Founded in 1966, Androscoggin Home Healthcare+Hospice is the largest, nonprofit provider of home health and hospice services in the state of Maine.
In recent years, Androscoggin has also expanded into palliative care, transitional care and more, according to CEO and President Ken Albert. The provider has long been bullish on telehealth, too, signing its first contract for remote patient monitoring two decades ago.
Despite its ability to stay ahead of the home health curve, the coronavirus has caused Androscoggin to completely shift its operational paradigm, Albert told Home Health Care News in late May while recording an episode of Disrupt.
We’re going to jump into how your organization has adapted during the COVID-19 emergency shortly. Before we do, I wanted to talk about your background. You had a bunch of interesting roles before Androscoggin, correct?
I did. I worked on the regulatory side for several years ago. At one point, I assumed the responsibility of being the chief operating officer for the Maine Center for Disease Control and Prevention.
And on top of that, you had 17 years of clinical practice experience in emergency and intensive care settings. Has your diverse background been beneficial in running Androscoggin?
I think the nature of home health and hospice today certainly is becoming more and more regulated. And I think having the regulatory background as well as the clinical background leads to being a better leader.
I also had the privilege of practicing law for several years in Maine. I had some home health and hospice clients, too. So, again, that lends itself to a different perspective on our operations. When you can come in with more angles of “subject matter expertise,” I think it just makes you overall a better leader and provider within the communities you’re serving.
For our listeners who aren’t familiar with your organization, can you share a little bit of basic info? You came to the organization in 2016, right?
Correct. And the organization had been a client of mine before that, so my interface with the organization was both as counsel and, prior to that, as a clinician in the community. I had referred and engaged with many of Androscoggin’s employees. I always knew that if I had an opportunity to jump in at a leadership level, I would do so.
Androscoggin was founded in 1966. We’re the largest independent nonprofit provider in Maine. We’re the only home care and hospice provider that is not affiliated with a health system, though we do serve about six different hospitals throughout our geographic area while collaborating with other health systems as well.
You provide home health care and hospice services. What else?
We view ourselves as a health care company, not necessarily a home health care and hospice company. The location in which we provide care is in the home, but we really have diversified our clinical portfolio.
In addition to our headquarters in Lewiston, Maine, we have five regional offices throughout the state and a 14-bed hospice general in-patient (GIP) facility. We also provide an extensive array of palliative care services. Our medical staff has grown from one to about 11 over the past three years, working in hospitals and in the community. We have palliative care navigators to assist specialists and primary care providers with palliative care needs for their patients. We have a rapidly expanding telehealth program.
We’ve actually been doing telehealth for two decades. Looking back, our initial telehealth contract with a vendor was 20 years ago. We’re skilled at remote patient monitoring and have been viewed as a collaborator with referral sources in that regard for many years.
We also have a large transitional care division that works with third-party payers, including Humana Inc. (NYSE: HUM), Anthem Inc. (NYSE: ANTM) and others. Within the transitional care division, we have a large program called our “Community Care Team,” which is largely a Medicaid program where we case-manage the highest 5% of Medicaid utilizers for about 50 physician practices throughout the state.
Overall, how many people does Androscoggin care for on a daily basis?
On a daily basis, we’re navigating the health care needs of over 2,000 patients.
Shifting to current events and the coronavirus: How is Androscoggin doing as we’re talking here on May 28?
In November, we went into emergency command because we lost access to both front-office and back-office EMRs for three-and-a-half weeks. Our entire staff converted to paper. We had roving medical records departments. We never skipped a beat, never denied an admission as a result of that. We were kind of recovering from that when COVID-19 hit in March.
We were already at a heightened pace, if you will, for several months leading into the coronavirus. So, we just continued that work. It’s been a long journey. I think it’s given us a unique perspective about the stress of “change,” especially during an emergency. But we’re doing well. And I think that’s a real testament to our team. We do our work with almost 500 employees and about 220 volunteers.
Can you walk me through what the past couple of months have looked like?
As an overarching sentiment here, I would say that it was a complete shift in our operational paradigm. I’ve heard the same thing from other providers across the country.
We’ve had to refocus everything from our patient service center, which is our intake area, all the way through to claims submission. All aspects of our operations have changed. This has meant redefining policies, procedures and workflows. It has meant educating personnel at all levels of our organization.
What have been some of the biggest challenges? We hear about PPE a lot. We hear about declined visits and a lack of testing a lot.
Initially, PPE was a major issue. In addition to my role at Androscoggin, I also sit in the elected hospice seat for the National Association for Home Care & Hospice (NAHC). I realized in talking with my counterparts that we were not alone when it comes to PPE challenges.
It’s been tough. I’ll give you an example of why: When FEMA provides guidance to states around PPE, they have different categories, or tiers — normally ranging 1 through 4, though some states have adopted a 1-through-3 system. Different states do different things based on what their needs are. But unfortunately, home health care and hospice was never articulated categorically within those tiers at the national level, which leads to confusion.
