Showing posts tagged with: Home Health

Top 5 Questions Home Health Providers Ought To Be Asking About HHGM

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Healthcare, HHGM, OASIS-C2

Top 5 Questions Home Health Providers Ought To Be Asking About HHGM

HHGM-Game Changer?

 
HHGM proposal is expected to reduce Medicare payment to providers by up to $4 billion. Unlike the current system, the groupings model doesn’t rely on the number of therapy visits performed to influence payment. It instead will rely heavily on clinical characteristics and other patient information such as diagnosis, functional level, comorbid condition and admission source according to CMS. The changes to the payment system would address the issues MedPAC identified in the home health PPS March 2017 report that noted both the incentives and the payment levels in the current payment system needed to be overhauled. Following the recommendations from the MedPAC report, Congress is attempting through new legislation to provide the Secretary of DHHS the authority to make assumptions about provider behavior, provide notice of those assumptions and implement them through comment rule-making in CY 2019. Top 5 questions Home Health Providers ought to be asking
  1. Is Congress giving the secretary authority to set payment without constraints? According to H,R. 3992 which was introduced in the House of Representatives on October 6, the Secretary would have the authority to set payments for 30 day periods and to revise that model through notice and comment rule-making.
  2. What consequences have occurred with the MedPAC reporting? It was MedPAC who suggested to Congress that providers had been adjusting their services based on reimbursement to increase financial margin. MedPAC has stated that the ACA rebasing provisions aren’t enough and that the appearance is that home health growth is slowing, it is still growing and only appears that way statistically because five states under pre claim review and increased scrutiny have decreased their utilization. MedPAC will continue to assess for trends related to reimbursement and provider response to those patterns.
  3. Is our industry under fire because of expected industry growth? Over the past decade, a lot of attention has been paid to the baby boomers turning the Medicare age of 65. This increase in potential patients is one of the reasons home health is expected to be the fastest growing marketplace in all of healthcare for the next decade. With 82.6% of Home Health patients over the age of 65, Medicare or a Medicare Advantage plan is responsible for a large portion of payments, as such the government has a vested interest in controlling costs. Healthcare costs are controlled by decreasing the volume of people using the service, decreasing reimbursement for the service and decreasing the cost of doing business.
  4. Can HHGM actually give me greater control over my payment? The higher degree of differences in potential payment, the more control over reimbursement received. What on the surface appears to be a model composed of more straightforward categorizations is, in fact, a differentiator. Does this mean the HHGM is without problems, no, but this will most likely be ironed out over the next year.
  5. What should I do in 2019? According to Elevating Home, an agency may expect a decrease in their Medicare reimbursement up to 17% with the new HHGM payment model. The new bill proposes that HHGM be delayed until CY2020 to provide organizations with the opportunity to prepare for the changes coming, but many providers may not know where to start.
Select Data has created SmartCare which has an HHGM predictive analytics model formed by our data science team that analyzes your historical episodes and compares them to the HHGM model to identify potential loss in revenue. SmartCare will be able to provide indicators to support these predictions and will have the capability to offer observations to prevent potential loss using prescriptive analytics. With the information SmartCare can produce, providers have the opportunity to start implementing changes needed to combat the future decline in revenue. Some agencies may be more prepared than others, but with the significant impact HHGM will make, isn’t it worth a conversation? Visit us at Booth 530 at NAHC to find out how to winFREE HHGM analysis.
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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Home Health and Hospice Industry Survey

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Healthcare

Home Health and Hospice Industry Survey

All participants in the survey will be entered into a drawing for a $100 Amazon gift card.

 
To enter to win a $100 Amazon gift card fill out your name and email address below and click the link to take the Home Health and Hospice Industry Survey 

Hurry! Survey ends October 31, 2017 at 11:59 PM PT.
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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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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January is National Glaucoma Awareness Month

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Healthcare

January is National Glaucoma Awareness Month

An important time to spread the word about this sight-stealing disease.

