Industry Insights

According to a national trend analysis by the Centers for Medicare & Medicaid Services (CMS), the average number of home health providers per county decreased by 7.31%, while hospice providers per county increased by 12.84% (October 2014 to March 2017).

The analysis and other utilization metrics can be viewed at the updated Market Saturation and Utilization Tool. These interactive maps include results at the national, state, or county level. The most recent data period is April 2016 to March 2017.

Sixteen health service areas are available for comparison including home health and hospice. The following metrics are available for comparison:

• Number of Fee-for-Service Beneficiaries
• Number of Providers
• Average Number of Users per Provider
• Percentage of Users out of FFS Beneficiaries
• Number of Users
• Average Number of Providers per County
• Total Payments

If you are interested in competitor data by agency or county level, click here to visit our web page on Business Intelligence or email info@fazzi.com.

The Home Health Compare results were updated on April 11, 2018.

For the Quality of Patient Care measures, 12 measures improved and 2 remained the same. No measures worsened. As with last quarter, improvement in bed transfer saw the most improvement of 1.3%. Improvement in management of oral medications and improvement in dyspnea both showed improvement of at least 1.0%. Multifactor fall risk assessment conducted and depression assessment conducted measures both saw no change. (Collection period July 1, 2016 to June 30, 2017.)

While the acute care hospitalizations measure improved again this quarter, from 16.2% to 15.9%, urgent, unplanned care in the emergency room continued to worsen with an increase of 0.1%. (Collection period July 1, 2016 to June 30, 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 4 stars declined, and the percent of agencies with 4.5 and 5 stars increased.

Updates were also made for HHCAHPS measures and the national averages continue to remain the same. The data collection period for these measures and the Star Ratings is October 2016 to September 2017.

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.

 

Edition #3: Managing the Workforce Crisis: First Do No Harm! Creating Optimal Culture

In this edition, we discuss the importance of culture in attracting and retaining employees, especially Millenials. In our work with agencies across the country, we have observed many organizations that unintentionally and unknowingly make their own workforce challenge worse… Continue Reading 

Edition #2: Supply and Demand for Key Positions (If you were worried about nursing, wait until you see the Home Health aide projections!)

In this edition, we look at the projected supply and demand for key positions in home care and hospice.  We also introduce a one-stop resource to view state by state data on Registered Nurses (RNs), Home Health Aides (HHAs), Personal Care Aides (PCAs), Licensed Practical Nurses (LPNs),  Licensed Vocational Nurses (LVNs) and Physical Therapists (PTs)… Continue Reading 

Edition #1: The Many Facets of Optimal Staffing

Home Health and Hospice agency staffing concerns are growing rapidly along with the aging population we serve. Agencies of all sizes are reporting record numbers of vacancies… Continue Reading 

 

The Journey Has Begun!

Anita Werner, RN, BCHH-C, COQS, Senior Compliance Consultant at Fazzi Associates

Here’s what we know about OASIS D so far:

• CMS has posted the new OASIS D instrument and a supporting statement at this link.
• Comments are due May 11 which can be submitted via this link.
• CMS expects to issue draft guidance in July and final guidance in November.
• The revisions effective January 1, 2019 are intended to comply with the 2014 IMPACT Act.
• Changes to the assessment are extensive. CMS is removing 235 data elements across all OASIS items as a part of the Paperwork Reduction Act, however 6 new questions with multiple data items are added. For example, at Start of Care 75 data elements are removed, however 65 new elements are added.

Here are excerpts from CMS supporting statement:

• GG0130-Self Care, GG0170-Mobility, J1800-Falls Since SOC/ROC, and J1900-Number of Falls are included to meet IMPACT Act requirements for post-acute care settings to standardize assessment and reporting of (1) Falls with Major Injury, and (2) Functional Assessment of and Care Planning for Function.
• M1311 has been standardized across post-acute care settings to now be used to measure Changes in Skin Integrity: Pressure Ulcer/Injury with removal of M1313.
• GG0100-Prior Functioning and GG0110-Prior Device Use are added to standardize this data collection across post-acute care settings.
• Fifteen of the 28 OASIS questions removed provided risk adjustment for publicly reported outcomes. This means accuracy in the responses to remaining OASIS questions will be even more essential. Competence in OASIS-C2 will set the stage for success with OASIS D.

Fazzi is here to help you with these changes! Our OASIS Package available through The Fazzi Learning Center will automatically be updated with the changes and all Fazzi Learning Center customers will receive a free “crosswalk” training on the changes during the fall – not too early and not too late!. If you’re not already a Fazzi Learning Center customer and would like to learn more, please click here.

Stay tuned for additional updates on the journey to OASIS D.

CMS has posted the initial publication of results from the CAHPS® Hospice Survey on Hospice Compare.  Results include all Medicare-certified hospices that had at least 30 completed surveys from April 1, 2015 to March 31, 2017.

