by Tim Rowan, Editor
According to comments we received through our 2021 Home Care EVV Survey, either in-home Medicare providers are difficult to please or EVV vendors are not trying very hard. Frankly, results were as surprising as they were disappointing.
Forty percent of survey respondents said their experience with EVV has been "frustrating." Not quite half as many said it has been "positive;" no one said "very positive." Many wished their state would allow them to switch vendors. Perhaps the only bright spot for EVV vendors is that the most severe comments were directed toward state Medicaid offices that built, and required use of, their own proprietary system instead of allowing providers to use a vendor of their own choosing.
An October 2019 CMS bulletin laid out the ground rules for home care software vendors getting into the EVV business:
EVV systems fall under the definition of a “mechanized claims processing and information retrieval system at 42 CFR 433.111(b), and are subject to the following provisions at42 CFR Part 433 Subpart C—Mechanized Claims and Processing Information Retrieval Systems:
- 433.112(b)(14) – [the system must] support accurate and timely processing and adjudications/eligibility determinations and effective communications with providers, beneficiaries, and the public, and,
- 433.112(b)(15) – [the system must] produce transaction data, reports, and performance information that would contribute to program evaluation, continuous improvement in business operations, and transparency and accountability.
The same bulletin added a reminder paragraph from the initial EVV rule, which offered a stick rather than a carrot to force state Medicaid offices to establish EVV policies:
Section 1903(l) of the Act, as added by section 12006 of the Cures Act (Pub. L. No. 114-255) and further amended by Public Law No. 115-222, stipulates states will be subject to a reduction in FMAP if they do not implement EVV for personal care services by January 1, 2020, and for home health care services by January 1, 2023, absent a one-year extension based on CMS approval of a state’s Good Faith Effort application.
With the freedom to select their own EVV model, providers across the country have had unequal experiences. Some states created their own EVV, others contracted with an established EVV software company. Some allow MCOs to select a vendor, some gave that choice to providers. Most contracted with a data aggregator service, which sits between state and provider computer systems to manage incoming visit or shift data and claims.
NOTE: See "EVV Survey Raw Data" elsewhere in this week's issue. Here is a summary of the pertinent findings.
Asked whether their overall experience was positive or negative, those who answered either "negative" or "frustrating" had a lot to say:
Families do not want the device in their homes so we have to do telephony. Families do not have landlines and are sometimes not present or available to use their cell phone; therefore, staff must call from their personal phones (they do not have company issued phones and the app does not work on the laptop). This seems counterintuitive if the goal is fraud prevention!!!! The other issue is many staff provide care to multiple clients [in the same home] so there is always a warning in the system because the same client has the same phone number listed as another client.
Data is not syncing on schedule; I wasn't paid for a few months due to technical issues. Consistently causing issues.
Initially was frustrating due to issues with handheld devices. Has significantly improved since our software vendor implemented a hands-off interface.
Mississippi has their own system and providers don't have a choice or option to use state or one of their choice. You cannot print reports from the system, then there is always per se audits showing you have duplicate claims and you owe money back. When you print RA's from another system but auditors or performance enforcement says you have to go by what LTSS says but can't print reports, no GPS or nothing. Before state mandated system I used Kinnser, which has all the requirements by CMS. State does not accept any documentation from another system besides the activity sheets. This has caused a lot of providers loss of revenue.
Absolutely ZERO benefit. With the use of personal phones for telephony, as well as waiver CMs and DODD SSA's writing into the service plans caregivers may bypass the verification portion (this is not related to the current temporary COVID related pause on this step) there is no way to ensure increased accountability.
Vendor responsiveness was another widespread concern, with more than half of all respondents describing tech support as "difficult to reach" or "non-existent" and fewer than 5 percent choosing the option "Excellent, they answer on the first call and seem to care about our success." 60 percent are unhappy with the EVV vendor assigned to them. While half of our respondents were from small organizations, one notable exception was a 3,000+ daily census agency whose VP wrote, "No communication, little follow-up, poor roll out."
It takes weeks for [our vendor] to respond. It took almost a year to even get a basic build of our EDI to work.
Creates more work, more delay with billing and no increase in revenue to offset additional time.
Because vendor was not ready have had multiple "breaks" to the system that require their staff to correct.
Errors, delayed payments, inaccurate audits, system down, etc.
Software and aggregator aren't working hand in hand. Issues are thrown back and forth.
Caregivers don't stay.
Curious about the two-year impact on tech companies providing EVV software, we asked them separate questions. Three-fourths of responding vendors said providing EVV services has brought them the added opportunity to offer other products to providers and payors. 49 percent said that opportunity has actually led to sales of other products.
In my 28 years in home care IT, I have come to learn that unresolved issues between tech companies and their customers are never one-sided. Users often request software features that have been in place all along. Training is frequently inadequate, but that can be because the customer tried to keep costs down during implementation by skimping on training as often as it can be because vendor training was insufficient. Turnover is also high, and providers rarely incur the added expense of re-engaging vendor training for new hires. When 24/7 online training is available, providers still have to bear the added cost of wages for training hours.
Vendors too are sometimes guilty of cutting costs by cutting corners, as is evidenced by the comments we heard about lengthy response times and support staff without sufficient knowledge to provide solutions.
Even when responsibility for the widespread dissatisfaction we found is shared by both vendors and customers, it is still worth noting that home care agency experience in the EVV realm is far worse than with agency management or Electronic Medical Record software. Clearly, something is off, but it goes beyond the scope of our survey to determine exactly what needs to be fixed.
EVV is scheduled to be extended to Medicare providers next year. To avoid what could be a cash-flow disaster for those 11,000+ providers, and to solve issues reported by Medicaid providers, every pain point we identified must be re-examined before the deadline. This examination must include:
The bottom line is that there is an urgent need to problem-solve, and it requires addressing two fronts simultaneously. Medicaid vendors currently mandated to use some kind of EVV reporting system need, and deserve, a higher level of attention from states, software companies, MCOs, and CMS. Their dissatisfaction exceeds the normal range of home care provider unhappiness with their software vendor.
The same stakeholders must step up to be ready for the introduction of EVV into the Medicare world. Two years of experience are sufficient to provide the data needed to make changes so that systems operate more efficiently in what is essentially the second time around. Most of the severe comments came from smaller providers, not from those large enough to support in-house IT support and corporate trainers. If that holds true next year, small Medicare agencies struggling with PDGM, OASIS-E, and the nationwide nursing shortage will have one more burden placed upon their operations, one they cannot afford.
©2021 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Home Care Technology: The Rowan Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. email@example.com