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.

CMS has announced that routine inspections for all Medicare- and Medicaid-certified providers and suppliers will soon resume, after suspending them as part of its response to the COVID-19 pandemic in March. Our Survey Risk Report can address risk indicators by ranking facilities that may be prioritized for survey based on the criteria.

On April 19, 2020, the Centers for Medicare and Medicaid Services (CMS) issued a QSO memorandum notifying nursing homes of new reporting and surveillance requirements in response to the (COVID-19) pandemic. IntelliLogix reporting tools help facilities analyze and manage data.

The 2020 AHCA/NCAL National Quality Award Program recipients have been announced and we are extremely pleased to congratulate the impressive 138 Team TSI clients who received the award this year.

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.

This new report helps long-term care and skilled nursing facilities analyze your NHSN weekly data and compare with county, state and national averages.

CMS announced a plan to send point-of-care tests directly to every nursing facility in the country. Based on the Clinical Laboratory Improvement Amendments (CLIA) however, unless the building has a specific waiver allowing staffers to perform tests, the facility will not receive the units. Facilities must secure a CLIA waiver in order to receive one of the free units.

The new COVID-19 NHSN Weekly Data Survey gives you the power to easily create and manage surveys. It walks you through survey questions based on the four Pathways outlined by NHSN—Resident Impact and Facility Capacity, Staff and Personnel Impact, Supplies & Personnel Protective Equipment, and Ventilator Capacity & Supplies.

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.

To further enhance our role as a data analytics partner for post-acute care organizations, SHP is proud to announce its acquisition of Team TSI. Team TSI is a leader in data analytics solutions for skilled nursing facilities (SNFs) that has been in business for 30+ years.

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).

As we continue to work through the COVID-19 pandemic, there is still much that can be done in preparing for potential recurrence or resurgence in the days and months ahead. Adequate assessment, critical planning, and implementing essential processes will be crucial in the following months.

COVID-19 has changed the way the world, thinks. Some say we have a “new norm” and it is going to take new strategies to face the unique challenges evolving every day. Along those lines, it is essential to look with fresh eyes at those who are not only dealing with their own safety, but those who are the first responders and are on the front lines caring for others. Here are six tips for supporting our front-line heroes.

With the implementation of the Patient Driven Payment Model (PDPM) on October 1, 2019 by CMS, it is important for SNFs to understand the new payment system that will help them transition smoothly into a value-based environment. Learn what's changed.

In response to recent CMS announcements regarding COVID-19, Team TSI has instituted additional coding alerts that are designed to inform providers to potential issues related to COVID-19 and updated CMS guidelines or waivers that may have an impact on MDS coding as well as resident care and services. These alerts are in no way meant to suggest or imply a change in coding is warranted; simply to alert providers to review the most recent CMS guidelines and waivers that may be in effect.

Section 6106 of the Affordable Care Act (ACA) requires facilities to electronically submit direct care staffing, including agency and contract staff and census information on a quarterly basis. The Centers for Medicare and Medicaid Services (CMS) has named their reporting system the Payroll-Based Journal (PBJ). What do you need to know?

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.

In response to recent CMS announcements regarding COVID-19, SHP has instituted additional coding alerts that are designed to inform providers to potential issues related to COVID-19 and updated CMS guidelines or waivers that may have an impact on MDS coding as well as resident care and services. These alerts are in no way meant to suggest or imply a change in coding is warranted; simply to alert providers to review the most recent CMS guidelines and waivers that may be in effect.

MDS 2020 is coming. While information is scarce, our industry experts have been hearing rumors and considering how Team TSI will tackle this new challenge. We asked them to share their thoughts.

For the first time, day to day, clinical personnel fluctuations are being made transparent. This new data required to be captured by the Affordable Care Act of 2010 and analyzed by Kaiser Health News is showing a not-so-pretty picture. Medicare has begun gathering and mining staffing information utilizing payroll data across more than 14,000 nursing homes. No longer is self-reporting for nursing homes an option.

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.

PDPM has been active for three months already and, as we predicted, it’s turning out to NOT be budget neutral. As has happened with previous adjustments to payment methodologies, when providers become more familiar with the system and start maximizing benefits, CMS will adjust rates. Providers are enjoying the benefits of adjusted therapy hours and rates but need to be prepared for potential/probable rate adjustments.

Since CMS launched its Five Star rating system for Medicare and Medicaid certified nursing homes in 2008, the pressure has been on for nursing homes to utilize measures to improve quality measure scores and stars. The rating system is a tool to help consumers compare and select a skilled nursing facility by awarding stars in three separate parts, or elements, of the star rating for each nursing home.

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).

With intimate knowledge of the residents they have been caring for; such as traits, likes, dislikes, wishes, and more—coupled with the resident’s clinical conditions, resident aides are considered crucial members of the optimal resident-centered care team. But does the clinical collaborative team stop there? The answer should be NO!