Since the first release of national averages in December 2017 of the family caregivers’ survey results, treating patient with respect improved along with training family to care for patient, while willingness to recommend worsened (see table).

Updates to patient preferences and managing pain and treating symptoms saw improvement in five measures, with the most improvement in beliefs/values addressed and dyspnea treatment.  Dyspnea screening and patients treated with opioid who are given a bowel regimen remained the same while a slight improvement was seen in all other measures.

For state level Hospice Compare charts, click here.

National Averages for CAHPS® Hospice Survey Measures

Measure	National Average
	December 2017	February 2018
Hospice Team Communication	80%	80%
Getting Timely Care	78%	78%
Treating Patient with Respect	90%	91%
Getting Emotional and Religious Support	89%	89%
Getting Help for Symptoms	75%	75%
Getting Hospice Care Training	72%	75%
Rating of Hospice	80%	80%
Willingness to Recommend	85%	84%

Source: Medicare.gov, Hospice Compare. Data.Medicare.gov

Nearly half of all jobs in the U.S. require workers to adjust to new schedules or locations. Forty-five percent of home health aides (HHAs) work in home health care and 75% of all HHAs have to adapt to changing work schedules. For registered nurses (RNs), 65% have to adapt to changing work schedules.

In almost a quarter (23%) of jobs, work location changes more than four times per year, and for HHAs, that’s 69%, compared to RNs at 14%.    

Selected Occupations and Percent of Jobs That Require Employees to Change Work Schedules or Change Work Locations More Than Four Times per Year, 2017

Source: Bureau of Labor Statistics, U.S. Department of Labor, The Economics Daily, Jobs with changing work schedules or work locations in 2017 on the Internet at https://www.bls.gov/opub/ted/2018/jobs-with-changing-work-schedules-or-work-locations-in-2017.htm (visited February 02, 2018).

If you are interested in competitor data by agency or county level, click here to visit our web page on Business Intelligence or email info@fazzi.com.

Medicare Cards Will No Longer Have Social Security Numbers – Here’s What You Need to Know

Social Security Numbers are being removed from all Medicare cards by April 2019. A new Medicare Beneficiary Identifier (MBI) will replace the SSN-based Health Insurance Claim Number (HICN) on the new Medicare cards used for Medicare transactions like billing, eligibility status, and claim status. Beginning in April 2018, CMS will start mailing the new Medicare cards with the MBI to all Medicare beneficiaries in phases by geographic location.

There will be a transition period beginning in April 2018 and running through December 31, 2019. Beginning in October 2018, through the transition period, when providers submit a claim using a patient’s valid and active Health Insurance Claim Number (HICN), CMS will return both the HICN and the MBI on every remittance advice. During the transition period, Agencies can use either the HICN or the MBI to exchange data.

Starting January 1, 2020, all providers will submit claims using MBIs, no matter what date the services were provided.

Begin to plan now for this change to assure everyone is educated and, all of your processes are tested and effective well before December 2019. The details to this initiative can be found here.

What Key Performance Indicators (KPIs) should Home Health leaders be setting for their agencies? Let’s hear from Cindy Campbell…

Establishing the right metrics is critical, but only part of a success story! A deeper, clear understanding of underlying processes and behaviors which “move the metrics” is the sweet spot needed by today’s agencies to achieve success clinically and financially. We call these Key Performance Behaviors or “KPBs”; hardwiring your organization for success.

Discuss how to hard wire the right KPBs for your agency with Cindy.

Learn More

The Home Health Compare results were updated on January 24, 2018.

For the Quality of Patient Care measures, 12 measures improved, with improvement in bed transfer seeing the most of improvement of 1.5%, followed by improvement in management of oral medications (increase of 1.4%). Depression assessment conducted slightly decreased. (Collection period April 1, 2016 to March 31, 2017.)

The acute care hospitalizations measure improved again this quarter, from 16.4% to 16.2%. The urgent, unplanned care in the emergency room measure worsened with an increase of 0.1%. (Collection period April 1, 2016 to March 31, 2017.)

Updates were also made for HHCAHPS measures and the national averages continue to remain the same. The data collection period for these measures and the Star Ratings is July 2016 to June 2017.

The national average for the Quality of Patient Care Star Rating remained at 3.5 stars, although the percent of agencies with 3.5 stars declined from 20% to 19%. The percent of agencies with 4 stars increased to 17% from 16%, and agencies with 4.5 stars decreased to 10% from 11%.

CMS will remove the influenza immunization received for current flu season measure from the Quality of Patient Care Star Rating effective with the April 2018 refresh. The rationale is due to differences across states’ regulations regarding transporting and administering vaccinations; no exclusion made for patients who were offered the vaccination and refused; and no exclusion made for patients who cannot receive the vaccination due to contradictions. The measure will continue to be reported on Home Health Compare to encourage vaccination, and the measure will be monitored by CMS to ensure the rates do not decrease.¹

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.

¹ Centers for Medicare & Medicaid. Home Health Quality Initiative. Updates.