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.

Register Now

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.
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Tim Ashe Named WellSky’s Chief Clinical Officer

Yesterday, our parent company, WellSky, made the exciting announcement that Tim Ashe has been named WellSky’s Chief Clinical Officer (CCO). In this role, Tim will ensure that clinical imperatives, including the insights of frontline practitioners, are incorporated into the solutions developed for all WellSky customers as we partner with providers to advance patient care.

Tim will also continue to serve as Fazzi’s President, leading our 40-year mission of making a real difference in health care by strengthening the quality, value, and impact of health care at home; a charge shared and fueled by our parent, WellSky. Together, we are committed to delivering solutions that not only meet regulatory requirements, but also deliver clinical outcomes that improve the patient experience, better the overall health of populations and reduce costs.

Please join the Fazzi team in congratulating Tim!

PDGM Readiness White Paper: It Begins with Leadership

Everyone knows that the Patient-Driven Groupings Model (PDGM) is the most sweeping change for Home Health since the Prospective Payment System (PPS), and industry veterans certainly remember that period of uncertainty and disruption.

With PDGM, yet again, every Home Health agency will need to adjust. And while you’ll need to analyze the impact on every core function, “step one” is to realize that what’s most important is leadership and the ability to manage change. Gina Mazza’s white paper, “Step One to PDGM: Leadership and Change Management” offers a “PDGM leadership checklist” to help get you started.

Continue reading “PDGM Readiness White Paper: It Begins with Leadership”

Hospice Compare Updated

CMS has posted the quarterly Hospice Compare refresh of quality data on December 4, 2018. All quality measures showed improvement since the last quarterly posting! Pain assessment showed the most improvement, from 83.4% to 85.5%, followed by pain screening.

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

CMS has added a new “Composite Process Measure” to Hospice Compare. As of this release, the national average is 83.6%.

Quality measure results are from data collected 1st quarter 2017 through 4th quarter 2017, and Hospice CAHPS® survey results reported 1st quarter 2016 through 4th quarter 2017.

View State Level Hospice Compare Charts

Understanding the Hospice SIA and Best Practices for Quality End of Life Care

CMS created the service intensity add-on (SIA) in recognition of patients and families needing more intensive care and services at the very end of life. The SIA also recognizes the higher costs of those services by offering hospice providers reimbursement for them. Specifically, the SIA payment covers direct care provided by a registered nurse or social worker that occurs during the last seven days of life, up to four hours per day, in addition to the routine home care per diem reimbursement.

However, two years after the 2016 Hospice Payment Rule instituted the SIA, it is clear that many hospice organizations have not realized the opportunity for optimizing the reimbursement model, enhancing care during the last seven days of life and capturing the SIA payment.

Fazzi’s complimentary white paper written by Catherine Dehlin, Fazzi’s Director of Hospice Services entitled, “Does Your Hospice Team Understand Service Intensity Add-On?”, provides a more complete understanding of the benefit and best practice strategies to help ensure patients and families receive high quality end of life care. This paper is full of specific and actionable recommendations in these areas:

  • Direct care
  • Scheduling and staffing
  • Escalation of services
  • Care planning
  • Interdisciplinary team communication
  • QAPI

Following these recommendations will benefit patients and their families as well as help agency leaders access this important resource.

Continue reading “Understanding the Hospice SIA and Best Practices for Quality End of Life Care”

Is Coding Holding Your Agency Back?

New Reasons to Outsource or to Examine Your Coding Vendor

The trend of outsourcing the coding function has been gaining momentum among home health and hospice agencies for a number of years. And now, with OASIS-D, the Patient-Driven Groupings Model (PDGM) and the changing regulatory landscape for hospice, the list of reasons to outsource – or to examine your coding vendor – is getting longer.

Our white paper entitled, “Is Coding Holding Your Agency Back?” provides important insights on this industry trend including a list of questions to ask your prospective or current coding vendor. Authors Kelly Murphy-Miller and Kerry Termine have packed a lot of information into a very readable five pages

Continue reading “Is Coding Holding Your Agency Back?”