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CMS Finalizes PDGM: PPS Final Rule Increases HHA’s Payments for 2019

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Clinical Practices, Healthcare, Legislation, Payment Rates, PDGM, Value-Based Purchasing

CMS Finalizes PDGM: PPS Final Rule Increases HHA's Payments for 2019

PPS final rule increases agencies' payments for 2019, finalizes PDGM

 
Wednesday, October 31, 2018, according to Decision Health, CMS has finalized a plan to launch a budget-neutral payment model for home health that utilizes 30-day periods of care and stops using the number of therapy visits to determine payment. That’s according to the 2019 PPS final rule posted Oct. 31 on the Federal Register website. The Patient-Driven Groupings Model (PDGM) will launch “on or after” Jan. 1, 2020, according to the final rule. That language differs from the proposed rule, when CMS indicated PDGM would start on Jan. 1, 2020 (Decision Health, 2018). Additionally, another major change with the final rule is that PDGM will have 432 HHRGs - which is of course double the number of HHRGs outlined in the proposed rule. Home health agencies have spoken and CMS has listened. The change is also likely to the 12 clinical groups that capture the most common primary diagnoses in home health. In the proposed rule, CMS only had sought six clinical groups: musculoskeletal rehabilitation, neuro/stroke rehabilitation, wounds, behavioral health care, complex nursing interventions and medication management, teaching and assessment (MMTA) (Decision Health, 2018). CMS wrote, “We note that although we are categorizing patients into [12] groups according to the principal diagnosis, these groups do not reflect all the care being provided to the home health patient during a 30-day period of care,” CMS states in the final rule. “Home health care remains a multidisciplinary benefit. Additionally, as stated in the CY 2019 HH PPS proposed rule, we will continue to examine trends in reporting and resource utilization to determine if future changes to the clinical groupings are needed after implementation of the PDGM in CY 2020” (Decision Health, 2018).

Payments to Rise in 2019

Decision Health writes, "Adjustments to Medicare’s home health payments under the final rule will increase agencies’ total reimbursement by 2.2%, or $420 million. What this increase means is that the effects of a 2.2% home health payment update percentage are now reflected from a 0.1% increase in payments due to decreasing the fixed-dollar-loss ration mandated by the Bipartisan Budge Act of 2018. Additionally, in order to pay no more than 2.5% total payments as outlier payments, a 0.1% decrease in payments due to the new rural add-on policy by the mandate. In contrast, the 2018 PPS final rue included a 0.4% or $80, payment reduction. The PPS final rule for 2019 now opens the  door for home health agencies to get paid by Medicare Part B to administer home infusion therapy for certain payments who don't qualify for the home health benefit. However, that change would not benefit home health agencies until 2021.

Other Changes Finalized in the Rule

  • No more requirement for a physician estimate - On or after Jan. 1, 2019 the requirement that the certifying physician estimate are required to estimate how much longer skilled services are needed for continued care. Thank you CMS.
  • Value-base purchasing changes (again) - Among the biggest changes to value-based purchasing is CMS’ decision to remove two OASIS-based measures and replace three other, existing OASIS-based measures with two new composite measures designed to evaluate improvement in activities of daily living (ADLs) (Decision Health, 2018).
  • Remote patient monitoring update - It seems CMS is embracing innovation and modernization of health care by allowing the cost of remote patient monitoring to be reported by home health agencies as allowable coast on the Medicare cost report. CMS stated in the final rule, “This is expected to help foster the adoption of emerging technologies by home health agencies and result in more effective care planning, as data are shared among patients, their caregivers and their providers" (Decision Health, 2018).
Read the final PPS rule at: https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-24145.pdf Resources Centers for Medicare & Medicaid Services (2018). Center for Clinical Standards and Quality /Quality, Safety & Oversight Group. Department of Human and Health Services. CMS.gov. Retrieved from: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/QSO-18-13-HHA-.pdf Cornell Law School (2018). 42 CFR 484.60 - Condition of participation: Care planning, coordination of services, and quality of care. Legal Information Institute. Retrieved from: https://www.law.cornell.edu/cfr/text/42/484.60
Check out our FREE 30-minute webinar for OASIS-C2 corrections and more. Select Connects with Clinicians Click here to read more.
Select Data is committed to a strong compliance program that includes educating all personnel on mitigating HIPAA breaches. For more information about Select Data and their commitment to quality in Home Health and Hospice, call 1.800. 332.0555.

