edition Greetings Rick Gandersman, Senior Vice President, Kindred at Home

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1 edition A Quarterly Newsletter APRIL 2013 Greetings With one quarter under our belts, we re off to a great As our division has continued to expand through purchasing established home health and hospice agencies and growing our existing locations, we re starting to see some exciting synergies among our affiliates. As many of you heard during our company-wide webcast with CEO Paul Diaz and President and COO Ben Breier in February, the Home Care Division of which you re a part has been renamed Kindred at Home to better reflect our participation in Kindred s post-acute continuum of care. This name will be used when addressing legislators, investors, managed care payors, healthcare system partners and potential employees through recruitment efforts. Your local brand names will be retained because we know that your referral sources recognize and trust those, and we don t want to disrupt those important relationships. However, you will start to see An Affiliate of Kindred at Home added to your current names. In this issue, we are introducing two new leaders in our division CFO Todd Higgins and Senior Director of Revenue Cycle Ron Kelley. Both positions are new for our group and are indicative of the growth we re experiencing. Todd will be heading up the finance team in Louisville, KY, and Ron will be leading our new centralized billing office in Grapevine, TX. We ve also included some details about that new effort in the following pages. As we continue to standardize many of our best practices, the roll out of Homecare Homebase remains central to our efforts. We expect that to be complete this year. Check out the article that follows for all the latest details. Our clinical programs are one of the distinguishing characteristics for our operations. Abe Mathai, Director of Operations for Illinois Family Home Health Services in the East Region, shares some case studies and outlines how his team is helping COPD and diabetic patients with their specialty programs. In working to facilitate the integrated model of care in the markets where Kindred offers multiple service lines, we re employing Clinical Integration Specialists (CIS) who will participate in the interdisciplinary team meetings at the Kindred hospitals and nursing and rehabilitation centers. In her article, our Senior Director of Compliance, Bonnie Austin, explains the role that these CISs will play in transitioning hospital and nursing center discharges to home health and hospice services when appropriate. Finally, April is the Month of HOPE, so we want to make sure that everyone is aware of how you can help and be helped by your fellow employees should you ever face a catastrophic life event. Thank you for being a part of our team and playing an important role in making us the home health and hospice provider of choice in the communities we serve. Rick Gandersman, Senior Vice President, Kindred at Home

2 Kindred at Home Names CFO By Rick Gandersman, Senior Vice President, Kindred at Home I m pleased to announce that Todd Higgins, Vice President of Finance and Controller of RehabCare, joined the Home Care Division as our Chief Financial Officer and Vice President of Finance on March 7, Todd, a graduate of the Company s Rising Star program, has been Vice President of Finance and Controller of RehabCare since March He has worked for the Company since 2008 when he joined us as Senior Director of Finance. Prior to joining the Company, he served as Manager of Finance at KFC Corporation, a subsidiary of YUM! Brands, from 2006 to Todd received his MBA from Bellarmine University. He has provided leadership of the finance and accounting functions of our company s Rehabilitation Division and will bring his expertise and dedication to our growing Home Care Division. Todd will report to me in his new role. Jim Eveslage, Division Vice President of Finance and Controller, under whose financial leadership the division has experienced robust growth, will now report to Todd. The Home Care Division currently consists of 103 locations covering 10 integrated markets in 10 states. The locations are organized in three operating regions. Please join me in congratulating Todd on his well-deserved promotion and wishing him all the best in his new role. Meet Ron Kelley, Senior Director of Revenue Cycle By David Hagey, Division Vice President, Central Region, IntegraCare Ron Kelley is our new Senior Director of Revenue Cycle. Ron will be leading our Centralized Billing Office (CBO) that will serve Kindred at Home in the days ahead. The CBO will work closely with Home Health and Hospice leaders across the East, West and Central regions -- ensuring that clean claims are billed and collected for the care we provide to our patients. Our current outstanding billing team led by Sherry Hawkins will be reporting to Ron. Ron joins us with 18 years of healthcare revenue cycle experience. This includes senior leadership roles at Tenet Health and Ernst & Young. Ron has managed and led billing operations for multiple large healthcare organizations going through turn-arounds, transitions and acquisitions. Just before joining the Kindred at Home team, Ron served as the Vice President of Revenue Cycle for two healthcare companies in the Dallas area, helping them successfully consolidate and enhance their revenue cycle. Ron has an MBA from Texas A&M University in Finance; he has been a speaker for and published articles with healthcare industry associations including HFMA and HIMSS. Please join me in welcoming Ron to our team.

