EVV in Home Healthcare Started January 1 – States Delay Deployment as Problems Mount

Confusion around EVV adoption has resulted in delays and troubled rollouts for state agencies, medical providers, and individual caregivers. These problem areas concern those in the PCS and HHCS industries but are easily addressed with the right strategies and support. 

Electronic Visit Verification (EVV) may be one of the most pivotal changes in the home healthcare sector in decades. As part of the 2016 21st Century Cures Act, EVV requires home health and homecare providers and practitioners operating under a state plan (Medicaid) to use an EVV solution to help monitor and record basic information on in-home visits.

As with any change in the healthcare world, problems have arisen. Several states have reported delays in their adoption of EVV systems for both personal care services (PCS) and home healthcare services (HHCS). 

The deadline for EVV use in HHCS was January 1, 2023 — or January 1, 2024, with a CMS-approved “good faith effort” exemption (GFE).

States that submit a good faith effort exemption to the Centers for Medicare and Medicaid Services (CMS) can delay the rollout of their EVV systems. However, they must continue to make strides to adopt EVV in their states — which brings us to the common problems complicating the adoption process despite the tight initial deadline.

What are the obligations around EVV?

Home health providers must use EVV systems to log the following information about each HHCS and PCS visit:

• The type of service performed 
• The individual receiving the service
• The date of the service
• The location of service delivery
• The individual providing the service
• The time the service begins and ends

States can add other requirements to their EVV systems and apply different rules for each data point collected. 

How are states implementing EVV?

EVV aggregation refers to collecting and consolidating data from different EVV systems to create a single, comprehensive record of home- and community-based services provided to clients. There are several various models that states may use for EVV aggregation, including:

1. State-managed EVV aggregation: In this model, the state government is responsible for managing the EVV aggregation process and consolidating data from different EVV systems into a single record. This model may be appropriate for states with a large, centralized EVV system and the resources to manage the aggregation process in-house.
2. Contracted EVV aggregation: In this model, the state government contracts with a third-party vendor to manage the EVV aggregation process. The vendor is responsible for consolidating data from different EVV systems into a single record and providing reports and analysis to the state.
3. Federated EVV aggregation: In this model, multiple EVV systems are connected and share data in real time, but each system remains independent and is responsible for managing its own data. This model may be appropriate for states with multiple, decentralized EVV systems that need to share data but don’t have the resources to centralize the aggregation process.
4. Hybrid EVV aggregation: In this model, the state government uses a combination of different EVV aggregation models, depending on the needs and resources of other regions or service providers within the state. For example, a state may use a state-managed EVV aggregation model in some regions and a contracted EVV aggregation model in others.

There are variations in each type of EVV aggregation as the models each state uses will depend on its specific needs and resources, as well as any applicable federal or state laws and regulations.

What’s preventing organizations from implementing EVV?

There’s no straightforward path to change in the healthcare market, and home healthcare is no exception. Some providers in home healthcare aren’t equipped financially to adopt a new EVV system; others have reservations about forced regulations.

The expansion of Medicaid and additional covered services has brought growing pains. Providers are still ramping up hiring and training for these services, and the onset of the COVID pandemic hindered progress due to social distancing requirements. 

Further complicating the rollout of many new programs, home health providers have an immediate and direct relationship with patients. These types of connections often require caregivers to take on the role of the go-between with other medical providers, such as nurses, specialists, rehabilitation providers, doctors, insurance providers, and hospital personnel. This expectation leads to caregiver burnout and lessens the drive to adopt new technology or systems.

What are the key problem areas around EVV adoption?

Change in the healthcare sector is challenging. EVV is no different. But careful planning and proper training can help providers avoid common pitfalls around EVV adoption to ensure compliance and the best possible care for patients. 

Problem areas include:

1. Communication 

There needs to be more communication between HHCS providers and other medical professionals. EVV adoption is an excellent opportunity to integrate case management and digital medical charts into a comprehensive EVV solution. Doctors, nurses, and other providers can instantly see notes and patient data down to the minute of each HHCS visit, allowing them to act upon more accurate insights. 

Because of the added pressure on HHCS providers to be personal medical points of contact for patients, organizations need to set expectations and milestones for success. Rather than adding another requirement to the provider’s workload with EVV tracking, incorporating EVV into a more coherent communication strategy is an achievable goal. 

HHCS providers can act as traffic controllers for medical information along a patient’s journey, helping patients understand their next steps to treatment and recovery by offering guidance toward resources and care. 

2. Training and Education

Each EVV rollout has left much to be desired regarding training and education, leaving providers and partners in the dark. That’s where the impetus for proper guidance from 3rd party EVV operators comes into play. 

Providers need guided and on-demand training, webinars, town hall meetings, and even private, 1:1 training sessions to ensure compliance and proper implementation. 

3. Follow-up and Issue Response

As part of a more prominent home healthcare technology solution, the right partner can even liaise between providers and patients to help communicate patient needs. Bridging this gap benefits not only reactive care for the patient but proactive communication and messaging. By creating a better workflow, we can reduce wasted billable time for providers, ensuring they can provide for major, pressing care needs rather than handling communication between the patient and the insurance provider or the doctor’s office.

Plus, a cohesive communications provider can integrate with EVV systems and coordinate between vendors, providers, payers, and caregivers, helping keep the patient’s care strategy efficient and on-task.

What are some misconceptions about EVV?

Beyond the confusion around adoption strategies and guidelines, the overall question around EVV is: Will it work? A lenient rollout has allowed states to delay their adoption, leaving patients and providers concerned about EVV and why it’s essential. 

For HHCS providers, EVV can feel intrusive. They may feel as if someone is monitoring their actions, micromanaging them, and what data is being collected during a visit. These concerns can distract HHCS providers and leave many questions unanswered as the rollouts continue. 

Another misconception is the purpose of EVV and what data is being collected. At a basic level, EVV was implemented by the Cures Act to mitigate fraud, waste, and abuse (FWA) in the Medicaid home health industry. Until reforms in 2017, an estimated 20-30% of health insurance billings were considered fraudulent.  

Whether or not EVV will successfully combat FWA is yet to be determined; however, greater transparency in provider visits will undoubtedly improve the patient experience and help reduce confusion and uncertainty about HHCS in general.

Where can Epiphany assist in the EVV transition?

As a trusted partner for healthcare providers, Epiphany is uniquely situated to help providers and caregivers navigate the transition to an EVV-based model. Backed by powerful technology, our in-house, U.S.-based contact centers are HIPAA-compliant and specifically trained to handle medical-related calls and communications. 

Epiphany liaises between vendors, providers, patients, insurance providers, and medical professionals daily and is no stranger to the complexities of the home healthcare market. During the onset of COVID, Epiphany worked behind the scenes to connect patients and caregivers in a suddenly digital-only medical world. 

Beyond EVV adoption and training, Epiphany can provide proactive and follow-up care services for providers, collecting vital information before and after a patient’s visit with an HHCS or other medical provider. We can help train vendors, 3rd-party providers, and caregivers with EVV technology. In addition, we provide ongoing technical and customer service support for medical providers and their partners. 

About Epiphany 

Epiphany is a customer experience and contact center that specializes in Healthcare and Healthcare Technologies.  Epiphany understands the problems facing healthcare and partners together with its clients to solve these problems. Whether it is a case study, pilot program, or the everyday customer experience, Epiphany is here to help build your brand and ensure your customers’ happiness. As a Certified Minority Owned Business, Epiphany values working within our community. Addressing diversity, inclusion, and equity when hiring and working with clients is key to our success. 

Contact Joseph Marte [email protected] 815-985-7195 www.epiphanymgmt.com