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Coding Is A Fixed Cost-Make It A Return On Investment

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Clinical Documentation Improvement, Healthcare, Value-Based Purchasing

Coding Is A Fixed Cost-Make It A Return On Investment

Leading the way by preparing Home Health Agencies for Value-Based Purchasing

 

We help you focus on patient outcomes

Coding should provide an accurate picture of the patient's clinical condition and help drive the focus of care. Coding to the highest level of specificity is a necessary part of providing quality care. It is not enough to review the entire integrated OASIS assessment for completeness and congruency. We query the agency clinician on incongruencies between the physician orders, clinical record and patient's condition. Our process changes behavior because we engage the clinician when suggesting changes. Have you outsourced coding? Are you happy with it? Select Data provides professional coding services to Home Health and Hospice agencies and are industry experts in the language of CMS. Select Data helps reduce reportable hospital readmissions up to 40%. We assist agencies with the accurate representation of their patient. To find out how Select Data can help you improve coding accuracy check out our OASIS review and coding services. To download the more information on how Select Data reduces reportable hospital readmissions fill out the information below

   
Check out our FREE 30-minute webinar for OASIS-C2 corrections and more. Select Connects with Clinicians click here to read more.
Select Data is committed to a strong compliance program that includes educating all personnel on mitigating HIPAA breaches. For more information about Select Data and their commitment to quality in Home Health and Hospice, call 1.800. 332.0555.

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Made in America has Meaning for American Providers of Care

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Compliance, Featured, Healthcare, Value-Based Purchasing

Made in America has Meaning for American Providers of Care

At Select Data your medical coding stays on shore right here in America!

 
The other night, David Muir honored American Workers as he does on a frequent basis in the “Made in America” segment of the ABC Nightly News. His honorees usually manufacture products and his segment reveals proud Americans smiling. Rightfully so, as American workers are known for their quality, attention to HIPAA privacy and security, and concern for expected outcomes as well as knowledge of American regulations. At Select Data, we too have proud Americans who assist many home health agencies achieve wonderful care and outcomes for thousands of patients confined to their home. Select Data specializes in document review, coding, and revenue cycle management services. On a daily basis their armies of clinicians, coding and billing specialists attend to, review, clinically query and recommend codes for hundreds of patients’ clinical records. That specialization, attention to detail, and continual updated knowledge base impacts home health agency clients’ clinical outcomes, their STAR Ratings, and their positioning for Value Based Purchasing. Select Data is leading the charge in aiding agencies and their clinicians in battling environmental stressors, time demands, and expected patient outcome expectations by providing services and friendly technology that complement the clinician’s skills offering oversight to improve congruence amongst clinical documents and promoting patient-specific care needs. So the next time you see David Muir honoring those wonderful Americans who manufacture fine products, think of those fine, highly skilled individuals at Select Data. They provide services for American home health agencies intent on providing wonderful care to older and younger patients confined to their homes in the cities and towns of our country and we all do it proudly and with a smile. For further information, contact Select Data and their all American based specialists at 1.800.332.0555.
Related Article We Do It Here! Don't Send Your PHI Offshore Check out our FREE 30-minute webinar for OASIS-C2 corrections and more. Select Connects with Clinicians webinar. Click here to read more. Select Data is committed to a strong compliance program that includes educating all personnel on mitigating HIPAA breaches. For more information about Select Data and their commitment to quality in Home Health and Hospice, call 1.800. 332.0555.

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Top 5 Challenges Facing Home Health Care Agencies

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Accountable Care Organizations, Clinical Documentation Improvement, Healthcare, The Affordable Care Act (ACO), Value-Based Purchasing

Top 5 Challenges Facing Home Health Care Agencies

Guiding The Home Healthcare Industry to Value-Based Purchasing Thru Clinical Documentation Improvement (CDI)

