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Health care technology provides the key to becoming the high performing efficient organization you want to be. But how do you sift through the many available solutions and determine which technology to acquire? Do you fully understand the best practices for choosing and using technology and measuring the value gained once your new solutions are in place? Get a map to the digital road from Suzanne Sblendorio, director of Healthcare Information Technology Consulting at Simione Healthcare Consultants.

Get the highlights of the HHFMA Leadership Panel, always a high point of the Financial Management Conference. This year home care and hospice providers face increasing pressure from Congress, CMS, MedPAC, Medicaid, and other payer initiatives to restrict service and compress margins. Yet home care and hospice will continue to bring value and quality to the health care delivery system and its patients. The dynamics created by the new health reform legislation--such as ACOs, bundling, and the home medical model--combined with the exploding Medicare and Medicaid populations and technological advances will change the face of home care and hospice. The esteemed panelists, representing a wide range of interests in home care and hospice, offer their five, ten, and 15 year vision into the future of the health care delivery system and the role home care and hospice will play.

The way we deliver health care is changing fast and going in the direction of home care and hospice. This timely program addressed the threshold question of how your organization should play a part in a new arena that includes accountable care organizations, bundling of post-acute care, and integrated transitions in care. Should you be a partner with other health care sectors, assuming some of the financial risk for the success or failure of the endeavor? Should you choose instead to be an active participant or possibly a vendor to an integrated health delivery model? Join our panel as they discussed how to determine your role and gauge the community of health in which you function.

Potential Medicare and Medicaid reimbursement cuts have made it critical for home health agencies to manage their gross and net operating profit margins. Agencies need to develop tools to analyze their margins and make sure they are following best practices. Try as you may, your agency might still face the question, "Why am I not meeting my budget?" Get some answers in this session from David Berman and Andrea L. Devoti. Berman is a principal at Simione Healthcare Consultants in Hamden, CT, where he is responsible for merchant acquisitions, business valuation due diligence, and oversight of the financial monitor benchmarking tool besides serving as interim chief financial officer. Devoti is chairman of the NAHC board and President & CEO of Neighborhood Health Visiting Nurse Association in West Chester PA.

This article incorporates findings from the first phase of a Hospice U-shaped Modeling Project conducted by Simione Consultants that were presented on July 14 at the 17th Annual NAHC Financial Management Conference & Exposition in San Diego, CA, by Robert Simione and Theresa M. Forster. SPECIAL NOTE: The National Association for Home Care & Hospice (NAHC) and its affiliated Hospice Association of America (HAA) extend special thanks to the agencies that volunteered to participate in the hospice payment modeling study referenced in this article, and particularly to Robert Simione, Jared Shure Michael Simione, and Kaitlyn Quada of Simione Consultants, LLC, for their significant contributions to advancing knowledge of the potential impact of hospice payment reform.

CMS requirements for hospice face-to-face encounters were effective January 1, 2011, with enforcement beginning April 1, 2011. Hospices still have some questions, however, on how to implement the requirements. In response, CMS has provided clarification on several areas of particular interest to hospices.

Health care reform at last: After nearly a century of effort by Presidents from Theodore Roosevelt on down, the Congress finally agreed on and President Barack Obama signed into law a system that covers most Americans, regulates sharp insurance practices, and embraces a paradigm shift from acute institutionally focused care to chronic disease management based on home and community-based care.

There is at least one home care and hospice industry association in each of our 50 United States and Puerto Rico. These associations represent tens ofthousands of home care and hospice providers. They provide state and local leadership, professional and para-professional training, and other services designed to help home care and hospice providers care for our nation's sick, disabled, and elderly. These are their stories.

The rapidly rising cost of fuel has had a profound impact on the home care and hospice industry. In an effort to quantify the increased burden, the National Association for Home Care & Hospice's (NAHC) Foundation for Hospice and Home Care conducted a study showing that home care and hospice providers drive over 5 billion miles per year to deliver services --about two-and-a-half times the number driven by United Parcel Service, the international delivery service. The findings garnered significant interest by the media and elected officials. Reprinted in this issue of CARING Magazine are the press release that NAHC issued regarding the study, as well as a graphic representation of the study's findings that was circulated to the National Conference of State Legislatures at its most recent meeting in July. Also represented on these pages is a reprint from the Congressional Record of July 11, 2008, in which Senator Debbie Stabenow (D-MI), one of the highest ranking Democrats in the US. Senate, entered into the record an article from the front page of the New York Times of July 5, 2008, that covered the mileage study.

This article addresses the wholly reformed appeals process in a broad based manner. It describes only the basic structure of a new appeals system. Appealing parties should be careful to learn in more detail the new system prior to pursuing an appeal. While many appeals can be pursued without legal counsel, it may be advisable to initially utilize an attorney for appeals until one becomes familiar and comfortable with the new process. Despite any of the shortcomings discussed above or new obstacles created by CMS in the rules, the appeals process should continue to be a very useful mechanism to successfully reverse inappropriate claim denials.

Support for the mission of home care and hospice from Congress continues to expand as more members of the House and Senate take time out of their busy schedules to visit with a home care or hospice patient. Take the case of Congressman Greg Walden (R-OR) who is currently in his fourth term representing the people of Oregon's Second Congressional District, which includes twenty counties in central, southern and eastern Oregon. He is a passionate advocate for home care and hospice who as chair of the Congressional Rural Health Care Coalition, is a key figure in the fight to restore the 5% rural add on for home health services to rural patients.

Financial staff and clinical staff do not necessarily see eye-to-eye. However, mutual understanding of one another's areas of expertise is essential to the success of a hospice. Financial and clinical staff can work together to streamline employee reporting, such as on time sheets and during annual reviews, to ensure that important data is being collected and staff don't waste time reporting on and analyzing extraneous data.

While following the same approach to care as hospice, palliative care reaches patients who do not necessarily have a terminal diagnosis or a life-threatening illness, and/or are seeking curative treatment. Reimbursement methodologies and requirements for palliative care differ from hospice, and are not explicitly covered by federal and state regulations. In the first article of a two-part series, the author reviews licensing issues, reimbursement requirements, fraud and abuse pitfalls, and cost report requirements for home health agency palliative care programs.