Now that CY 2023 is closed and we await the CMS CY 2025 proposed rule for home health, it is an opportune time to revisit the data trends in the Patient Driven Groupings Model (PDGM) by leveraging SHP national benchmarks. Delving into these insights, one can discern intriguing patterns that have emerged over the years. To no one’s surprise, Home Health Agency (HHA) Medicare visits per 30-day period have continued to decrease over the first four years of PDGM.

Since the advent of Payroll Based Journal (PBJ) reporting by CMS in 2016, facilities have struggled with preparing and submitting accurate PBJ data. Penalties applied for a failure to submit complete and accurate data can result in defaulting to a one-star rating and negatively impacting overall 5-star ratings.

In the first week of January 2024, CMS quietly announced the release of the latest draft of OASIS version E1. The subdued announcement can be attributed to the limited updates planned for the tool, set to take effect on January 1, 2025. CMS has mentioned that the accompanying OASIS-E1 manual will be made available at a later date.

The recently published Medicare and Medicaid CY 2024 Home Health Prospective Payment System Rate Final Rule, documented in the Federal Register on November 13th, solidifies significant shifts in the Home Health Value-Based Purchasing Program (HH VBP) and Home Health Quality Reporting Program (HH QRP). Despite input from industry stakeholders, the Centers for Medicare & Medicaid Services (CMS) held firm on their proposed changes.

In the recent release of the Medicare and Medicaid CY 2024 Home Health Prospective Payment System Rate Final Rule, CMS finalized the PDGM permanent behavioral adjustment. Originally proposed as a 5.779% cut, CMS decided to phase in the reduction, with only half of the rate being adjusted in CY 24. This mirrors the approach taken in the previous year, where the proposed permanent behavioral cut was also halved.

BerryDunn is pleased to announce that the National Association for Home Care and Hospice (NAHC) has joined the firm in launching a research study and quality improvement project aimed at helping home health and hospice agencies improve patient and family satisfaction. In addition, Strategic Health Programs (SHP), a leading data analytics and benchmarking company, will play a pivotal role in facilitating streamlining data for the project.

The 2023 AHCA/NCAL National Quality Award Program recipients have been announced and we are extremely pleased to congratulate the impressive 127 SHP clients who received the award this year.

The annual SHPBest™ award program was created to recognize home health and hospice providers that consistently provide outstanding performance in patient and caregiver satisfaction. SHP would like to congratulate the 2022 SHP Best-of-the-Best winners, who have been acknowledged for achieving the highest overall HHCAHPS patient satisfaction or CAHPS Hospice caregiver satisfaction scores of all eligible SHP clients during the 2022 calendar year.

CMS shared the details of the new Hospice Special Focus Program (SFP) in the CMS Home Health Prospective Payment System Proposed Rule posted in the Federal Register on July 10th. While expected, CMS often adds rule-making for non-home health services when either timing or urgency makes it necessary. Based on the scrutiny Hospice has been under from numerous OIG reports and the negative publicity from articles written by ProPublica and the New Yorker, Hospice has been in the crosshairs of increased oversight.

The proposed CMS Home Health Prospective Payment System Rate Update was released on Friday, June 30th in advance of the official posting to the Federal Register on July 10th. CMS is proposing an overall 2.2% rate cut that includes a market basket increase of 3.0% (less a productivity adjustment of .3%) along with a 5.65% cut due to permanent behavioral adjustments in switching from PPS to PDGM. Since the CY 2023 rulemaking reflected only half of the permanent behavioral cuts (using data from CY 2020 and CY 2021), CMS is proposing to implement the second half of the CY 2023 cut along with another 1.51% to account for behavioral changes recognized in CY 2022.