 
Currently, more than 3 million people in the United States have glaucoma. The National Eye Institute projects this number will reach 4.2 million by 2030, a 58 percent increase. In the United States, approximately 120,000 are blind from glaucoma, accounting for 9% to 12% of all cases of blindness. Here are three ways you can help raise awareness:

Help Raise Awareness

  1. Talk to friends and family about glaucoma. If you have glaucoma, don’t keep it a secret. Let your family members know.
  2. Refer a friend to our web site, www.glaucoma.org.
  3. Request to have a free educational booklet sent to you or a friend.
  4. Get involved in your community through fundraisers, information sessions, group discussions, inviting expert speakers, and more (Glaucoma.org, 2016).
 

What is glaucoma?

Visual loss from glaucoma results from characteristic deterioration of the optic nerve leading to progressive loss of the field of vision. At least 3 million Americans suffer from glaucoma. Glaucoma is one of the leading causes of adult blindness, and it is also the leading cause of preventable blindness. Most people who go blind from glaucoma are blind in at least one eye at the time of original detection, which points to the need for better early diagnosis. Because glaucoma usually does not manifest any symptoms until extensive peripheral visual loss becomes apparent in the final stages of the disease, it is often likened to the “sneak thief of sight.” Unlike most eye diseases, most varieties of glaucoma are chronic, virtually lifelong disorders than can be controlled but not cured. Like diabetes, high blood pressure, asthma, or arthritis, glaucoma requires some modification in lifestyle, such as compliance with medical regimens, regular physician visits, and acknowledgment of the disease to achieve successful treatment (Cioffi & Van Buskirk, 2016). Connect with us on Facebook or follow us on Twitter for regular updates on glaucoma research, treatments, news and information. Share information about glaucoma with your friends and family. For more information visit www.glaucoma.org/news/glaucoma-awareness-month.php

References

Cioffi, G. A., & Van Buskirk, E.M. (2016). Glaucoma Basics & Frequently Asked Questions. American Glaucoma Society (AGS). Retrieved from: http://www.americanglaucomasociety.net/patients/faqs#A1 Glaucoma.org (2016). January is Glaucoma Awareness Month. Retrieved from: http://www.glaucoma.org/news/glaucoma-awareness-month.php
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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Home Care and Home Health…What’s the difference?

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Frequently Asked Questions

Home Care and Home Health…What’s the difference?

Skilled care givers verus unksilled care providers. Which type are you looking for?

 
Home health care is an umbrella term that describes a wide range of health care services that can be provided in your home. Home health care can be divided into two additional descriptors “Home Care” and “Home Health” Home Care describes unskilled care provided by caregivers, usually referred to as home health aides, personal care givers, or homemakers. These individuals are trained in the intricacies of senior care. Home care aides can provide assistance with activities of daily living or provide companionship. Home care is classified as personal care or companion care and is not considered “skilled” care. Home Health is a phrase that describes clinical medical care provided by a Registered Nurse, Occupational Therapist, and Speech Therapist, Physical Therapist or other skilled medical professionals. Home Health is typically prescribed as part of an interdisciplinary, multi-setting approach to medical care following an acute illness, exacerbation of chronic illness or surgery. The fundamental difference between Home Care and Home Health is who pays for the service. Due to its unskilled nature Home Care is typically privately paid with some state programs providing assistance with the cost. Home Health is a service that is paid for by Medicare, Medicaid and private insurance. Agencies can find it difficult to meet the regulatory demands of the Centers for Medicare/Medicaid Services (CMS). CMS doesn’t recognize the patient as Jane Smith but instead views Jane Smith through a series of codes. These codes are diagnosis codes, OASIS items, G-codes from claims, and procedure codes. These codes are also used in different formulas that are important in measuring outcomes and re-hospitalizations. Select Data provides professional coding services to Home Health agencies and are industry experts in the language of CMS. 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 click here.
Check out our FREE 30-minute webinar for OASIS-C2 corrections and more. Select Connects with Clinicians webinar on December 14, 2016. 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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Kentucky Home Care Association Annual Fall Conference

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Events

Kentucky Home Care Association 2016 Annual Fall Conference

In the Lexington, Kentucky area? Thinking about attending?

