Initial COVID-19 Results Under Medicare PDGM

December 02, 2020 Home Health
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.

CY 2021 Home Health Final Rule Behavioral Adjustment as Proposed

November 17, 2020 Home Health
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.

CMS Announces Home Health Data Frozen Until 2022

October 13, 2020 Home Health
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.

PDGM will stay the course

July 22, 2020 Home Health
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.

SHP announces 2019 Best-of-the-Best winners

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.

OASIS-E is delayed due to COVID-19

May 08, 2020 Home Health
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).

CMS OASIS-E is closer to reality

March 26, 2020 Home Health
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.

Star Ratings will not be painful anymore

February 04, 2020 Home Health
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.

New PDGM Period and Stay Detail reports released

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’s HHRG Worksheet redesigned for PDGM

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.

PDGM has arrived – Coding not so much!

January 09, 2020 Home Health
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).

CMS releases Home Health Final Rule: Behavioral adjustments cut in half

November 07, 2019 Home Health
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.

PDGM Preview Report Released

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.

SHP releases new PDGM feature: Unacceptable Diagnosis Alert

SHP is pleased to announce the release of a new Unacceptable Diagnosis Alert to help home health agencies prepare for coding requirement changes under PDGM. Come January 1st, 2020 primary diagnosis codes will be categorized as either “acceptable” or “unacceptable”. Our new alert will notify users whenever an unacceptable primary diagnosis code is entered. This will help agencies train their staff now to be ready for PDGM and avoid the delays and lost time associated with claim rejection and recoding.

Goodbye “Questionable Encounter”, Hello “Unacceptable Diagnosis”!

July 10, 2019 Home Health
In the CY 2019 Home Health Prospective System Rule Update, CMS finalized the ICD-10 codes that would be “acceptable” to use as a primary diagnosis code under the Patient-Driven Groupings Model (PDGM). The term "Questionable Encounters" (QE) was absent from the proposed and final rules, now there is only “acceptable” or “unacceptable” codes. Learn more and see whether SHP agencies are already phasing out unacceptable codes.

SHP announces 2018 Best-of-the-Best winners

The annual SHPBest™ recognition program was created to acknowledge home health and hospice providers that consistently provide high quality service. SHP would like to congratulate the 2018 SHP Best-of-the-Best winners, who have been recognized for achieving the highest overall HHCAHPS patient satisfaction or CAHPS Hospice caregiver satisfaction scores of all eligible SHP clients during the 2018 calendar year.

PDGM Insights are in the Period Details

May 29, 2019 Home Health
The home health industry is six months away from the new Patient-Driven Grouping Model (PDGM). There is a lot of educational content available to help agencies prepare but much of it reports on PDGM metrics and payments using average values. Using 30-day periods as an overall average can be misleading. It is more meaningful to break out this data into the sequence of periods across groupings like clinical category. In this way one can analyze the impacts of periods to help define the clinical and operational improvements necessary to manage your agencies under PDGM.

SHP enhances its risk of hospitalization model, helps agencies better prevent hospitalizations

February 13, 2019 Home Health
Given the significant role that hospitalization rates play in publicly reported scores, star ratings, and value-based purchasing calculations, preventing unplanned hospitalizations is one of the top priorities for home health agencies. To ensure that our clients have the best possible tools to identify patients that are at risk of being hospitalized and help prevent unplanned hospitalizations, SHP has released a major update to our acute care hospitalization risk model.

SHP’s CareStat aims to alleviate “Difficult Decisions About Post-Acute Care"

January 18, 2019 Home Health
An informative report from the United Hospital Fund described the overly complex process patients and their families go through to navigate Post-Acute Care (PAC) options such as skilled nursing facilities (SNF) and home health agencies (HHA) after a hospital stay. SHP's CareStat product addresses current challenges with transitioning care by providing hospitals and ACOs with real-time home quality and patient data.

CMS releases Home Health Final Rule: PDGM Starts in CY 2020

November 08, 2018 Home Health
The CY 2019 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. In our blog we provide a summary of changes to the model, such as the expansion of clinical groups from six to twelve, as well as home health PPS Case-mix updates and significant HHVBP changes confirmed in the final rule.

