On March 18, 2020 the Center for Medicare and Medicaid Services (CMS) announced that the draft OASIS-E instrument is now available on their OASIS Data Sets webpage. All clinical assessments will use the new tool as of January 1, 2021. As part of the IMPACT Act, CMS has been updating OASIS data elements to enable post-acute care (PAC) providers to report standardized patient assessment data, new quality measures, and data on resource utilization. The intent is interoperability which allows for the exchange of data using common standards and definitions, facilitates coordinated care, and improves outcomes for Medicare beneficiaries.

CMS has begun the process to remove the measure, Frequency of Pain Interfering with Patients Activities or Movement (“Pain”) from the Home Health Quality Reporting Program (HH QRP), as part of an effort to address the national Opioid crises. The Pain measure will no longer be publicly reported on HHC, Star Ratings, CASPER reporting, or any other QAPI program. How might this affect your star ratings? Read on.

SHP is pleased to announce a new suite of financial reporting to help home health agencies improve efficiency and maximize margin under the PDGM. The new PDGM Stay Detail and Period Detail reports show patient data within PDGM Core Categories at the home health stay level, and at the 30-day payment period level. They help guide visit utilization management, LUPA tracking, margin analysis, efficiency of functional improvement, and much more.

SHP is pleased to announce the release of our completely redesigned HHRG Worksheet tool. Since HHRGs have been completely overhauled with PDGM, SHP has took the opportunity to re-engineer the report to support the new payment rules and highlight potential revenue opportunities within the PDGM components. It is designed to explore the variety of factors which contribute to the HHRG score for patients. It provides a complete look into the HHRG, Case Mix Weight, and the Total Revenue for the payment period.

Our most heavily utilized report, Episode Einstein℠, just got a major upgrade to support the new payment model. Compare multiple assessments in a home health patient’s stay to monitor patient progress and improvement opportunities. The marriage of clinical and financial details make this a great case conference tool.

Finally, after a couple of years of preparation and anticipation, the Patient-Driven Groupings Model (PDGM) is underway. It’s a little early to get a read on how agencies are doing under PDGM, but one area I was curious about was how much agencies improved on coding “unacceptable” diagnoses (formerly known as Questionable Encounters, or QEs).

The CY 2020 Home Health Payment System Rate final rule was published last week and, as expected, the Patient-Driven Groupings Model (PDGM) will be implemented for 30-day periods of care starting on or after January 1, 2020. The good news is that CMS reduced the behavioral adjustment to 4.36%, just over half of the revised 8.39% estimates. Read our blog for highlights on the final rule, plus insights and predictions for what's to come.

SHP is pleased to announce the release of the PDGM Preview report to help home health agencies prepare for the January 1st, 2020 implementation of the Patient-Driven Groupings Model (PDGM). The PDGM Preview report provides a view into your 2019 payment episode information, as applied to PDGM 30-day payment periods, and grouped by HHRG. The report includes period breakouts by distribution, visit information, and LUPA rates, with state and national benchmarks.

We are pleased to welcome Columbine Health Systems as one of our first SNF customers. We look forward to working together to help Columbine optimize its resources under PDPM, improve readmissions, outcomes and relationship with referring entities.

PDPM is almost here and will drive a shift in the way SNFs think about provide care. The complexity of PDPM will require a cookbook of recipes that are more sophisticated, allow for individualization, and require a higher level of monitoring and tweaking to achieve the best outcome. To be successful, new tools and the right data will be essential to help SNFs optimally distribute resources, achieve desired outcomes, and maximize reimbursement. How is your SNF going to determine the right "recipes" for care?