 
It’s no secret that growth in the home care industry is on the rise. More new agencies emerge on the scene every day. In fact, it’s one of the largest growing trades nationwide, with individual and franchise businesses popping up from coast to coast.  But, it’s also one for the most difficult business opportunities to get a handle on.  Partly because of the tremendous growth and partly because of the numerous fundamental changes occurring simultaneously, the home healthcare industry could be classified as particularly volatile (Kenyon Homecare Consulting, 2014). But despite the challenging nature of the industry, there are some bright spots on the horizon. Most of you agree, for example, that the movement to value, the rise of consumerism, and the use of new technologies could transform the industry for the better—it's just a matter of turning that potential into reality (Brown, 2014). Here are five of the heaviest hitters: Increasing Demand America is home to an aging population. By 2020, an estimated 17% of the entire population will be 65 or older. That’s 50 million men and women who will be increasing their reliance on the healthcare industry as a whole (Halvorson, 2013). With more aging individuals preferring to receive care in the comfort of home, many home care agencies will struggle to meet the growing demand with qualified staff and capable caregivers (Kenyon Homecare Consulting, 2014). Advances in Technology The home health care industry is in the middle of a tremendous technological revolution. In fact, figures released by Lucintel predict over $29 billion in growth by 2017. Older, outdated systems are being replaced with faster, less-intrusive and more powerful equipment. And the home health care industry is struggling to keep up.  Learning how to correctly and effectively use these new gadgets takes a considerable investment of time and effort.  While some agencies are leading the pack, others are lagging behind – put off by either the added cost of the added hassle (Halvorson, 2013). Political Pressure With the ongoing debate about who is right and who is wrong in Washington raging, healthcare is a big fat target for political movers and shakers (Halvorson, 2013). With a Trump Presidency political pressure is at an all-time high. President Trump has promised a repeal of the Affordable Care Act (Obamacare) but, has not outlined how or when. In a debate Tuesday night, Senator Ted Cruz made it clear that nothing is happening yet (Newkirk, 2014). Accountable Care Organization (ACO) Establishing an accountable care arrangement with a payer means entering into a total-cost-of-care system that rewards or penalizes based on the total cost of a patient population. These complex arrangements are growing even faster than bundled payments. There were approximately 500 ACOs as of year-end 2013. CMS announced 123 new ACOs that would start in January 2014. According to a Premier survey, ACO participation has almost quadrupled since spring 2012, and should continue to grow with participation projected to double by the end of 2014 to 50 percent of all hospitals participating (Brown, 2014). Home health agencies should be encouraging discussions among provider leaders of all levels of the care continuum. Patient ultimate outcomes should be shared by all providers. Establishing those mutual patient outcomes is a primary step in a strategic alliance between ACOs and PCMHs. It may be wise for some organizations to ease into the ACO world incrementally by starting with P4P and bundled payments. Entering into shared savings agreements is one of the main strategies hospitals must pursue to survive in this environment. Value-Based Purchasing However, the number one most challenging factor impacting Home Health Care agencies is the transition to value-based purchasing. Moving to value-based reimbursement continues to be a top challenge, according to our survey. While most respondents said their organization has at least started shifting its operations toward value, nearly one out of every five said they have not yet started transitioning and are "waiting to see what works for other organizations." How does Select Data improve your Agency's quality? Select Data improves your Agency's quality through our Clinical Documentation Improvement (CDI) system. Clinical documentation is at the core of every patient encounter (Ahima, 2017). Consider Select Data as a partner in achieving the best patient plan of care for the diagnoses to be coded and the goals needed to achieve those high quality goals and succeed with the CMS quality measures. Select Data improves your clinical documentation and provides a clear picture of your patient's health. Don’t wait, if you are an agency in one of the 41 states not yet officially affected. VBP is here to stay. Payors other than CMS are also looking at patient outcomes by diagnoses and using that factor as a guide as to whether or not they wish to contract with a provider. For a small Medicare certified agency, a 3% reduction in payment will be painful and a 5% reduction could be unsustainable. You need to be active in VBP education NOW! You may need to designate a position only for data analytics. You need to have strong partners whether in your EMR, your coding and document review, or in analyzing and providing the best plan of care for the patient in order to meet the VBP outcome level goals. Call Select Data at 1.800.332.0555 for more information. References Ahima (2017). Clinical Documentation Improvement: Overview. Retrieved from: http://www.ahima.org/topics/cdi Brown, Bobbi (2014) Healthcare Payers and Providers: The Best System for Process Improvement. Retrieved from: http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/top-5-industry-challenges-2016 Top 5 industry challenges of 2016 Halvorson, Chad (2013). Top 7 Challenges Facing Home Health Care Agencies in 2013. Retrieved from: https://wheniwork.com/blog/top-7-challenges-facing-home-health-care-agencies-in-2013/ Kenyon Homecare Consulting (2014). Top 5 Challenges Facing Home Care Agencies in 2014. Retrieved from: http://www.kenyonhcc.com/top-5-challenges-facing-home-care-agencies-2014/ Newkirk, Vann (2017). Republicans Don't Know How or When to Repeal Obamacare. Retrieved from: https://www.theatlantic.com/politics/archive/2017/02/nobody-knows-when-obamacare-repeal-is-happening/515955/
Related articles https://www.selectdata.com/value-based-purchasing-glance/ https://www.selectdata.com/home-health-value-based-purchasing-model-one-year-old-growing/

