The Centers for Medicare and Medicaid (CMS) penalizes hospitals for Medicare readmissions. Hospitals have difficulty tracking and managing patients after discharge. At Strategic Healthcare Programs (SHP), we look at millions of records each year from the Home Health Agency Outcome Assessment Information Set (OASIS) to correlate the patient characteristics that led to a transfer or discharge to an acute care hospital (readmission). With CMS incentives increasingly directed at reducing readmission rates, hospitals can maximize their Medicare reimbursement by selecting a post-acute care (PAC) home health care provider that uses actionable, real-time analytics.

The Home Health Groupings Model (HHGM), which is the most significant change to the home health prospective payment reimbursement model since its inception, was finally released on Thursday, July 28th as part of the Home Health Payment Proposed Rule for CY 2018, although it is not scheduled to be implemented until CY 2019.

On January 18th, CMS presented a slideshow through their Medicare Learnings Network on a possible new payment refinement to home health care reimbursement called the Home Health Groupings Model (HHGM). This was the second call in six months where Abt Associates, CMS’ contractor, shared the HHGM background in addition to the 178 page technical report they issued in November 2016. This sure seems to be picking up speed.

January 1, 2016 marks the start of the new Centers for Medicare and Medicaid Services (CMS) regulation on how hospices are reimbursed.

For many years Hospice has been under the radar, but not anymore.

Based on SHP's national database, visits per episode have been decreasing by close to a full visit over recent years, but there is something else in play.