Low Case Weight, High Admin Costs, Lengthy Days to RAP: What’s the Real Culprit?

By Lynda Laff
January 23, 2013 Home Health

Lynda Laff

Lynda Laff is a familiar and much respected consultant. Home health agencies, hospices and home healthcare vendors across the country regularly call on her for insights and she has done a lot of work with us here at SHP. She brings a tremendous store of senior management knowledge, hands-on implementation experience and industry "smarts" to every assignment.

Low Case Weight, High Admin Costs and Lengthy Days to RAP:  What’s the Real Culprit?

I work with many home health agency owners and CEOs to help them identify why they’re losing money and what they can do to improve clinical productivity.  Clinical “productivity” is typically where the finance department focuses first. However, I’ve found that while this is a factor, it is rarely the main reason an agency is losing money. Too often the real culprits behind low case weight, high administrative costs and lengthy days to RAP are OASIS inaccuracy and diagnosis coding inefficiencies. Because of the constant cost increases and trickling cash flow the industry faces, an inefficient OASIS review process can literally put an agency out of business.

It is extremely important to evaluate your OASIS coding and quality review process and determine if you are spending money wisely. Clinical managers have a way of protecting “comfortable” behavior – meaning that there is a reluctance to trust new methods and new technologies designed to assist and streamline the review process. Consequently, available tools are not correctly implemented allowing inefficiencies to persist.

Fear that “something will be missed” by letting go of manual OASIS review often means that data management systems like Strategic Healthcare Programs do not always get correctly integrated into the review process. Manually reviewing a single OASIS assessment can take an hour or more.  If the clinical reviewer continues the “comfortable” manual review process prior to letting the software do its job FIRST, the agency will see less increased efficiency or financial benefit from their data management system. This duplicative OASIS review process is essentially like “cleaning the house before the maid comes.”

Diagnosis codes and other measures recorded in OASIS are the basis for both patient and agency outcomes including episode revenue. Some agencies separate the responsibility of reviewing codes and other measures between a certified coder and a certified OASIS-C reviewer. Some have one person (hopefully a clinician) who fills both roles. In either case, it is critical that these highly trained and costly staff members are utilized for maximum financial and quality assurance benefit to the agency. This can only be achieved by using a data scrubbing system to streamline the workflow for these employees.

Here’s how a good data “scrubbing” system like SHP should work. Assessments are “swept” and “scrubbed” by the system as soon as the field clinician completes the OASIS and releases it for review. CMS requires the admitting clinician to document the diagnosis descriptions in the appropriate OASIS fields. Most information systems will give the clinician a group of codes associated with the descriptors from which they select the appropriate codes. Although most clinicians are not expert coders, they know which codes to select for the majority of common diagnoses – but the important issue here is – the coder will get alerts for coding convention errors as well as suggestions for more appropriate codes to use, leaving only codes missed by the field clinician to be identified by the coder. 

Depending on the number of co-morbidities involved, a diagnosis coder with “scrubbed” alerts from the vendor should be able to code diagnoses for a minimum of 25 OASIS assessments a day (diagnosis coding only). The total OASIS quality review should not take more than 20 to 30 minutes if using a scrubber. The bottom line is that the coder can process a much higher volume of OASIS assessments per day if the data is scrubbed before their review of the OASIS codes.

Best regards,
Lynda Laff RN, BSN, COS-C
Laff Associates


About the Author
Lynda Laff
Lynda Laff
RN, BSN, COS-C Home Care and Hospice Consultant Laff Associates
Lynda Laff is a familiar and tremendously respected consultant. Home health agencies, hospices and home health care vendors across the country regularly call on her for insights and she has done a lot of work with us here at SHP. She brings a tremendous store of senior management knowledge, hands-on implementation experience and sheer industry "smarts" to every assignment.

She has held several senior management positions and worked as a consultant for home health and hospice agencies. She has successful hands-on experience with Telehealth implementation, change management, clinical operations management and outcomes improvement in the home care setting.

Lynda served as a JCAHO home care and hospice registered nurse surveyor for 10 years. She has conducted workshops at state and national home health care and hospice forums on an array of subjects; including home care clinical models, management and operations, home care outcome improvement strategies, hospice QAPI compliance, Telehealth implementation and OASIS-C.

She was selected by the National Association for Home Care to develop and present workshops on PPS implementation in 2000 and 2007 and to represent NAHC in presentations on operational strategies to home health administrators in preparation for the 2008 CMS Home Health PPS. She has published articles in Caring Magazine, DecisionHealth, Clinical Nurse Supervisor, The ACHCThe Surveyor, and The Remington Report. She consults nationally with home health agencies, hospices and home health care vendors.