OASIS-D1: What You Need to Know

Just this week CMS announced that OASIS-D1 is available for review. The revised OASIS data set will take effect on January 1, 2020 and includes updates that will support the Patient-Driven Groupings Model (PDGM).

Highlights include:

Two existing items are added to the Follow-Up time point for data collection. This includes:

  • M1033 Risk for Hospitalization
  • M1800 Grooming

In addition, data collection at certain time points for 23 existing OASIS items is optional.

Click here to find a memorandum containing details about the changes to OASIS effective January 1, 2020.

Get access to our entire suite of OASIS online learning and testing programs with the Fazzi Learning Center. This includes OASIS-D1 updates as well as training on the key PDGM OASIS items.

Learn More About OASIS Education

PDGM Readiness: Fazzi’s Answers to Questionable Encounters

Fazzi’s Findings and Advice about Questionable Encounters: A Complimentary Position Paper

One of the biggest concerns for agency leaders around the Patient-Driven Groupings Model (PDGM) is the issue of submitting claims with primary diagnoses that do not fit into one of the 12 clinical groupings in the payment model.

Read our position paper on this topic to learn:

  • Fazzi’s findings about questionable encounters from our own database.
  • How Fazzi is helping our outsourced coding clients to minimize questionable encounters.
  • Important compliance considerations.

Continue reading “PDGM Readiness: Fazzi’s Answers to Questionable Encounters”

PDGM Readiness Webinar Recording: Clinical Groupings, Case Management and LUPAs

Under PDGM, it is critical that you fully understand the clinical groupings, how they impact case mix and, of course, reimbursement. Also, best practice case management including efficient visit utilization and managing LUPAs will become even more important in the new world.

Join PDGM industry experts Gina Mazza and Cindy Campbell as they explain, discuss and provide insights about:

  • The Clinical Groupings component of the PDGM case mix
  • Key concepts for best practice case management
  • Effective approaches for efficient visit utilization including managing LUPAs

Continue reading “PDGM Readiness Webinar Recording: Clinical Groupings, Case Management and LUPAs”

Hospice Compare Updated

CMS has posted the quarterly Hospice Compare refresh of quality data on February 26, 2019. All quality measures showed improvement since the last quarterly posting! Pain assessment showed the most improvement, from 85.5% to 87.8%, followed by pain screening.

Updates to the family caregivers’ survey results showed seven measures remained the same.

As of this release, the new “Composite Process Measure” national average is 84.2%, an increase from 83.6%.

Quality measure results are from data collected 2nd quarter 2017 through 1st quarter 2018, and Hospice CAHPS® survey results reported 2nd quarter 2016 through 1st quarter 2018.

View State Level Hospice Compare Charts

Commonly Asked Questions – and Answers – About PDGM

We’ve been talking with agencies all across the country about the Patient-Driven Groupings Model (PDGM) and there is a common theme to the questions people are asking. In our ongoing effort to help the industry understand and prepare for PDGM, we want to share the answers to those questions with you here:

Will the plan of care and supplementary orders need to be signed before submitting 30 day bills? Under PDGM, the OASIS assessment must be completed, the certification signed, and the plan of care and all other orders must be signed and dated before submitting the final claim for each 30 day payment period.  A RAP may be submitted without the signed orders. These are the same guidelines as under the current Home Health Prospective Payment System (HHPPS).

What are the admission timing categories “early” and “late”? Under the admission category in PDGM, each 30 day period of payment will be classified as an “early” or as a “late” period. The first 30 day period is classified as an early 30 day period and then, all subsequent 30 day periods are classified as late.

If the first 30 day period is early and then, all other subsequent 30 day periods are late, how is this determined for payment since the OASIS assessment time frames are not changing? The timing category assigned to each 30 day period will be based on claims information in the Medicare systems. The system is expected to automatically assign the early or late timing category during claims processing.

Will Medicare Advantage Plans implement PDGM? PDGM is a payment model developed for the Medicare Home Health benefit provided by certified Home Health Agencies. Private payers, such as Medicare Advantage plans, are not required to follow this payment methodology. While some private payers may follow PDGM guidance, it is not required. The requirements from various private payers will vary widely.

How can we find out which diagnoses are currently included in the comorbidity groups? The current diagnoses included in the comorbidity adjustment of PDGM are listed on tabs labeled “comorbidity low/high” within the Updated PDGM Grouper Tool . The grouper tool is one of many PDGM resources located on the CMS Home Health Agency (HHA) Center site’s home page.

Are LUPA thresholds based on 30 day payment periods or 60 day certification periods? LUPAs will continue under PDGM. The LUPA thresholds will vary for each 30 day period depending on the payment group to which it is assigned. The LUPA thresholds range from 2-6 visits.

How can an agency identify which Nursing/Therapy Ratio quartile they have been assigned by CMS? We have an easy to use tool on our website to receive information about your agency’s quartile placement and an overall reimbursement projection. View the tool.

Additionally, every agency is listed with their quartile placement in a spreadsheet labeled as PDGM Agency Level Impacts on the CMS Home Health Agency (HHA) Center site’s home page. The Agency listing is one of many PDGM resources located on the CMS Home Health Agency (HHA) Center site’s home page.

Will Home Health Agencies continue to employ salaried Therapists under PDGM? Therapy services are an important service provided by Home Health Agencies. The PDGM model does not eliminate the need for or dismiss the payment of therapy services. PDGM accounts for the provision of multidisciplinary care through the case mix model based on patient characteristics. Case mix items such as the primary diagnosis, functional impairment level and comorbidity adjustment will account for the multidisciplinary patient needs. Home Health Agency leadership will continue to determine the best model for obtaining therapy services.