In Maine, we have county emergency management agencies that report up to the State Emergency Management Agency, which collaborates with the Maine Center for Disease Control and Prevention. Nowhere was it articulated that home health care and hospice should be receiving PPE.
PPE was one big area that we had to address early on. I was really concerned for my staff and our ability to take patients. I was not going to assume responsibility for the care of patients if I could not put my staff out there in a safe way.
You mentioned, too, declined visits. I hear from other organizations across the country that have seen upwards of 20% to 30% of their business declined. We have not experienced those same dips. As a matter of fact, our home health census has stayed pretty flat. We have definitely seen a decline in hospice.
But the biggest challenge is related to delivering care within facilities, where many of our patients reside. For example, 50% of our hospice patients reside in either assisted living or long-term care facilities.
Right, wrong or indifferent, the facilities essentially locked their door and prevented access to care. That meant we had to have constant communication with facility administrators.
We worked very hard to have them understand the value that we could bring, the steps that we were taking to implement infection control standards. We screen our employees so we can have access to patients who are in the facilities and are on the federal hospice benefit.
I made it very clear that we were not going to discharge patients from our services — and that our documentation would reflect that we were denied access. That’s not a good or a fun conversation to have with facilities we have to work with on an ongoing basis.
What have been some silver linings that you’ve seen amid all of this disruption? What success stories can you share?
Nationally, the collaboration we’re seeing is great. Even locally, the amount of communication that is occurring between our organization and the hospitals that we serve has been great. We’ve sat at their emergency response tables. They sit at ours. It’s been just a lot of effort to ensure the health care needs of our citizens are being met.
You recently were on a webinar and talked about investing in your front-line workforce. What steps has Androscoggin taken to support staff and employees during this time?
We don’t have time to go into all of them, so I’ll highlight just a few. The resilience of our workforce is paramount, and resilience is derived from knowing that you’re cared for, knowing that you have a purpose and a mission.
No. 1, we have to keep staff safe and protected. That’s really been a focus. We know our staff members care about their own health and safety, but also their families’ health and safety. And I’ve heard over and over from staff saying they do not want to be responsible for transmitting COVID-19 to one of their patients or family members.
In addition to keeping staff safe, there are all the financial elements in a public health emergency that we had to address.
And then I really believe that an effective response to an emergency situation starts first and foremost with communication.
So those are the three areas we focused on: effective communication, physical and emotional well-being of our personnel, and then the financial well-being of our staff.
When we talk about those communication components, what are some examples of that?
Communication in an emergency situation really does require that people not over-communicate.
In talking with peers, I heard some people were putting out emails several times a day. That’s just over the top. That information becomes noise at some point.
We decided to do a daily, branded update that’s color-coded. For example, we have a green banner for some of our employees. We have a maroon banner for others. External stakeholder communications we did with a gold banner.
In terms of that financial investment, is that providing something like hazard pay? Can you provide a little bit of detail around that point?
If you’ll recall, when the Emergency Paid Sick Leave Act and Emergency Family and Medical Leave Expansion Act came out, there were questions for providers about whether or not they would opt into those programs. From my perspective, there was concern around the federal unemployment benefit as well. Some of our clinicians can make more on federal unemployment than they can working for us part-time or otherwise. We had to be really thoughtful about what benefits we wanted to put out there for our employees. We decided that we’re just going to make it all available.
We also applied for and received monies from the Paycheck Protection Program (PPP) right away — like the day that it became effective. We had our application submitted and received that immediately. We also have a program where, once a year, you can cash in earned time or paid time off. Then also, from the CARES Act, we were able to provide bonus pay for our staff. All of our staff received bonus pay, but our clinicians received an enhanced bonus pay based on the risk that they were incurring in working in the COVID environment. Again, those are just some of the steps we’ve taken.
There’s a lot that’s happened on the federal level to support home health providers. What actions have you found especially helpful? And is there anything else that you think still needs to be done to further support home health agencies?
What I found particularly helpful was in the hospice arena — being able to use telehealth for face-to-face. That was really helpful.
Lifting the 2% sequestration helped a lot of providers with enhanced cash flow, so that was really important, too.
But even more needs to be done in that regard. Revenues are down nationally for some providers, on average, by 20% to 25%. On the advocacy front, we’ve asked for a 15% increase in Medicare rates during the public health emergency.
What is Androscoggin planning in the year ahead?
We’re in the process of implementing a new EHR. We’re launching on June 1. I see a great opportunity for expanding the use of digital technologies. I don’t think that the telehealth toothpaste is going back into the tube. CMS has really been encouraging telehealth use by home health and hospice providers. They haven’t necessarily followed through to have that count for visits — and they’re not necessarily reimbursing appropriately for it. But that’s another story.
I also see an expansion of palliative care really playing out here as you look at serious illness and advancing illness in this country. I’ve definitely seen an expansion of that over the past two or three months.