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.
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.
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.
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.
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.
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.
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.
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.
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.
Now that we know the Patient-Driven Groupings Model (PDGM) will officially start January 1, 2020, it’s time to dig a little deeper into understanding how the case-mix weights of the 432 PDGM groups were established.
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.
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.
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.
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 is pleased to announce Brightree recently incorporated our OASIS Integrated Alerting functionality into their iPad point-of-care app. This enhancement gives our joint customers the tools they need to improve speed and efficiency, while continuously providing high-quality care to patients.
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.
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.
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 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.
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.
Amedisys has been steadily expanding their breadth of care into markets across the continuum. Part of the company’s strategy of adding personal care services to improve care involves enhancing overall capabilities through new technologies. In 2016 Amedisys announced it would partner with Strategic Healthcare Programs (SHP) to help achieve this goal.
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!
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.
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).
Republished with permission from Decision Health. Article originally published on Home Health Line October 16, 2016. Whether they’re discussing QAPI, 5-star ratings or rehospitalization rates in general, more and more agencies are showcasing their quality of care when they market to referral sources, a new HHL survey shows.
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.
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.
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.
Brightree LLC, a leading provider of cloud-based software, and Strategic Healthcare Programs (SHP), a leading provider of data analytics and benchmarking to post-acute care providers, have released Integrated Alerting to further enhance the existing interface between two companies.
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.
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.
CMS issued the Final CY 2017 Home Health PPS Rate Update in the Federal Register on November 3rd. All of the proposals to update the VBP program were finalized with no changes regardless of stakeholder comments, except for one...
With provider and industry comments now in, the Centers for Medicare and Medicaid Services (CMS) will take the next 60 days to evaluate and make any suggested changes in the Home Health CY 2017 Final Rule.
Value-Based Purchasing: CMS says “No” to 4 new measures.
SHP is pleased to provide you with a complete side-by-side comparison of the OASIS-C1 and OASIS-C2 assessment forms.
With March coming to a close, it is important to intensify your efforts so that patients whose episodes start before the end of the month have access to the flu vaccine.
CMS recently announced they were establishing a new technical expert panel (TEP) to review the Quality of Patient Care Star Ratings.
Republished with permission from Decision Health. Article originally published on Home Health Line January 11, 2016. The list of quality measures for home health CMS may ultimately use to help determine payments to agencies just grew six measures longer.
On December 31st, CMS released their first Q&A on the CMS website, and in doing so provided some key information.
Earlier this month CMS provided many updates with the release of the 2016 final rule and Value-Based Purchasing program. However, home health agencies are still waiting for vital information they need to determine their agency’s overall quality.
With the addition of Star Ratings to Home Health Compare this year, agencies now have an indicator of overall clinical quality.
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...
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).
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.
I was curious to see how the Medicare case-mix weights and revenue were impacted, relative to the Home Health Final Rule published on November 6, 2014.
As one of our most popular reports, the Clinical Executive Advantage serves as a starting point for high level data analysis across a wide spectrum of clinically oriented home health quality metrics.
CMS announced an additional set of Star Ratings for HHCAHPS.
CMS is introducing new reports as an educational tool for Home Health Care in July 2015.
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.
CMS made the Star Rating Preview Reports available within the last two weeks. Where does your agency fall in the ratings?
There's still time to submit a Participation Exemption Request, but not much!
What’s not to love about CMS’ star rating system for home health? Plenty.
With CMS’s proposed Five-Star quality rating system, overall quality will be depicted as one score, ranging from one to five stars.
To help Home Health agencies navigate the changing PPS landscape, SHP has released a new version of the popular HHRG Worksheet.
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.
Rumors have been circulating that come 2019, all patient assessment documents would utilize one instrument.
Clients using the Delta Crescendo software now have access to a new style of SHP interface!
Home health offers hospitals one of the best strategies to reduce admissions, but are we living up to the challenge? See what the data show.