3 Haven HealthCare Welcomes Curo Home Health Employees and Patients By Ed Seiler, Senior Director, Operations, West Region In mid-march, Kindred at Home was approached by Curo Health Services ( about assuming all the company s home health business in Utah. Curo provides services in 10 states and aims to focus primarily on hospice care. In Salt Lake City, Curo Home Health had a census of 195 patients and a staff to support those operations. We will welcome 27 clinical and sales employees (15 of which are full time) into our Haven HealthCare offices in Murray, Layton and Provo, UT, to provide continuity of care to the Curo Home Health patients who choose to come on service with Haven. We expect to assume about patients as a part of this arrangement. Haven provides home health in all of Salt Lake, Weber, Davis and Utah counties and also serves parts of Morgan, Tooele and Summit counties. This coincides with the previous service area of Curo in Utah. Curo Home Health was already using Homecare Homebase (HCHB), but Haven hasn t yet implemented this technology. We are reacting entrepreneurially and have shifted the HCHB schedule so that it can be launched at Haven in May. The former Curo employees will be a great resource to the Haven staff as they learn the new system. We re excited about the new expertise in vestibular rehabilitation therapy, an exercise-based program designed to promote central nervous system compensation for inner ear deficits, that we are gaining from Curo as well. This will serve as a differentiator for Haven in the market and can be shared across all Kindred and RehabCare sites of service. Kindred at Home CBO and Revenue Cycle Update By David Hagey, Division Vice President, Central Region, IntegraCare The Kindred at Home Central Business Office (CBO) located in Grapevine, Texas (near the Dallas-Fort Worth airport) is excited to be moving into a new building in April. Previously located inside of the IntegraCare (Central Region) offices, the CBO will move into a building directly across the street from its current location. This will allow the CBO to scale up as the Kindred at Home division continues to grow in the days ahead and as existing agencies roll into Homecare Homebase (HCHB). development of the CBO and the overall revenue cycle for our division as we continue to grow throughout 2013 and beyond. The CBO will be responsible for managing Kindred at Home s revenue cycle, and ultimately will be responsible for more than $200 million of business. The revenue cycle consists of all the activities needed to create and collect a healthcare claim. The CBO sets up new payers in the HCHB system, assists branches by verifying insurance, submits claims to payers, and collects accounts receivable. Ron Kelly (see article in newsletter) will lead

4 Homecare Homebase 2013 Best in KLAS Awards! By Paul Johnson, Senior Director, Operations and Systems As Homecare Homebase (HCHB) states, Third Time s Charming. Why? Because they have been awarded the Best in KLAS awards for Software and Services since 2011! KLAS in an independent organization whose mission is to improve healthcare technology delivery by honestly, accurately, and impartially measuring vendor performance for their provider partners. It is exciting that Kindred at Home has selected one of the premier home health and hospice software systems available. Because HCHB is web based, it will provide real-time data that is financially and clinically consistent. Since every branch will be on the same system, senior management will have the tools to efficiently and effectively manage dayto-day operations. In April of 2012, we conducted a pilot of the HCHB system at our Signature Health Services branch in Akron, Ohio. Thanks to the great team in Akron. After the pilot, we then completed the implementation at the remaining 12 Signature branches. Since then, we have completed the implementation at our two Illinois Family Home Health branches in the Chicago area and at our Homecare Advantage branch in Torrance, California. We are currently in the implementation phase at our two PeopleFirst branches in the Boston area. Our Central Region, which consists of our Integracare branches, had implemented HCHB prior to being acquired by Kindred at Home. We have been able to utilize their expertise, knowledge, and excellent staff for our 2013 rollout. The plan is to complete the roll-out of HCHB in 2103 for the remaining West Region home health and hospice branches, as well as our East Region hospice branches. We are currently working through the scheduling process, and hope to provide the rollout plan soon. For those who would like a preview of the HCHB system, we have included three system overview videos on our divison s Knect site (Knect - Homecare and Hospice Division - HCHB Support Materials). Scroll to the bottom to access videos. Auditing and reviewing documentation is much easier for the reviewer than I have seen. The additional information found in the episode summary and detail report help to focus the review. - Deb Locke, Director of Clinical Operations, East Region HCHB is a clinician driven program that is very intuitive and process oriented. It gives the clinician everything they need at their fingertips in order to provide the best care for our patient. It also provides the processes necessary for the office to function in a smooth and efficient manner. I have worked with four other systems and HCHB is the only one that provides this type of system with a comprehensive reporting database as well. - Stephanie Phillips, Director of Operations, San Diego and Garden Grove, CA I have found HCHB to be a system that is easily taught to surveyors when they come on site for the agency review. It is useful to have a separate survey log-in that has specific rules attached to that log in. This saves so much paper rather than printing every chart and allows the surveyor to move through the documents with ease. - Marilyn Bowen, Director of Clinical Operations, Central Region Having the goals and interventions as clinical carepaths in HCHB permits greater consistency in care and makes documentation correspond to the 485 orders. - Cheryl Lamade. Executive Director, East Region The system is incredible. The things you can track for quality of care, for accuracy of documentation, billing, scheduling are part of what helped us achieve elite status, I m sure. - Rebecca Boodt. Branch Director. Campbell, CA

