Dr. Ed Breazeale approaches the 21st Century CURES Act with a unique perspective. As a plastic surgeon, he told us in an exclusive interview, he has always had an interest in the problem of fraud, waste and abuse in healthcare. Finally, he decided to do something about it, a decision that led to the creation of HealthStar EVV.
"I don't like people who cheat the system," Dr. Breazeale bluntly began our conversation. "I watched as healthcare reached a juncture where everyone was talking a good game about reducing F/W/A but nobody was attacking it. So I decided to attack it."
He said he became aware of the problem ten years ago, thanks to his wife, a physical therapist who had worked in home health. "Nearly $3.6 billion in personal care services were paid improperly in 2015," he said, citing the U.S. Department of Health and Human Services. Around the same time, he spoke with a friend who had designed a GPS system to keep track of fleet vehicles. "I thought, why couldn't GPS be used in home health? Then, one night as I left my office, my wife asked me to swing by the store to pick up some things on my way home. Here it was, eight o'clock at night, and there was a car parked there with a home health logo on it. I wondered why."
It was at that point he started working on the software that eventually became the flagship product of HealthStar, LLC, based in Knoxville, Kentucky. "I wanted to develop a win/win/win system for all stakeholders: patients, providers, and payers. I wanted healthcare provider agencies to have insight into where each caregiver is, and to possibly generate a claim directly into a payer's system. The provider spends less time chasing claims and the payer gains the assurance that payments are for care that actually happened.
The HealthStar system begins with GPS technology embedded in a clinician's or caregiver's tablet or vehicle. The software checks that the address where the remote worker checks in is an approved address. It also can be set to query the worker at random times during the visit, eliminating the practice of logging in, leaving, and returning to log out.
Why this level of scrutiny? Dr. Breazeale's preliminary research indicated that it is necessary. "When I first started, I sought out University or Home Health providers to agree to participate in double-blind GPS studies. We would track behaviors and match activity to billings. We discovered that about 15 percent of visits billed never occurred, which alarmed me. On the other end of the spectrum, 15 percent were perfectly on time, like clockwork. But the middle 70 percent of the bell curve had a wide variety of issues, some due to fraud, some to sloppiness or laziness."
After studying the result of these experiments, he realized that an EVV system has to do more than ensure that a worker showed up at an address and placed call at the beginning and end of an hour. "Our system knows all of a home care agency's approved care locations, and it tracks real-time check-in and check-out. But we also patented "in-visit" verification, where a caregiver has to check in at set times or at random times, depending on the preference of the payer.
Payers can control costs
While Breazeale cites benefits to home care agencies, HealthStar's direct customers are payers such as UnitedHealth, Aetna, and Anthem. They found some early success starting in October, 2015, serving two of the three MCOs that contract with HealthStar's home state of Tennessee and are now in the process of leveraging those relationships to bid on contracts with the same payers in other states.
Looking to the future, Dr. Breazeale's commitment to GPS and in-visit verification has led him to Capitol Hill. "We are working to get GPS and in-visit verification added to the six EVV requirements already in the CURES Act," he said.
©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. firstname.lastname@example.org