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.
True performance improvement happens when you marry data with high accountability and embed it in your daily process. The right tools make it possible.
This guide is an excellent reference for anyone who works with OASIS Assessments to improve accuracy.
Attaya will be a panelist on the FMC Financial Managers Open Forum / Closing General Session.
SHP clients now have even better insights into how well telehealth technologies are reducing visits without compromising quality, lowering hospital readmissions rates, controlling costs, improving clinical outcomes, and leading to a better patient experience.
In the State of the Industry Report for Home Health and Hospice, three things in particular struck a chord with me as a technology executive
Long-time SHP client National HealthCare Corporation (NHC), has been named by Forbes magazine as one of the 100 Most Trustworthy Companies in America.
Efforts on the vendors’ part will greatly ease the transition(s) for home health agencies.
Despite double warnings, late recerts continue to be an issue. Why do they matter and what can you do about it?
Costs may continue to increase, even as reimbursement rates decline. Efficiency and productivity are being cut because of downsizing.
In late February, CMS announced that, for the first time, quality measures have been added to Physician Compare for group practices and ACOs.
In the period November 1st, 2013, through January 30th, 2014, we averaged a new client every other business day.
We think the new measure is more favorable to home health and strikes a nice balance between emulating the hospital measure and giving agencies an accurate evaluation of their performance.
If you insist on outsourcing your coding, we’re very accustomed to working with those organizations in a complimentary manner.
Clients of HCHB now have access to a new style of SHP interface where both transmission of data and retrieval of all SHP alerts takes place directly within the HCHB application.
Take a look at the data, particularly the difference in length of stay, but with little impact on quality metrics.
I'm interested in learning how your agency has responded to the change.
We're pleased to announce that the SHP Real-time Home Health Compare report will be right in synch with the CMS changes.
SHP clients have access to a breakdown of average visits by discipline on the Financial Executive Advantage report.
Whether looking at financial, clinical or patient satisfaction benchmarks, an organization needs to compare itself to a robust peer group.
The total OASIS quality review should not take more than 20 to 30 minutes if using a scrubber.
It’s difficult enough to get into SHP’s top 20 percent rank, so imagine what it takes to be No. 1.
We thought it was interesting and just wanted to share that with you.
To drive compliance even more, SHP is working with select home health vendors to integrate these edits directly into their software.
Agencies may use the MAHC-10, including incorporating it into internal documents and computer systems, at no cost.
As reimbursement shrinks and costs inch up, it’s so important to let go of old behaviors and let efficiency reign.
Hospital-based agencies have had lower re-admit rates in general, and tend to lead the industry by a month or more in declining readmit rates.
Too few people have too little data on what actually drives patients into the hospital.
The report contains a line item list showing where all the Case Mix points are being generated – essential for staff education and financial management.
This dilemma paints agencies into a corner, and they answer 'no' to M1910 on OASIS, thus resulting in poor public scores.
With additional public reporting on the way for both home health and hospice, as well as performance-driven payment and stiffer competition, providers have to work differently than they have in the past.
How about the variance between case weights at RAP and Final Claim?
Two HHCAHPS administration tools are now at your disposal to make this possible.
Managers and executives can determine the impact of telemonitoring on hospitalization rates, Home Health Compare outcomes and a host of other metrics.
With the new interactive staff Overview and Scorecard reports no piece of information remains a mystery.
Shared clients can intelligently manage financial data, staff performance, clinical outcomes, patient satisfaction (HHCAHPS), CMS Home Health Compare scores and home care benchmarks – all from one dashboard.
Remember, interpersonal communication is determined to be the single most important contributor to patient satisfaction.
If you have an outside data management company such as Strategic Healthcare Programs (SHP) and you have been analyzing your process measure data, good for you.
54.8% of home care agencies chose their HHCAHPS vendor because of their relationship, SHP is the largest HHCAHPS vendor. Thank you for your vote of confidence.