Hospice Compare Updated

CMS has posted the quarterly Hospice Compare refresh of quality data on May 23, 2019. All quality measures improved since the last quarterly posting or stayed the same. Pain Assessment showed the most improvement, from 87.8% to 89.2%, followed by Composite Process Measure.

Updates to the family caregivers’ survey results showed seven measures remained the same. However, ‘Willing to recommend this hospice’ decreased by 1%.

Quality measure results are from data collected July 1, 2017 – June 30, 2018, and Hospice CAHPS® survey results reported July 1, 2016 to June 30, 2018.

View State Level Hospice Compare Charts

Long Time Industry Leader Shares Insights about Interim Leadership

Our industry is experiencing a high number of senior level retirements and other types of vacancies, and it’s becoming harder to find qualified people to fill these positions. Therefore, we’re getting a lot of questions about Interim Leadership, and so we thought we’d share with you this Q+A with long time industry leader, Eileen Freitag, who directs Fazzi’s Interim Leadership program.

Q: What types of situations cause agencies to consider engaging an Interim Leader?
A: We’ve seen many different scenarios including short term leave of absences; maternity leaves; retirements and other vacancies when there is no internal candidate to fill the job; retirements and other vacancies when none of the internal candidates are the right fit; and situations when the agency is underperforming and a key manager leaves either voluntarily or involuntarily.

Q: What positions has Fazzi filled in the past?
A: We have placed Interim Leaders in these positions: CEO, COO, Clinical Director, Director of Patient Services, Director of Quality, Clinical Manager and Billing Manager.

Q: Can you share specific examples of how agencies have utilized Fazzi’s Interim Leaders? 
A: In one agency, the CEO left on short notice for medical reasons while in the midst of software selection and negotiation with a therapy vendor. Our Interim CEO steered both projects to successful conclusion, and additionally, the agency experienced increases in staff retention and productivity.

A: We’ve had many situations in which agencies’ performance was in decline at the time of the CEO’s departure. In these instances, our Interim Leaders have conducted assessments and developed turnaround plans to fix problems and stabilize the organization so that the new incoming Leader starts with a clean slate. In many of these instances the agency found it easier to find permanent candidates for a stable organization instead of needing to find someone with turnaround skills.

A: In other scenarios, agencies have engaged Fazzi’s Interim Leaders to mentor a new executive – especially if they’ve come from outside of home health or hospice.

Q: Who are Fazzi’s Interim Leaders?
A: Our Interim Leaders are people who have retired early, have had successful track records in home health and/or hospice and still love the field and want the opportunity to take shorter term assignments (up to one year). They love the adventure of coming into an agency, quickly assessing the needs, and developing and executing a plan for results. They understand that often times, staff have been through a lot of stress when they’ve lost a leader that they knew and respected. Our Interim Leaders are skilled at balancing the need for sensitivity to this as well as the need to make changes to improve the performance of the agency.

Q: What is the process of getting an Interim Leader placed? 
A: We start with an in depth discussion about the client’s needs; i.e. the duties of the position, specific challenges the agency is facing, the characteristics of the agency and specific qualities and/or skills the client wants this person to have. From there we will send a potential candidate for the client to review. Our goal is to find someone that has the skills needed with the least possible travel time and expense.

If you’d like to speak with Eileen further about Fazzi’s Interim Leadership program, please contact us.

More Than PDGM: Home Health’s Top Legal and Compliance Issues Now

Thursday, June 20  |  12:00pm-1:00pm CT
Register Now

Since Fazzi Associates is now a member of the WellSky team, we’re able to bring you even more important industry resources and insights. Today, we’re pleased to present this complimentary webinar to be hosted by WellSky on June 20.

Although most home health providers are intensely focused on PDGM, it is far from being the only regulatory and legal issue that is impacting compliance today. Issues ranging from the ongoing Brookdale litigation to the Department of Labor’s notice of proposed rulemaking that would make more than a million more American workers eligible for overtime will have huge impacts on the home health industry.

While you’ve got your eye on PDGM, don’t overlook the big picture of compliance risk!

Join renowned home health attorney Robert W. Markette of Hall, Render, Killian, Heath & Lyman, P.C. for an exclusive webinar that will prepare you and your team for key changes in compliance that you may have missed while busily preparing for PDGM.

Attend and learn:

  • The risks of sudden practices shifts in 2020
  • What the Supreme Court decision to decline the Brookdale case means for home health
  • How the #metoo movement is leading to renewed focus on sexual harassment and what that means for employers
  • The Department of Labor’s salary notice of proposed rulemaking and what it means for professional exemptions

This is the guidance your agency needs right now. Don’t miss it!

Register Now

About the Presenter
Robert W. Markette, Jr., CHC, HCS-C of Hall, Render, Killian, Heath & Lyman, P.C.

Robert has focused his practice on representing home health, hospice, private duty and DME providers in all aspects of their operations. Robert has developed a reputation for understanding the operational, compliance and legal/regulatory issues facing homecare providers. He serves on both the Board of Medical Specialty Coding and Compliance and the Board of the Association for Home Care Compliance. Robert drafted the Second Edition of the Homecare Administrator’s Field Guide and the Home Health Patient Rights Policy and Procedure Manual. He has been awarded the HCS-C credential signifying his knowledge and experience in home care compliance and is also certified in health care compliance by the Health Care Compliance Board. Robert is widely recognized for his expertise in this space and is a frequent speaker on home health, hospice and private duty matters across the country.

Home Health Compare Quality Charts Updated

The Home Health Compare results were updated on May 17, 2019.

For the Quality of Patient Care measures, 11 measures improved, 1 worsened, and 2 remained the same. As with last quarter, improvement in bed transfer saw the most improvement of 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 July 1, 2017 – June 30, 2018).

Acute care hospitalizations and Urgent, unplanned care in the emergency room both stayed the same at 15.8% 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 2.5 and 3.5 stars declined, and the percent of agencies with 1,1.5 and 5 stars increased.

HHCAHPS measures also updated and the national averages remain the same for 4 measures. Patient willingness to recommend worsened by 1%. The data collection period for these measures and the Star Ratings is October 1, 2017 – September 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.

Proposed Hospice Rule Summarized

On Friday, April 19, the Federal Register posted the public inspection copy of the FY2020 Hospice Wage Index proposed rule. Comments on the proposal are due to CMS by June 18, 2019.

Fazzi is pleased to provide you with a comprehensive summary of the proposed rule prepared by Catherine Dehlin, Fazzi’s Director of Hospice Services.

Please complete the form to download your copy.

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.

Learn More