5 Clinical Integration Specialists Ensure Optimal Patient Care By Bonnie Austin, Senior Director of Compliance In certain geographic areas, Kindred at Home has used Clinical Integration Specialists (CIS) to facilitate intake to homecare services for residents/patients referred by Kindred Nursing and Rehabilitation Centers and Transitional Care Hospitals. These nurses have used their expertise to provide education about the homecare industry (home health, hospice, palliative care and private duty) to facility staff. The CIS could attend the facility interdisciplinary team (IDT) meeting only during the time referred patients were being discussed. Over time, homecare and facility staff have recognized that having the CIS present during facility IDT meetings would improve communication about the patients medical conditions and care needs information that is valuable to ensuring smoother transition from facility to home for the patients and their families. Realizing that some of the patients being discussed during IDT meetings have not been referred to homecare, our division was challenged with a question: How can a homecare CIS participate in IDT meetings while adhering to HIPAA and other laws? With the help of Kindred clinicians, business and operational leaders, and legal counsel, a CIS program was designed and an implementation plan was developed. The initial pilot began in February 2013 in the nursing centers located in Columbus and Cleveland, Ohio. The Cleveland area transitional care hospitals are implementing in April. Commonly Asked Questions Why are we doing this? The CIS program supports alignment with Kindred s Continue the Care strategy. We want to be leaders in helping to coordinate and deliver high-quality care. We want to participate in the development of new care delivery models that provide superior clinical outcomes. We believe that the patient s clinical outcomes can be improved if the CIS is fully informed about the holistic picture of the patient. We want to support continuity of care and are striving to improve the patient/family experience during the homecare intake and transition process within the Kindred continuum. How does the CIS Program work? As soon as possible after a patient is admitted to a Kindred facility, a facility staff member must review the Acknowledgement and Authorization form with the patient. The form includes a HIPAA authorization. This form has one purpose only: to obtain consent for the CIS to participate in the IDT meetings. If there is no referral and the patient chooses not to provide written consent, the CIS must exit the IDT when that patient s care is discussed. If the CIS in the IDT without either a referral or proper consent from the patient, it is a HIPAA violation for both the facility and for homecare! If patients sign the consent form, does that mean they are choosing Kindred homecare services? No! The patient has the right to choose his/her homecare provider. The sole purpose of the consent form is to allow the CIS to participate in the facility IDT meeting. The patient s right to choose will always be honored. This is clearly explained on the consent form. Patients who have chosen a homecare provider other than Kindred can still sign the form. How do the facilities know about the CIS Program? Prior to implementing the Program, education must occur for the facility staff as well as for operational and clinical leadership. Education materials include a brief handout, a copy of the consent form, and review of the policy. The education is provided by Kindred at Home staff. Will the CIS Program be implemented in other locations? Education has already begun in the Boston and Southern California areas which are planning to implement in April-May, soon followed by Indianapolis, Dallas, and Las Vegas. We will evaluate processes and monitor outcomes to ensure effectiveness. Since the CIS Program involves only Kindred facilities, future implementations must be in geographic locations where Kindred at Home and Kindred facilities both exist. If you have questions or comments about the CIS Program, please contact me at [email protected]. An update on the progress and successes of the Program will be provided in the next issue of the newsletter.

