against the evaluation features customized by the chief medical officer. You can track the facility evaluation over time and manage the facility issues easily.
We partnered with AMDA, and our goal is to bring all membership benefits like CME training and others to the user. After that, our goal is to be able to do a fair market value assessment for the medical director’s compensation.
I am also working on another idea to collect objective patient reported outcomes data during clinical trials through a company called DigiBiomarkers (www.digibiomarkers.com).
Laura: It’s fascinating to hear how those companies started and how you took an idea and turned it into action. What are the most difficult issues that your clients face?
Bharath: Two major issues with care providers in nursing facilities, home care, and palliative care: uniform delivery of high quality care and compliance with regulations:
Laura: I’d say you’ve identified two extremely important issues there. Moving forward, what is your vision for how technology can improve health care delivery and operations?
Bharath: In health care delivery and operations, there are several data points that the provider has to know and apply. Most important of them is the latest research on diseases, treatment plans, and how that knowledge applies to the patient in front of them. On the other side of the equation, there are so many rules and regulations that they ought to know. Our goal with CareAscend is to automate the non-clinical items like compliance, time tracking, orientation, training, CME credits, facility evaluation, etc., to allow physicians and facilities to focus their time and efforts on providing the best care possible to patients.
Laura: What is the most important issue you believe should be addressed by the health care industry now that will affect health care delivery and operations in the future?
Bharath: Care coordination and having the patient and the family at the center, I believe is the key issue that needs to be addressed.
Taking care of a patient holistically, along with the input from the family members and caregivers, is very important. Health systems should and need to realign their care processes and care models such that information flows smoothly between their care teams, the patients, and their families.
Patient goals have to be in the center of all care workflows and accomplishing those goals for the patients has to be the metric of successful care delivery. These goals should include a focus not just on medical goals, but also on key social determinants such as access to food, affordability of health interventions, patient safety, and much more.
Thanks for reading this interview with Bharath. I love hearing about how technology can positively influence compliance, and most importantly, patient care. Let me know if you want to see more interviews in future Compliance Checkups, and be sure to subscribe in time for the next issue in two weeks!
This blog is intended to provide information generally and to identify general legal requirements. It is not intended as a form of, or as a substitute for legal advice. Such advice should always come from in-house or retained counsel. Moreover, if this Blog in any way seems to contradict advice of counsel, counsel's opinion should control over anything written herein. No attorney client relationship is created or implied by this Blog. © 2019 Brouse McDowell. All rights reserved.
May 15th, 2019
by Michael Wasserman, MD, CMD
In 2001 I co-founded Senior Care of Colorado. We were a small group of six geriatricians and a couple of physician assistants working out of two clinics who provided primary care geriatrics in local nursing homes. We immediately had offers from several local nursing homes to take positions as medical directors. Naively, we thought that these offers reflected a desire for these facilities to gain expertise in geriatrics. Realistically, they probably thought that hiring us would bring them more patients. Within a year we were under investigation from the OIG. They interviewed several nursing home administrators.
Fortunately, as a private practice that was completely beholding to Medicare reimbursement, we had begun our practice with a commitment to following Medicare guidelines to the letter. As medical directors, this meant submitting monthly time sheets to our nursing facilities, listing specifically what we did over the course of each month. Our average administrative time was between 10 and 14 hours for a facility. We had precise documentation of the administrative tasks performed over each month. After a year of investigation, with nothing in hand but our excellent documentation and services performed on behalf of the facilities we were contracted with, the OIG turned its focus onto our billing records. Seven years later, they finally stopped investigating our practice, having found absolutely nothing over the entire eight years. That’s a story for another article. This article is about the inflated risk that today’s nursing homes are taking in relation to their medical director contracts.
Many nursing home administrators believe that hiring a medical director will result in that physician directing patients to their facility. First of all, this is a myth. It is actually rare for a physician to be able to direct patients to a specific facility. Patient and family choice, and the influence of hospital discharge planners, not to mention managed care and ACO arrangements, precludes most physicians from having an impact on directing patients to a facility. The focus of medical direction should always be on providing high quality care, and never on providing patients to a facility. The House of Delegates of The Society for Post Acute and Long Term Care (AMDA), passed a resolution this year affirming this very fact. When we took on medical directorships at Senior Care, it was our intent to help those facilities provide the highest quality of care. If we achieved that goal, new patients would come, regardless of who their physician was. I wish that I could say that the majority of nursing homes and medical directors pay strict attention to this issue.