What are some best practices that will align therapy service delivery with the individual clinical groups? The Home Health Conditions of Participation (CoPs) continue to require that each patient accepted for home health care receive an individualized and coordinated plan of care. The best approach to ensure safe, effective and efficient care planning is through interdisciplinary care management. Consider using the SBAR approach (Situation, Background, Assessment and Recommendations) for best practice, patient centered care management to provide the right level of care, the right amount of service, by the right discipline at the right time for the right reason.

We will continue to keep you up to date about this important change for our industry. Click the link below if you’d like to learn more about Fazzi’s PDGM Readiness Services.

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Survey Reveals Agencies’ Current Thoughts on PDGM Impact

The change from 60 day to 30 day payment periods, the elimination of therapy thresholds and education of staff and management are agencies’ top concerns about PDGM, according to a recent survey conducted by SUNY Oswego.

You may recall that late last year, we co-sponsored a survey by SUNY Oswego to gauge agencies’ understanding of and perceptions about the Patient-Driven Groupings Model (PDGM). If you completed the survey, you will soon receive the full report, but we wanted to share some of the highlights with all our readers here. The following results are based on 161 respondents:

These factors are agencies’ top concerns:

49.7%  Change from 60 day to 30 day payment periods
17.0%  Elimination of therapy thresholds
8.2%    Education of staff and management

Clinical Preparation
Agencies were asked if they were making changes in their clinical practice to prepare for PDGM, to which they responded in this manner:

21.5%   Yes, they have already started making changes in anticipation of the new model
55.7%   Not yet, but are creating a plan to be implemented when PDGM goes live
19.0%   Said that their current practices would translate into the new payment model

Help Needed
Agencies said they would need the most help in these areas:

22.9%   Understanding the impact of PDGM on their quality outcomes
45.8%   Understanding the impact of PDGM on their reimbursement
11.8%   Educating their clinical staff on the new model

We will continue to keep you up to date about this important change for our industry. Click here if you’d like to learn more about Fazzi’s PDGM Readiness Services.

CMS Announces Test for Medicare Advantage Hospice Benefit Carve-In

In case you didn’t hear the news, CMS recently announced a number of Medicare Advantage (MA) health plan innovations to be tested in the Value-Based Insurance Design (VBID) model. One of those innovations to be tested for MA plans beginning in 2021 is a carve-in for hospice.

According to the CMS Fact Sheet, “Beginning in CY 2021, the VBID model will also test the Medicare hospice benefit in Medicare Advantage. CMS will release additional information and guidance on this intervention for interested stakeholders in the coming months through the VBID model website, and through open-door forum type events.”

Read the full fact sheet here.

We will continue to keep you informed of important developments for the hospice industry. In the meantime, if you’d like to learn more about Fazzi’s Hospice Consulting Services, please click here.

Home Health Compare Quality Charts Updated

The Home Health Compare results were updated on January 23, 2019.

For the Quality of Patient Care measures, 12 measures improved, 1 worsened, and 1 remained the same. As with last quarter, improvement in bed transfer saw the most improvement of 1.1%. Improvement in management of oral medications improved by 0.9%. Multifactor fall risk assessment conducted saw no change and Depression assessment conducted worsened by 0.1%. (Data Collection April 1, 2017 – March 31, 2018).

Acute care hospitalizations and Urgent, unplanned care in the emergency room both stayed the same, 15.8% at and 13.0%. (Data Collection January 1, 2017 – December 31, 2017).

The national average for the Quality of Patient Care Star Rating remained at 3.5 stars. The percentage of agencies with 3 stars declined, and the percent of agencies with 4.5 and 5 stars increased.

HHCAHPS measures also updated and the national averages remain the same. The data collection period for these measures and the Star Ratings is July 1, 2017 – June 30, 2018.

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. You can also compare measures by state, by year, by release date, and the top 10 or top 20 percent.

PDGM Readiness Webinar – It all Starts Here: Referrals and Intake

Wednesday, February 27 at 1:00 PM EST

Are you aware of the case mix adjuster that’s tied to referral source under the new Patient-Driven Groupings Model (PDGM)? Do you know your referral source mix and, the impact it will have on your reimbursement under PDGM? Register for the next of our complimentary webinars to learn about the admission source and timing components of the PDGM model and, the best practices for the intake, liaison and sales staff that you’ll want to start now. Plus, capturing accurate and specific information at admission is critical to assist clinicians with care planning, accuracy of primary and secondary diagnosis and the entire revenue cycle.

Join us to:

  • Understand what you and your intake, liaison and sales staff need to know now about the PDGM structure related to admission and timing.
  • Understand how to improve the working relationship between your clinical, intake and sales teams.
  • Identify the steps to take now to change your referral source mix.

Gina Mazza and Eileen Freitag will provide their best practice recommendations for referral, marketing and intake to position your agency for success under PDGM.

View the Recording

PDGM Readiness Webinar Recording: What About Therapy?

One of the biggest questions about the Patient-Driven Groupings Model (PDGM) on everyone’s mind is “what about therapy?” While the new model eliminates the therapy thresholds for payment, PDGM case mix includes mechanisms to include all disciplines.

In our complimentary PDGM Readiness webinar, Gina Mazza and Kerry Termine explain how therapy will be reimbursed in the PDGM case mix structure — and provide best practices for providing high quality patient-centered therapy services under this payment model.
Continue reading “PDGM Readiness Webinar Recording: What About Therapy?”