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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 Older, outdated systems are being replaced with faster, less-intrusive and more powerful equipment.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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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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VNAA Public Policy Town Hall 2016 Presentation

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Events, The Affordable Care Act (ACO)

VNAA Public Policy Town Hall 2016 Presentation

Did You Miss it? No Sweat! Download the VNAA Public Policy Town Hall Presentation Notes.

 
VNAA's policy team for a discusion of current legislation and policy activities affecting home-based care providers. VNAA is a national association which supports, promotes and advances providers of high-quality home-based care. These agencies provide a full range of prevention and health care programs. VNAA members share a mission to provide cost-effective and compassionate care to some of the nation's most vulnerable individuals, particularly the elderly and individuals with disabilities. For more information on VNAA, visit www.VNAA.org. Download the presentation note below 

Don't miss the next event hosted by VNAA - Hospice Round table Monday, December 12, 2016 at 12:30 PM ET click here for more information https://www.eventbrite.com/e/hospice-roundtable-tickets-25130613341?aff=erelpanelorg

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