The greatest risk is to a facility paying a medical director a significant stipend, say $3-4,000/month, and having that physician only delivering an hour or two of administrative services to the facility. That will ultimately give the perception that the medical director is being paid for admissions, even if that’s not truly the case! Which makes even less sense from a business perspective! It is obviously even worse if the medical directors actually manages to direct patients to a facility where he isn’t actually providing significant medical direction.
It is critical that medical directors document every minute of administrative time that they spend. They can even account for their “on call” time being available to the facility for emergencies. In my experience, a very reasonable fair market value for that time ranges from $250-350/hour. For a 99 bed facility, 10-14 hours a month of medical director times also quite reasonable. These numbers can flex with higher acuity and complexity. The facility should NOT take responsibility for documenting the medical directors hours. An administrator should NEVER “guess” or estimate a medical directors administrative time in PBJ. Any facility administrator that is doing that today is putting themselves and their facility at unnecessary risk.
Fortunately, there is an App to assist medical directors and facilities in the documentation of medical director hours. It is called CareAscend. CareAscend was developed by nursing home medical directors and is approved by AMDA. It has other beneficial applications that are pertinent for Chief Medical Officers and Chief Compliance Officers, but first and foremost, facilities should be making sure that their medical directors are accurately documenting their services. There is no need to put a red flag out in front of the OIG. If you do, the next thing you know they’ll also be looking at your billing records!\
https://www.caltcm.org/index.php?option=com_dailyplanetblog&view=entry&year=2019&month=05&day=14&id=25:medical-director-billing
By Laura F. Fryan on March 26, 2019
Are you a medical director or does your practice, hospital, or facility have medical directors? Medical directorships are common and necessary in many health care settings, but these compensation arrangements should be regularly reviewed.
The Office of Inspector General (OIG) is on the lookout for “sham” arrangements, where the medical director position is just a cover to disguise otherwise illegal payments for referrals. In 2015, the OIG issued a special fraud alert regarding medical directorship compensation. The OIG reached a settlement with 12 physicians who had entered into questionable medical directorship and office staff arrangements. The special fraud alert is a reminder that medical director compensation must reflect fair market value for bona fide services that physicians actually provide. Even though this alert was issued in 2015, it is still a good reminder to check your compliance with the relevant Stark Law exception and Anti-Kickback Statute safe harbor for medical director arrangements.
Here are key questions for evaluating your medical directorships:
1. Does the compensation match the services provided?
Medical directors must be paid fair market value, meaning the compensation must be reasonable for the services actually provided. This is where many medical directorships go awry.
2. Are the services necessary and legitimate?
The services must be actual services required by the entity employing the medical director, not duplicative or unnecessary work. An arrangement where an entity pays a physician for services that the physician does not provide or are not actually needed is likely an illegal arrangement, often because the arrangement is a disguise to compensate the physician for his or her referrals to the entity.
3. Are the services documented by the medical director?
The key to a good medical directorship is robust documentation of services actually performed. Time sheets should be submitted as a condition of payment, and there are many options for documentation, including apps and other electronic time tracking mechanisms.
4. Is there a written agreement between the entity and the medical director?
The employer must execute a written contract with the medical director for a minimum of one year, and both parties must sign the agreement. The agreement should cover all the services that the medical director will perform and set the aggregate compensation for the services to be performed.
Periodically review your medical director agreements to ensure that you have compliant arrangements, whether you are a medical director or employ medical directors.
If you have any questions or any specific situations that should be reviewed for compliance with these guideposts, contact the Health Care Practice Group at Brouse McDowell.
https://www.brouse.com/compliance-checkup-guideposts-for-medical-directors
Three years ago, I made an exciting career move, leaving an academic career to join an innovative...
Three years ago, I made an exciting career move, leaving an academic career to join an innovative Post-Acute care organization, Signature HealthCARE. Much credit to my mentor Malaz Boustani, who made me realize that I had a chronic "itch to implement”, and I believed him instantly because he seemed to suffer from the same “diagnosis”. He had responded to it by creating the Center for Healthcare Innovation & Implementation at Indiana University.
For me, being part of the Center had only intensified the itch. The Center primarily focused on healthcare solutions for the acute care, whereas, my goals pertained to innovations in the Post-Acute setting, and hence the decision to move. So far, the move has worked really well, as we are working on several outside-the-box solutions. But nothing has been more satisfying than the design and implementation of the physician engagement platform, CareAscend.
It was 15 years ago that I first stepped into the medical director role for a skilled nursing facility. Asked to attend the monthly quality assurance meetings, the next three months I sat quietly, listening to discussions that I could not contribute to. Strategies to find lost laundry or to fix TV remotes were not my cups of tea! It needed a heart to heart with the facility administrator before I started bringing value to the team.
