August Compliance Newsletter

OASIS C-2 Questions and Answers

Have you ever come across an unusual patient situation that didn’t seem to ‘fit’ the OASIS? Human beings are so complex and our lives are so varied that it’s no wonder we sometimes find ourselves scratching our heads when trying to select an OASIS response. CMS no longer provides one centralized system to answer and publish quarterly OASIS Questions and Answers, but we have had 20 pages of Q&A’s released from the November 16th/17th Home Health Quality Reporting Training conducted by CMS. Another training was held May 3rd/4th and additional Q&As should be released sometime in August if the timeline is similar to the November event. You can find the November Q&As (released February 2017) on the CMS web page by scrolling to the downloads section at the bottom of the page. Continue reading “August Compliance Newsletter”

A Minute in the Morning


Average Case Mix Weight by State*

Based on Fazzi’s analysis of home health claims data for non-LUPA episodes, the national average case mix weight (CMW) for 2016 was 1.0384. See table at right for results by state.

Nationally, the overall CMW decreased (-0.7%) from 2014 to 2016.

Twenty-three states had a decrease in CMW from 2014 to 2016. Twenty-nine states had an increase in CMW, and two states had no change in the same period. Minnesota had the largest percentage increase of 5.0%, followed by North Dakota (4.5%) and Washington (3.9%). Mississippi and Missouri had no change in 2016 from their 2014 CMW. Guam saw the largest decrease (-4.9%) in percent change of CMW, followed by Florida (-4.3%), Utah (-3.4%), and New Mexico (-3.3%).

The five states with the lowest CMW in 2014 (CA, LA, TX, OK, GU) were also the lowest in 2016. Of the five states with the highest CMW in 2014 (FL, ID, UT, TN, WV) only three, WV, ID, and FL, were the highest in 2016 (FL, ID, WV, CO, WA).

Idaho had the highest CMW in 2016 compared to Guam at the lowest – a difference of 0.285 ($845 per episode or $870 per episode with rural add on).

If you are interested in case mix by agency or county level, click here to visit our web page on Business Intelligence or email
* Fazzi analysis of Medicare home health claims

Home Health Compare Quality Charts Updated – July 2017

The Home Health Compare results were updated on July 12, 2017.

All Quality of Patient Care measures, which include measures under Value-based Purchasingshowed improvement again this quarter! Measures included in the Star Ratings continue to show the most improvement. The depression assessment conducted measure remains unchanged since the first quarter of this year. The data collection period for these measures is from January 1, 2016 to December 31, 2016.

The acute care hospitalizations measure worsened slightly again this quarter, from 16.5% to 16.7%. The urgent, unplanned care in the emergency room measure remained the same. (Collection period October 1, 2015 to September 30, 2016.)

All national averages for HHCAHPS measures continue to remain the same. The data collection period for these measures is calendar year 2016.

The national average for the Patient Care Star Ratings remained at 3.5 stars. The percent of agencies with 3 stars dropped from 20% to 19%, and the percent of agencies with 4.5 stars increased from 10% to 11%. 362 agencies received a 5 star rating. To see where the 5 star agencies are located, visit our Home Health Compare page and use the drop down for Star Ratings at the agency level.

Our Home Health Compare page also provides drop downs to compare measures by state, by year, and by release date. You can also select comparisons for the top 10 percent or top 20 percent.

New Conditions of Participation (CoPs) Effective Date Officially Delayed

The proposed rule delaying the new Home Health CoPs was finalized today. This final rule delays the July 13, 2017 effective date for the “Medicare and Medicaid Programs: Conditions of Participation for Home Health Agencies” originally published in the Federal Register on January 13, 2017.  The rule posted today delays the effective/compliance date for an additional six months until January 13, 2018. Agencies will have until July 13, 2018 to implement one QAPI standard: Performance Improvement Projects.

CMS is planning on releasing the Interpretative Guidelines in December 2017.  According to Gina Mazza, Partner, Fazzi Associates, “Agencies should continue to prepare with diligence as most agencies will need the full, additional six months to be in full compliance with new Patient Rights, Care Planning and QAPI standards by January.”

