Effective April 1st 2020, CMS embraced the new ICD-10 code (U07.1) by adding it to the MMTA-Respiratory Clinical Group to reimburse home health agencies for these patients. I was curious to see how the PDGM model aligned specifically to these patients. Read more to see how frequently COVID-19 was utilized as a primary diagnosis code in Medicare PDGM 30-day period starts, and how COVID-19 patients compare to the SHP national database in regards to Comorbidity Adjustments and Functional Impairment. Also a look at Source and Timing attributes of COVID-19 stays, along with case-mix weights, and LUPA rates.

CMS published the CY 2021 Home Health Payment System Rate final rule on November 4th. As it stands, all of the PDGM methodology, the Behavioral Adjustments level, LUPA thresholds and case-mix weights will be kept the same in CY 2021 as they were in the first year of PDGM. With another quarter of data under our belts and with the better understanding and management of COVID-19, Chris Attaya takes a look at several areas of expected PDGM behavioral changes.

The advent of the Patient Driven Payment Model (PDPM) significantly expanded the Minimum Data Set (MDS) items that impact reimbursement and moved the focus from therapy minutes and ADLs to clinical diagnoses and resident characteristics. Now, more than a year post-implementation, there appears to still be significant opportunity to improve coding accuracy in areas that drive payment.

CMS recently announced some changes that will be implemented in the Hospice Quality Reporting Program (HQRP). For one, they are proposing to replace the Hospice Visits when Death is Imminent Measure Pair (HVWDII) with one new claims-based measure, Hospice Visits in the Last Days of Life (HDVDL). Another big announcement is that after the November 2020 refresh, Hospice Compare data will be frozen until February 2022. Hospices will need access to real-time quality scores to guide and enhance their quality improvement programs.

CMS recently announced that data displayed on the Home Health Compare (HHC) website will remain the same until January of 2022. That does not mean Home Health agencies should get complacent however. Performance now will affect future scores. In order to manage quality scores, home health agencies and hospices need access to real-time scores to guide and enhance their quality improvement programs.

What does CMS have in store for the Home Health (HH) industry in CY 2021? PDGM will stay the course, good news for most agencies, whose operations have been mired with the impacts of COVID-19. Looking at the SHP National database for the first six months compared to the CMS PDGM model, there are clearly some behavioral changes that we are beginning to observe. Changes related to comorbidity adjustment, functional impairment, and LUPA rates are highlighted in the blog.

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 2019 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 2019 calendar year.

Last week, the Centers for Medicare and Medicaid Services (CMS) announced in their Interim Final with Comment Rule a delay in the implementation of OASIS-E which was slated to begin on January 1, 2021. This is good news for Home Health Agencies (HHAs) that have been consumed with the impact of COVID-19 as part of the Public Health Emergency (PHE).

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.