6 Transitional Care Programs By Abe Mathai, Director of Operations, Illinois Family Home Health Services, East Region Illinois Family Home Health Services (IFHHS) originally developed a Care Transition Program in anticipation of and in response to the October 1, 2012, hospital readmission reimbursement cuts. With the changing landscape of healthcare, IFHHS sought to improve on its better-than-average hospital readmission rates and develop these programs with the needs of hospital discharges in mind. Currently we have specific Transitional Care Programs for COPD, diabetes, wound care, CHF, and orthopedic patients. The first step in developing its Transitional Care Programs was to identify what things we were already doing that were effective in keeping hospital readmissions down. Our telemonitoring program had been a good way to supplement the clinician visits for its patients. Patients would then get followup calls to check vitals and assess condition on non-visit days. These calls could then be tracked within the system and, if needed, the case manager could be contacted in the event of an issue, which was crucial in avoiding certain rehospitilizations. All patients in the Transitional Care Programs are included in telemonitoring as well. All patients are also given diagnosis-specific self-care kits. These kits include tools to assist the patient and caregivers in disease management and control. As many healthcare professionals can attest to, patient compliance is often the biggest challenge in improving outcomes. By giving patients the tools and education to self manage, along with the accountability of the visits and telemonitoring calls, they are empowered to manage their own conditions. Another aspect of fostering positive patient outcomes is understanding healthcare providers need to work together to leverage their strengths for the benefit of the patient. IFHHS developed strategic relationships with Abbot Labs in including their nutrition intervention program for care transitions. This program was developed by Abbot using specific diagnosis-based dietary supplements with the goal of reducing hospital readmissions and better patient recovery post-hospital discharge. We also have a strategic relationship with a local pharmacy program where patients who are enrolled can have a face-to-face pharmacy tech consult to go over their medication and any changes. Evidence suggests that a large number of hospital readmissions are due to medication mismanagement. Care Transition patients are offered this program as a way to mitigate that risk. All nurses take competencies in the various programs allowing them to treat their patients with a higher level of care. IFHHS is now in the process of expanding its Transitional Care Programs to include lymphedema wraps. Under the new Kindred affiliation, IFHHS is seeking to be known in the Chicago market as specialists in transitional care in the home. COPD Patient Success Kenneth Kenneth had been hospitalized multiple times over a three-month timeframe with exacerbations of COPD. Upon his most recent discharge, he was admitted to home health with the hospital discharge planner specifically instructing that our goal was to prevent rehospitalization. Both the patient and caregiver were educated verbally and with the COPD patient care kit, along with supplemental telemonitoring. He has not been readmitted and he continues to be seen for continued assessment, teaching and support. It has been over seven months since his hospital discharge. Diabetes Patient Success Charles Charles has a history of diabetes and morbid obesity. He had a wound on his lower extremity that he had been dealing with for over a year. It progressed to a severe cellulitis and he developed numerous open, draining wounds. Since being admitted for home health, nursing has seen him for education and daily dressing changes. The case manager was supported by the agency wound care specialist, and follow up on his condition was done by case manager visits. Within a month of his admission and with the help of both the Wound Care and Diabetes programs, the wounds have all closed and Charles now has only some patches of dry, sloughing skin which are resolving quickly and his diabetes has remained under control.

7 April Is the Month of HOPE! By Jim Sturgeon, Senior Director, Human Resources, Kindred at Home Board Member, The HOPE Fund Kinded s HOPE Fund is in the midst of its annual fundraising campaign, Month of HOPE. We are deeply grateful to the many employees who give continuously to The HOPE Fund so that we can help our employees who are faced with disastrous events. If you have not been donating to the HOPE Fund, we hope you ll consider setting up a payroll deduction. Any size donation helps us to help others. The HOPE Fund team is well aware of the needs our employees have for assistance; but those of you who don t see the requests might wonder what some of the issues are. We can help you here by including this example of a recent HOPE Fund request. We d like you to meet a little girl named Evadny, whose mother, Ruby, is a Kindred employee. Ruby had been out of work for weeks due to illnesses prior to her delivery. Added to that were the out-of-pocket expenses for care for a premature baby, and the daily trips to the NICU. Ruby and her husband were struggling to get back on their feet. Her manager stepped in and applied to The HOPE Fund on her behalf, and her request was funded. Ruby was overwhelmed and wept with joy when she received her HOPE Fund check. As for Evadny, she was able to go home just two weeks before her original due date of March 27. She weighed a whopping 6.6 pounds. She s still on monitors, but she s home, she s happy, and she is a delightful little sister to her 8-year-old brother, Adan. She s also reached 7.5 pounds! Ruby was hospitalized seven times in the month preceding her daughter s birth. One of the issues from the hospitalizations caused her to go into early labor at just 28 weeks of pregnancy. And so, on January 8, Evadny made her entrance into the world weighing just 3.1 pounds. This little girl had physical problems, as premature babies often do. She had tubes and monitors attached everywhere, and she spent her first two months of life in the NICU. Ruby was hospitalized too, spending four days in the ICU with pneumonia after she delivered Evadny Kindred at Home CSR