InnovAge: Citing CMS Audit, Company Management Notifies Staff of At Least a Dozen Areas in Need of Improvement

Published on Sep 10, 2021

On an internal staff call earlier today, InnovAge (INNV) management notified doctors and nurses of at least a dozen areas of improvement in its Colorado operations, citing issues found in the Centers for Medicare and Medicaid audit of the company’s Colorado operations. InnovAge, which is based in Colorado, is the country’s largest provider of senior healthcare services under the Program for All Inclusive Care for the Elderly (PACE) and receives over 99% of its funding from a mix of federal Medicare and state Medicaid dollars.

The areas for improvement, according to management, include:

· Ensuring the interdisciplinary team (IDT) coordinated care delivery

· Ensuring primary care provider oversight of patient use of medical specialists

· Appropriate categorization of service determination requests

· Recognition of patient complaints as grievances

· Conducting initial and semi-annual in-person assessments as often as required

· Ensuring that all personnel and contractors that have direct participant contact act within their scope of authority and practice

· Maintenance of medical records that are complete, accurate, and available to staff

· Ensuring participants and caregivers are involved in the development and reevaluation of a participant’s care plan

· Development and reevaluation of care plans in a timely manner

· Ensuring the IDT remains alert to pertinent input from other team members, caregivers, and participants

· Ensuring required IDT members are involved in creating and reevaluating care plans

· Providing services that are accessible and adequate to meet the needs from participants

During the training call, of which The Capitol Forum obtained a recording, company management gave no indication as to the scope of the findings or any potential repercussions of the findings, nor did they say whether the CMS audit had concluded. A separate audit conducted by the Colorado Department of Healthcare Policy and Financing (HCPF), which oversees InnovAge’s Medicaid funding, is still ongoing as of last week and no findings from that audit have been disclosed.

Management also told staff that CMS had found similar issues in a separate audit of some of InnovAge’s operations in California. “As you can see, California and Colorado pretty much have the same areas of opportunities” for improvement, the speaker on the Zoom conference said.

The issues highlighted by management broadly touch on almost every aspect of a PACE program’s operations because coordination among the interdisciplinary team of doctors, nurses, dieticians, and social workers is key to a PACE program’s goal of early intervention and holistic care.

As such, InnovAge devoted a large portion of the call to training staff to appropriately track patient diagnoses and orders.

“Some of the efforts you are going to be seeing for fiscal year 2022” the call leader said, “the goal is to improve processes and delivery of care services. As you should know, we’re looking to replace our current EMR [Electronic Medical Records] with Epic.”

The company also intends to work on “eliminating order delays and help with the backlog.” The Capitol Forum has previously reported on delays in medical orders at InnovAge facilities that have stretched well over six months, and an email from an InnovAge center director ordered staff to cancel over 300 orders that were six months outstanding.

This audit, as previously reported by The Capitol Forum, came as a surprise to InnovAge, with auditors showing up at the company’s centers minutes after informing the CEO of the action. Another goal for 2022, the call leader said, was to do “more audit preparation… to pass our audits. There will be more of those types of practice rounds to get us more in tune.”

While InnovAge management did not discuss any potential consequences stemming from the CMS audit, CMS has previously barred other PACE programs from enrolling new participants until identified deficiencies were fixed.

InnovAge, CMS, and HCPF did not immediately respond to a request for comment.