Physician leaders have a lot to learn from other team members, but that can’t happen without setting formal expectations, and a clear communication strategy with their facility leaders. Medical directors need to know their priorities, their purpose on the team and also need feedback on their performance.
Meaningful feedback on one’s performance and impact prevents physician burn-out. Material motivators are important but are insufficient to garner engagement and internal motivation; the key ingredients to high performance. Traditionally, health care systems lack such structures as clearly shown by the fascinating research done by Dr. Dan Ariely, concluding that physician engagement requires a strategic focus on enhancing mastery, autonomy and purpose at work (https://advanced-hindsight.com/).
In my early days at Signature HealthCARE, our CEO Joe Steier challenged me to energize our medical director force. Accepting the challenge, I met dozens of medical directors, administrators and other team members, whose input helped to formalize a framework for physician engagement. A consistent rise in our company engagement scores, clearly validated this approach. At Signature, we strive for revolutionizing healthcare not just settling for local impact, so this question emerged: how could we use technology to broaden the impact of this framework?
Our team partnered with MavenSphere (www.MavenSphere.com) to transform the medical director engagement framework into a digital application. After 18 months of experimentation and beta testing, we have CareAscend (www.careascend.com) that represents the first medical director engagement solution. Over the next few months we will be busy implementing this across 10 states, empowering and engaging medical directors. Many thanks to several of my AMDA (www.paltc.org) friends & colleagues who contributed to this project, particularly Chris Laxton and Dr. Rich Feifer.
Addressing medical director engagement is just one step in the right direction. Yes, CareAscend will help nudge medical directors to perform key tasks, log their hours to facilitate PBJ compliance, provide professional development resources and hopefully improve their impact, but many other critical areas still need solutions. Well, truth is that CareAscend may have dulled it temporarily, the itch remains, and that is alright, as we have just begun scratching the surface of possibilities!
Carmel, IN - Signature HealthCARE., an integrated healthcare company operating across 10 s...
Carmel, IN - Signature HealthCARE., an integrated healthcare company operating across 10 states has made a deal with the leading digital health software company CAREASCEND to streamline enterprise-wide the Medical Director administrative role. The smart-phone based solution formalizes the tracking of all tasks medical directors perform in their role and addresses critical compliance risks inherent in the medical director relationship.
The CAREASCEND App, by digitally capturing medical director tasks, will also address the Center for Medicare and Medicaid Service’s requirements to report medical director work logs under the Payroll-Based Journal rules and to achieve compliance at all times in financial transactions.
“Financial transactions with physicians are one of – if not the highest - risk area for health care providers. In order to maintain compliance, health care providers not only have to enter into transactions with physicians that are at Fair Market Value and address community need, but they also have to ensure going forward that the physicians are meeting the terms of the contract,” said Bharath Bynagari, chief executive officer and co-founder of CAREASCEND. “This includes completing assigned duties, meeting the minimum number of hours if specified, submitting time sheets by their due dates and not exceeding the contractual caps for payment.”
Dr. Arif Nazir, Signature HealthCARE’s Chief Medical Officer and a leader in the post-acute and long-term care setting said, “Finally, we have a solution incentivizing medical directors to perform the highest value tasks and providing them crucial feedback on care.”
Besides facilitating compliance in financial transactions, CAREASCEND also fosters teamwork and collaboration with a community’s leadership, a crucial piece to delivering the highest quality of care.
CAREASCEND application platform’s unique tools facilitate the success of skilled nursing communities’ key leaders, including: Chief Compliance Officers, Medical Directors, Administrators and the Chief Medical Officer.
George Burkley, Chief Strategy Officer at Signature HealthCARE, said, “A key to our future strategy is assuring that our physician leaders are aligned with our vision and are performing to meet our communities’ needs. CareAscend will go a long way in achieving this vision.”
CAREASCEND provides the tools and resources to document Medical Directors efforts and to see the impact they are creating on a daily basis in Skilled nursing facilities. The application has also received guidance and validation from AMDA, the Society of Post-acute and Long-term Care Medicine, the premium physician and practitioner organization in the post-acute setting.
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Signature HealthCARE is a family-based healthcare company with integrated services at each point of the continuum of care: skilled nursing, home health, assisted living and in-home care. The company’s organizational culture inspires more than 17,000 employees at over 100 locations with three pillars: learning, spirituality and innovation. A growing number of Signature HealthCARE centers are earning five-star quality ratings, the highest classification from the Centers for Medicare & Medicaid Services, and 102 Signature HealthCARE locations earned QAPI accreditation. Inc. 5000 recognized Signature HealthCARE most recently on its 2017 list of fastest growing private companies.