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Value-Based Purchasing At A Glance

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Accountable Care Organizations, Clinical Documentation Improvement, The Affordable Care Act (ACO), Value-Based Purchasing

Value-Based Purchasing At A Glance

Successfully Navigating the Home Healthcare Industry to Value-Based Purchasing Through Clinical Documentation Improvement (CDI)

 
On April 29, 2011, the healthcare industry changed forever. It’s on that date that the Centers for Medicare and Medicaid Services (CMS) released its Hospital Value-Based Purchasing (VBP) Final Rule, required under the Patient Protection and Affordable Care Act (StuderGroup, 2016). What is Value-Based Purchasing? The Hospital Value-Based Purchasing (VBP) Program is a Centers for Medicare & Medicaid Services (CMS) initiative that rewards acute-care hospitals with incentive payments for the quality of care they provide to Medicare beneficiaries. How does Hospital VBP Work? CMS rewards hospitals based on:
  • The quality of care provided to Medicare patients;
  • How closely best clinical practices are followed; and
  • How well hospitals enhance patients’ experiences of care during hospital stays.
Hospitals are no longer paid solely on the quantity of services they provide. The Affordable Care Act of 2010 established the Hospital VBP Program, which applies to payments beginning in Fiscal Year (FY) 2013 and affects payment for inpatient stays in more than 3,000 hospitals across the country (cms.gov, 2016). How to improve your Agencies quality?
  • You must build a solid foundation...
  • Great field clinicians are not necessity
How does Select Data improve your Agencies quality? Through Clinical Documentation Improvement (CDI). Clinical documentation is at the core of every patient encounter (Ahima, 2017). Consider Select Data as a partner in achieving the best patient plan of care for the diagnoses to be coded and the goals needed to achieve those high quality goals and succeed with the CMS quality measures. Select Data improves your clinical documentation and provides a clear picture of your patients health. Don’t wait, if you are an agency in one of the 41 states not yet officially affected. VBP is here to stay. Payors other than CMS are also looking at patient outcomes by diagnoses and using that factor as a guide as to whether or not they wish to contract with a provider. For a small Medicare certified agency, a 3% reduction in payment will be painful and a 5% reduction could be unsustainable. You need to be active in VBP education NOW! You may need to designate a position only for data analytics. You need to have strong partners whether in your EMR, your coding and document review, or in analyzing and providing the best plan of care for the patient in order to meet the VBP outcome level goals. Call Select Data at 1.800.332.0555 for more information. References Ahima (2017). Clinical Documentation Improvement: Overview. Retrieved from: http://www.ahima.org/topics/cdi CMS.gov (2016). Hospital Value-Based Purchasing. Department of Health and Humans Services: Centers for Medicare & Medicaid Services. Retrieved from: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Hospital_VBPurchasing_Fact_Sheet_ICN907664.pdf Studer Group (2016). VALUE-BASED PURCHASING AT A GLANCE:Fiscal Year 2016 and Your Organization. Studergroup.com. Retrieved from: https://www.studergroup.com/industry-impact/value-based-purchasing
Select Data is committed to a strong compliance program that includes educating all personnel on mitigating HIPAA breaches. For more information about Select Data and their commitment to quality in Home Health and Hospice, call 1.800. 332.0555. Click here to contact us.