SHP Releases New Hospitalization Patient Detail Report

We are excited to announce the release of the Hospitalization Patient Detail report to our SHP for Agencies customers. This powerful new report provides a complete picture of the home-health stay for any patient, including: hospitalization risk, transfer history, and discharge details, with one row of data for each SOC/ROC to any available Transfer/Discharge. Also included are indicators for 30-Day Rehospitalizations, 60-Day Hospitalizations, Emergent Care, Hospitalization outcome details, and more.

CMS Proposes to Overhaul HHVBP

September 18, 2018 Home Health
In the CY 2018 Home Health Proposed Rule, CMS is dramatically changing the scoring methodology for the pilot program known as the Home Health Value-based Purchasing Program (HHVBP). What is striking to me is that these changes are being made during the fourth year of the five-year program, where up to 7% of Medicare revenues are at risk.

CMS Home Health Proposed Rule shares PDGM winners and losers

September 05, 2018 Home Health
In the CY 2019 Home Health Proposed Rule, CMS shared a level of detail not seen before – an agency specific list of how agencies will fare under the changes they are proposing. Wow. CMS shared the agency revenue impacts of the Patient-Driven Groupings Model (PDGM) versus the current 153-group PPS reimbursement revenue. The range of the revenue impact is quite wide. Looking at the SHP national database for CY 2017, about 17% of the 3.6MM payment episodes in our database had a primary diagnosis code that would be considered a QE under PDGM.

SHP releases OASIS-C2 to OASIS-D Crosswalk Guide

August 14, 2018 Home Health
With the OASIS-D assessment form going into effect on January 1st, 2019, SHP is pleased to provide home health agencies with a complete side-by-side comparison of the OASIS-C2 and expected OASIS-D assessment forms. This easy-to-follow guide is an excellent reference for anyone who works with OASIS Assessments and will improve accuracy, help reduce coding errors, and potentially reduce the number of returned claims.

SHP announces 2017 Best-of-the-Best winners

The annual SHPBest recognition program was created to acknowledge home health and hospice providers that consistently provide high quality service. SHP would like to congratulate the 2017 SHP Best-of-the-Best winners, who have been recognized for achieving the highest overall HHCAHPS patient satisfaction or CAHPS Hospice caregiver satisfaction scores of all eligible SHP clients during the 2017 calendar year.

Home Health CY 2019 Proposed Rule warms over HHGM

July 23, 2018 Home Health
July usually starts the month off with fireworks, but this year the proposed rule was issued on July 2nd with its own bang at just under 600 pages. The big news - Home Health Groupings Model (HHGM) is now the Patient-Driven Groupings Model (PDGM). Below are a few other highlights from the proposed rule related to the Home Health Value Based Purchasing (HHVBP) program, Home Health Quality Reporting Program (HHQRP), new Home Infusion Benefit and the changing HH PPS case-mix weights (CMW).

CMS announces new star rating algorithm

July 09, 2018 Home Health
CMS announced on their Medicare Learning Network (MLN) national call a proposed change to the Quality of Patient Care (QoPC) Star Ratings starting next year. CMS has proposed to eliminate the “Drug Education on all Medications Provided to Patient/Caregiver” measure and add the “Improvement in Management of Oral Medications” measure to the QoPC algorithm. What seems to be overlooked with these subtle changes is how often Star Ratings by provider change each quarter.

Home Health Value-Based Purchasing – What scores should I be shooting for?

June 05, 2018 Home Health
With the second performance year (CY 2017) of HHVBP over, I wanted to see how the year over year measure outcomes changed across our SHP national database. Comparing the same agencies year over year it appears both HHVBP states and Non-VBP states improved about the same on their average outcomes and process measure scores with little change in the HHCAHPS scores. Notice that with a few exceptions, VBP agencies had better outcomes than their non-VBP state agency peers. I expect CMS has noticed that too. In deciding what scores you want to target, it is best to know what percentile rank you want to realistically achieve.