If you have any questions or would like assistance with your plans to comply with the new CoPs, please Contact us or call 800-379-0361. .

Hospice Compare – Important Update

CMS has recently announced that a Hospice Compare site will be released in 2017. The long anticipated hospice public reporting initiative is expected to begin with the HIS items in Summer 2017 with ongoing quarterly updates from then on. Then, Hospice CAHPS results are expected to be included with one of the quarterly data updates released in the winter of 2018.

Prior to the release of data on Hospice Compare, you will have the opportunity to review your HIS results during a 30-day preview period using a Hospice Provider Preview Report, which will be issued quarterly by CMS. CMS is encouraging all Hospice providers to review their results in advance of each Hospice Compare release. Your first Preview Report is available now in the CASPER system for the release planned for this summer. For details on access and log in, click this link , and scroll to the bottom of that page to the download section.

With Hospice QAPI requirements and now public reporting right around the corner, it is more important than ever for Hospices to focus efforts on improving their CAHPS results. To assist you, as one of the largest CAHPS vendors in the country, Fazzi has released a white paper sharing key insights on Hospice CAHPS from a QAPI perspective.  We’ve put our CAHPS results to work by conducting a study to identify the Hospice CAHPS survey items with the highest correlations to the two global questions:

  • Overall Rating of Hospice Care
  • Willingness to Recommend
Download the White Paper: “CAHPS: Why it’s Good for Hospice!

Paying close attention to your service standards, practices and CAHPS scores can help your agency provide better quality care and quality of service – and will help you be a top performer in public reporting.

Contact us if you have questions or would like information about Fazzi’s Home Health or Hospice CAHPS services, 800-379-0361 or


The 2016-2017 National State of the Industry Report

Fazzi Associates, in collaboration with our National Steering Committee, is pleased to bring you the results of our latest best practice study for home care and hospice.  Derived from in depth interviews with 751 agency leaders representing every sector of our industry, this national study is the fourth of its kind and the most comprehensive in the history of home care and hospice.

The intention of the study is to provide information and insight to help all agencies improve quality, profitability, efficiency and patient satisfaction. That’s why we undertake and fund this project and that’s why we offer its findings for free.

The 49-page report covers more than 30 topics of interest to home health and hospice agency leaders, from use of telehealth and outsourced services to productivity, clinical team structure, employee engagement and much more.  Many of the findings clearly provide agency leaders with insights that may be of help to their agency.  Issues addressed include:

  • Clinical models that most impact quality and financial outcomes.
  • Role of accreditation on outcomes.
  • Staffing ratios and their impact on quality and financial outcomes.
  • Difference in outcomes by size or auspices or location.
  • Difference in outcomes based on payment models.
  • Impact and growth in outsourced coding and their implications.
  • Role of productivity on outcomes.
  • Biggest concerns by agencies.
  • Role of telehealth and other technologies on outcomes.
  • Impact of employee engagement surveys on employee retention.

Continue reading “The 2016-2017 National State of the Industry Report”

Home Health Compare Quality Charts Updated

The Home Health Compare results were updated on April 12, 2017.

Other than depression assessment conducted remaining unchanged, all national averages for the Quality of Patient Care measures showed improvement!  Most of the measures with the greatest improvement were those included in the Star Ratings.  The data collection period for these measures is from October 1, 2015 to September 30, 2016.

All quality measures included under Value-based Purchasing showed improvement except for urgent, unplanned care in the emergency room which remained the same, and acute care hospitalizations (collection period July1, 2015 to June 30, 2016).  The acute care hospitalizations measure has worsened slightly again for this quarter. This measure remained at 16.0% from January to July 2016 and worsened in October 2016 to 16.2%, to 16.3% in January 2017, and to 16.5% this data collection period.

All national averages for HHCAHPS measures remained the same as last quarter. The data collection period for these measures is from October 2015 to September 2016.

The national average for the Patient Care Star Ratings increased from 3.0 to 3.5 stars.

Visit our Home Health Compare page with drop downs to compare by state, by year, and by release date. You can also select comparisons for the top 10 percent or top 20 percent. We also provide a drop down to agency level for Star Ratings.