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Home Health Value Based Purchasing Model: It’s One Year Old and Growing

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Clinical Practices, The Affordable Care Act (ACO), Value-Based Purchasing

Home Health Value Based Purchasing Model: It’s One Year Old and Growing

Successfully Navigating the Home Healthcare Industry to Value Based Purchasing

 
Last January, 2016, the CMS Innovation Center launched the Home Health Value Based Purchasing (HHVBPM) aka VBP Model in the following nine states:
  • Arizona
  • Florida
  • Iowa
  • Maryland
  • Massachusetts
  • Nebraska
  • North Carolina
  • Tennessee
  • Washington
This is part of a larger movement across the healthcare system in the US. CMS, as well as other payors want payment tied more closely to the quality of care delivered.  CMS wants to reward those Medicare certified agencies that perform well on select quality measures. The belief is that those agencies that perform well under VBP will have an increase in revenue and those agencies that cannot perform well with the identified quality measures will be penalized by shrinking margins. The maximum payment adjustments are planned as follows:
  • 3% upward or downward in 2018
  • 5% upward or downward in 2019
  • 6% upward or downward in 2020
  • 7% upward or downward in 2021and
  • 8% upward or downward in 2022
CMS expects to expand the VBP model to other states in the future. There were originally 24 quality measures proposed for review, however in June, 2016, CMS proposed dropping four of those measures.  Using data from OASIS, Medicare claims, HHCAHPS surveys, and other reported data, agencies will be evaluated quarterly receiving reports on their performance compared to their baseline in previous quarters as well as how their performance stands up against other agencies within their state. There are nine quality outcome measures used to determine payment awards:
  • Improvement in Ambulation
  • Improvement in Dyspnea
  • Improvement in Bed Transferring
  • Improvement in Bathing
  • Improvement in pain interfering with activity
  • Improvement in Oral Medication Management
  • Emergency department use without hospitalization
  • Acute Care Hospitalization
  • Discharge to the Community
There are three quality process measures used to determine payment awards:
  • Influenza immunization received
  • Pneumococcal vaccine received
  • Medication education
There are five consumer outcome measures used to determine payment awards
  • Care of patients
  • Specific Care issues
  • Communication between the patient and the care provider
  • Patient willingness to recommend the provider of care
  • Patient’s overall rating
There are three new additional measures used to determine payment awards:
  • Influenza vaccination for provider’s home health personnel
  • Herpes zoster vaccination for provider’s home health personnel
  • Advanced care planning
Using the above measures, agencies will receive an “achievement score” that compares an agency to peer agencies and an “improvement score” that compares the agency with their baseline year. For each process and outcome measure, those two scores will be calculated and the higher of the two scores will count toward the agency’s overall “Total Performance Score (TPS).”  The three new measures count toward 10% of the total score. What can your agency do to positively impact the agency’s score?
  • Your agency must become educated in the HHVBP model and the measures.
  • Industry experts believe CMS will implement this nationwide sooner than anticipated. Look at each item and hone in on 1-2 items at a time. Consider focusing on the process measures, as they are seen to be easier to affect change.
  • If you are a high performing agency, then more opportunity may exist with achievement scores.
  • If your agency has consistently struggled, focus on the improvement scores.
  • Conduct a gap analysis as to clinician understanding of each OASIS and HHCAHP item.
  • Provide OASIS education specifics. Hone in on SOC opportunities for assessment evaluation.
  • Provide clinician education regarding HHCAHPS and the questions that will impact your agency.
  • Be certain your agency’s software has the capability to assist in analysis of clinical documentation analytics and reporting regarding OASIS and Claims data.
Don’t wait, if you are an agency in one of the 41 states not yet officially affected. VBP is here to stay. Payors other than CMS are also looking at patient outcomes by diagnoses and using that factor as a guide as to whether or not they wish to contract with a provider. For a small Medicare certified agency, a 3% reduction in payment will be painful and a 5% reduction could be unsustainable. You need to be active in VBP education NOW! You may need to designate a position only for data analytics. You need to have strong partners whether in your EMR, your coding and document review, or in analyzing and providing the best plan of care for the patient in order to meet the VBP outcome level goals. Consider Select Data as a partner in achieving the best patient plan of care for the diagnoses to be coded and the goals needed to achieve those high quality goals and succeed with the CMS quality measures. Call Select Data at 1.800.332.0555 for more information.
Select Data is committed to a strong compliance program that includes educating all personnel on mitigating HIPAA breaches. For more information about Select Data and their commitment to quality in Home Health and Hospice, call 1.800. 332.0555. Click here to contact us.

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