 
The KHCA Staff and Conference Planning Committee would like to invite you to the 2016 KHCA Fall Conference & Exhibition on Tuesday, November 15th and Wednesday, November 16th at the Marriott Griffin Gate in Lexington, KY.

As always, we have a great lineup of sessions addressing the hot topics impacting the home health industry. We hope you will join us for this great opportunity for education and networking. Just click the links below for more details and respond by clicking YES or NO at the bottom of the invitation.

Exhibitor Deadline: November 4th
Participant Deadline: November 10th
Lodging Deadline: October 24th

 

Select Connects With Clinicians

Also, attend our free 30-minute training to help clinicians improve OASIS assessment accuracy. All attendees will be eligible for prize drawings. Select Connects with Clinicians on Wednesday, December 14, 2016. Click here to read more.

Sources

Kentucky Home Care Association(2016). KHCA 2016 Events & Education. KHCA.net. Retrieved from: http://www.cvent.com/events/2016-khca-fall-conference-exhibition/invitation-7c82e4588b19414c86146dac51f6746c.aspx
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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HIPAA and Faxing: A Potentially Dangerous Combination

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Clinical Practices, Compliance, HIPPA, HITECH

HIPPA and Faxing: A Potentially Dangerous Combination

Thinking about sending PHI through your fax machine? Read this before you do.

 

The Right to Privacy

In 1890, Supreme Court Justices Samuel Warren and Louis Brandeis published “The Right to Privacy” in the Harvard Law Review. They defined privacy as the “right to be left alone.” Over 100 years later the Health Insurance Portability and Accountability Act (HIPAA) established a set of standards for protection of personal health information (PHI).

The world has changed greatly in that 100 years. There was and is a serious need to ensure accountability; to establish a national uniform baseline for privacy and uniform standards for transmission of health information. Today, almost everyone carries a smartphone and has a computer, laptops, and/or notebook to transmit words and images on a host of sites such as SnapChat, Twitter, Facebook, and YouTube for all to see…forever.

And, while there are many seminars and webinars regarding texting and the potential perils of using a mobile device to transmit patient information, no one is talking about faxing. It seems to be such a benign device. But, it is not. Breaches are on the rise. The Office of Civil Rights (OCR) is stepping up their audits.

Many agencies do not have adequate policies that cover the faxing process. First of all consider, is all the faxing done in your agency really necessary? Scanning and email or use of traditional postal service should be considered, if possible. It can be safer.

Consider setting up a “To be Faxed” sending bin close to the fax machine. This way faxing can be done when it is less busy in your agency office. This can reduce errors of transposed or incorrect digits because the sender’s mind may not be fully on the task.

Policy and Procedures For Home Health Agencies

Have a policy requiring reconfirmation of all fax numbers at least every 6-12 months. Your agency should fax an “Agency Fax Number Confirmation” sheet to all offices faxed routinely and confirm their fax number. Have them confirm, sign, date it and fax it back to your agency. Recently, an agency learned that certain numbers embedded in the EMR used had some outdated numbers. Your fax sheet should have your Agency name, phone number, fax number, address, and contact personnel if there is a question. It should include the legal warning as to what a person should do if the fax is sent to the wrong person or agency/company/practice. Include the person and number at your agency who should be contacted in case of a mistaken fax.

HIPAA HITECH has teeth now and the fines are significant. Your bottom line is fragile as is your agency’s reputation. Don’t jeopardize either with an inappropriately sent fax.

Sources

Centers for Medicare & Medicaid (2016). Does the HIPAA Privacy Rule permit a doctor, laboratory, or other health care provider to share patient health information for treatment purposes by fax, e-mail, or over the phone? CMS.gov. Retrieved from: http://www.hhs.gov/hipaa/for-professionals/faq/482/does-hipaa-permit-a-doctor-to-share-patient-information-for-treatment-over-the-phone/ Centers for Medicare & Medicaid (2016). Can a physician’s office fax patient medical information to another physician’s office? CMS.gov. Retrieved from: http://www.hhs.gov/hipaa/for-professionals/faq/356/can-a-physicians-office-fax-patient-medical-information-to-another-physicans-office/
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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