Why Has the Demand for Supervisory Training Grown?

In an industry where it is critical that staff in all departments be knowledgeable about new developments and new demands, training is always a high priority. Some demands are new, i.e. new regulations or new clinical procedures and some demands have always been around, i.e. how to best supervise, motivate and ensure quality staff performance.

It is easy to understand why new trainings are always being developed for new changes and requirements. It is less obvious why age old requirements such as the qualifications to be a great supervisor have suddenly become much more in demand. But, the answer is simple. More and more agency leaders have come to realize that highly skilled and motivated supervisors impact more than the quality and performance of their staff. Strong well trained supervisors impact the bottom line of an organization… the financial bottom line.

Poor Supervision, Turnover and Cost

Here are some basic facts:

  • A study by Brad Gilbreath in the Journal of Work and Stress reported in Psychology Today, stated that the number one reason “for lower than expected work productivity is not workers, but bosses.” Steve Oppermann in an article in FedSmith went on to say “that poor boss performance may affect the long term health of company employees, and that will become a financial issue.”
  • A study by Gallup reported that “employees don’t leave companies, they leave managers and supervisors. The impact that a supervisor has in today’s workplace can be either very valuable or very costly to the organization and the people who work there.”
  • Combine these studies with a study by the Society for Human Resource Management that found employers will need to spend the equivalent of 50% to 75% of an employee’s salary in order to find and train their replacement.

Do the math. If you have an employee earning $80,000 salary and benefits, it will cost your organization an additional $40,000 (50%) to $60,000 (75%). That is just to replace one employee. Other studies would say this number is conservative. Continue reading “Why Has the Demand for Supervisory Training Grown?”

Compliance Newsletter

OASIS-C2 Q&A Released.

Did you know CMS has released a compilation of all the OASIS Q&A that apply to OASIS-C2? The last time this type of merging of guidance occurred was in April 2015, and six additional quarterly Q&A guidance documents were released after that time. Now you can look at the October 2016 collection of Q&A’s whenever you need guidance and will no longer need to search through seven different documents. Click here to download the compilation file. When you use the drop-down box you’ll be able to save the PDF files for the four categories: Category 1-Applicability, Category 2-Comprehensive Assessments, Category 3-Follow-up Assessments, and Category 4-OASIS Data Set-Forms and Items. Monitor this page for the quarterly Q&A releases in January, April, July, and October every year.

New Home Health Conditions of Participation for Medicare and Medicaid (CoP) Finalized!

The HHCoPs have been revised and are effective on July 13, 2017. Ready to review and determine how your agency will comply with the final rule updating the Home Health Conditions of Participation for Medicare and Medicaid (CoP)? Gina Mazza provided this executive overview of the key components to the new CoPs earlier this month. Click here to view the webinar recording. Continue reading “Compliance Newsletter”

Fazzi Announces Leadership Transition

Bob Fazzi, Managing Partner

This has been an exciting time for Fazzi. We have grown, added a number of incredibly strong, seasoned and passionate staff and have added new programs and services, particularly those related to Value-Based Purchasing. With growth comes the need to strengthen our overall leadership structure. Within this context, I am pleased to announce that Tim Ashe, RN, MS, MBA has been promoted to Chief Operating Officer and is now responsible for the firm’s day to day leadership.

Tim Ashe, RN, MS, MBA

Tim joined Fazzi in 2006 and became a Partner in 2007. Since that time, he has led our Operational Consulting Division to provide organizational, operational, turn around, and change management services to home care and hospice agencies across the country. Under his leadership, Fazzi has helped hundreds of agencies improve outcomes and profitability through best practices in organizational structure, clinical and operational processes, and new models for staffing, supervision and care management. More recently, Tim also assumed responsibility for our Outsourced Billing, Finance and Information Technology divisions. A long-time leader in the field of home care and hospice, Tim’s expertise and career has included a unique blend of clinical, operational, fiscal and academic roles. He is a frequent presenter at national and state conferences and is often asked to contribute to industry forums. Tim is also the Co-Director of the 2016-2017 National Home Care and Hospice State of the Industry Study.

Continue reading “Fazzi Announces Leadership Transition”