CMS Open Door Forum concludes a busy news month

March 06, 2018 Home Health
On February 28th CMS ended the month hosting their regular Home Health Open Door Forum with some very notable updates to the home care industry. With little fanfare and during the Q&A portion, CMS responded to a question regarding the timing of the new OASIS forms as OASIS-D!

CMS confirms changes to Quality of Patient Care (QoPC) Star Ratings

December 24, 2017 Home Health
At their December 14th HH QRP webinar, CMS announced the deletion of the Influenza Immunization Received for Current Flu Season measure from the algorithm in calculating the home health Quality of Patient Care (QoPC) Star ratings. CMS made this after the month-long comment period ended in November 2017. The change will take effect in the April 2018 Home Health Compare (HHC) refresh.

HHGM is not finalized — but here are the final rule changes you still need to know

November 07, 2017 Home Health
The CY 2018 Home Health Payment System Rate final rule was published last week and CMS announced the news the industry was hoping to read – “We are not finalizing the implementation of the Home Health Groupings Model (HHGM) in this final rule.” Below are a few other highlights from the final rule related to the Home Health Value Based Purchasing (HHVBP) program, Home Health Quality Reporting Program (HHQRP) and the changing HH PPS case-mix weights (CMW).

What’s next – OASIS-C3 or OASIS-D?

August 15, 2017 Home Health
The big news in the latest proposed rule for HH PPS was the Home Health Groupings Model (HHGM). Along with the typical recalibration to case-mix payments and case weights, did you see the significant proposals regarding the Home Health Quality Reporting Program (HH QRP)? Almost a third of the 389 pages in the rule were in regard to the HH QRP.

Home Health Groupings Model (HHGM) is Here

July 31, 2017 Home Health
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.

SHP Announces 2016 Best-of-the-Best Winners

The annual SHPBest recognition program was created to acknowledge home health and hospice providers that consistently provide high quality service. We are pleased to announce the 2016 SHP Best-of-the-Best winners, who have been recognized for achieving the highest overall HHCAHPS patient satisfaction or CAHPS Hospice caregiver satisfaction scores of all eligible SHP clients during the 2016 calendar year.

Home Health Payment Groupings Model is gaining momentum

February 02, 2017 Home Health
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.

Amedisys uses SHP benchmark data in pilot program to lower readmissions, empower patients

After seeing promising preliminary results, our customer Amedisys is expanding a pilot program that aims to lower overall costs through fewer readmissions. The outcomes from the pilot and future results from the program will be evaluated against Strategic Healthcare Programs' (SHP) benchmark data on 3 metrics: hospital readmission rates, functional status of the patient and shortness of breath.

Value Based Purchasing – What is my target?

September 11, 2015 Home Health
One of the sections in the Home Health Proposed Rule outlines how Home Health Value Based Purchasing (HHVBP) total performance scores will be calculated. Both sets of calculations are derived using base year scores. Thus the quandary...

CMS Continues to Surprise

August 05, 2015 Home Health
The Home Health Proposed Rule was posted by CMS on the Federal Register July 10th and it was full of surprises, especially in light of the much anticipated proposal on Value Based Purchasing (VBP).

July is Heating Up

July 09, 2015 Home Health
It’s going to be a busy month. The Home Health Proposed Rule was just issued and the new Home Health Compare measures for 30-day readmissions and Quality of Patient Care star ratings, along with the PEPPER reports are all scheduled to be released.

30-Day Readmits - A Deeper Dive into CHF Trends

May 11, 2015 Home Health
I was curious to see how rehospitalization rates have been changing over the last several years. With CHF widely being touted by CMS as one of the diagnosis categories with high avoidable readmissions, I figured I would start there.

OASIS-C1 Reimbursement Comparison (Complementary Tool)

December 08, 2014 Home Health
As you reach the final stages of your OASIS-C1 preparations, take a moment to double check your processes and ensure you are ready for the 2015 PPS changes. A lot is changing in how case mix points and HHRG scores are calculated and there are some simple tools available to help you understand these changes and maybe make your New Year a little brighter.