HHS Ahead of Schedule with Value-Based Payment Models: Audits Can Help Agencies Prepare

To help drive the health care system towards greater value-based purchasing rather than continuing to reward volume regardless of quality of care delivered, HHS set a goal in 2015 to have 30 percent of Medicare payments in alternative payment models by the end of 2016 and 50 percent by the end of 20181. In March 2016, the Administration announced that it estimates it has already hit its first target – 11 months ahead of schedule2. There’s no doubt that the home health fee-for-service payment model is quickly being replaced with payments tied to quality of care results with increasingly rigorous scrutiny. Unfortunately, as reported in Home Health Care News, our data indicates that many home health agency staff continue to struggle with obtaining accurate OASIS assessments which will drive many outcomes, revenue and compliance activities.

Fazzi’s Compliance Division recently completed an analysis on the home health coding and OASIS audits they conducted over the past 12 months. The study revealed that on average $150-$200 per episode was not captured by agencies because of inaccurate completion of the OASIS! Furthermore, it appeared that multiple outcome measures did not show improvement because of inaccurate OASIS selection at the start of care.

Given the price of inaccurate OASIS documentation, understanding how your clinicians are handling the OASIS and which areas are most problematic is a key component to your Agency’s success.  Consider conducting a targeted record audit. Our audit will:

  1. Likely pay for itself,
  2. Tell you quickly if your OASIS assessments are accurate, and
  3. Indicate which areas should be prioritized for improvement.

Only after you know that your OASIS assessments are accurate, should you identify 1-2 QA/PI projects focused on improving quality of care measures.

Contact us about the cost and options for a focused OASIS audit.

Final National OASIS Testing Results and What They Mean for The Future of our Industry

As you know, I love data.  It fuels understanding, learning and improvement.  Even when the data is not good, we need to know it.  And in this issue of our Benchmark newsletter, I have some eye opening data to share.

You may recall that earlier this year we provided preliminary results from the national OASIS testing project that we conducted.  This project tested agency staff competencies on OASIS across the country.  There were 57 questions covering all areas of OASIS including a special focus on Value Based Purchasing and Star Rating items.  Here are the results:

Average Score by Position











Top Problem Areas

Neuro-Emotional/ Behavioral

Therapy Need/

Plan of Care

Respiratory Status






Scores by Type of Impact

Average Score on Items with Impact on

Average Score on Items with Financial

Average Score on Items Impacting Value-Based
Purchasing Measures

& Star Ratings





The Concern

I find this data eye opening and also concerning, because OASIS is the foundation of home care.  It is the single most important tool used by clinicians to assess the clinical status of every home care patient in the country.  OASIS is used to determine reimbursement.  It is the heart of compliance reviews.  It is the foundation for Home Health Compare public reports including Star Ratings.  It is the source for comparing agencies in the new CMS Value-Based Purchasing Program.  In short, OASIS is the foundation for the entire clinical, operational, quality and reimbursement process in home care.  Given the critical nature of OASIS, these scores should be higher. Continue reading “Final National OASIS Testing Results and What They Mean for The Future of our Industry”

It’s Time to Answer the Phone!

The phone calls are about to begin! By that I mean the phone survey calls for the 2016 National Home Care and Hospice State of the Industry Study.

With over 1,700 suggestions from you and your colleagues across the country, the questionnaire is now complete and we are about to begin making the survey calls. Every agency that participates will receive an advance copy of the findings to be released this fall. If you would like to volunteer to participate, you may do so by clicking this link.

This is our fourth biannual State of the Industry Study. Given the new world of Value-Based Purchasing and the inevitable Pay-For-Performance model that will be mandated nationwide, there is no question it will be the most important. Everything about this project is designed to help agencies improve quality and lower costs, because we know that the Invincible agencies will be those who embrace “who we were yesterday cannot be who we are tomorrow.”

I am so pleased and thankful for all of the input we received from the industry in designing this study.  A sampling of topics includes:

Continue reading “It’s Time to Answer the Phone!”

Home Health Compare Charts Updated – April 2016

The Home Health Compare results were updated April 20, 2016.  Nearly all measures showed improvement.  Four measures remain unchanged while one measure decreased.  The data collection period for these measures is from October 1, 2014 to September 30, 2015.


Seven of the nine measures for the Quality of Patient Care Star Ratings showed improvement.  Influenza immunization received for current flu season decreased for the second reporting period in a row and Acute Care Hospitalization remained unchanged.  The nine measures used to calculate the star ratings are identified with an asterisk on Fazzi’s Home Health Compare Charts.  The Quality of Patient Care Star Ratings show 22% of agencies receiving 3 and 3.5 stars.

For HHCAHPS averages, the national score in Specific care issues decreased.  The remaining measures are unchanged. The data collection period for these measures is from October 1, 2014 to September 30, 2015.

Check your Patient Survey Star Ratings.  If your star rating decreased, contact our Gina Mazza, our HHCAHPS Survey Director for improvement tips.

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.

Fazzi’s National OASIS Testing Project Preliminary Results

8e908b30-d157-4786-80f5-e543854dfdd0Well, we made it, at least season-wise.  Spring!  It is absolutely my favorite time of the year.  It always feels like a new beginning.  It is not just the more pleasant temperatures, it is the excitement of seeing buds emerging on trees, birds returning to New England and the first signs of flowers.  Longer days and more sun makes it especially exciting for our colleagues in northern states.

Unfortunately, what hasn’t changed are the demands on our agencies, especially data demands.  This month I’d like to touch on a few different topics that share a common thread – research, data and the importance of continuous learning (the fun part!).

Our industry is flooded with data demands.  Data that must be reported.  Data that affects STAR ratings.  Data that impacts reimbursement and quite frankly could possibly threaten the existence of some agencies (especially in the Value-Based Purchasing pilot states).  That’s exactly why we’re so intent on providing research and data that fuels insight, learning, and improvement.

Let’s take a look at some research that we feel is important and telling.  First, as you may recall, we are currently conducting a national OASIS testing project to test agency staff competencies around OASIS across the country, and we have some preliminary results to share.  (Note that if you haven’t participated in this testing, please see the next article.)

Fazzi’s National OASIS Testing Project Preliminary Results:

Average score by position:

  • Manager 71%
  • PT 75%
  • RN 73%
  • Auditor 81%

Average score for those items impacting Value-Based Purchasing (VBP) and STAR Rating: 77%

Biggest problem areas are those that impact VBP/STAR scores:

  • ADL/IADL average score: 62%
  • Respiratory Status (specifically M1400) score: 54%

Continue reading “Fazzi’s National OASIS Testing Project Preliminary Results”

National State of the Industry Study: Fazzi Needs Your Help

Fazzi puts out a lot of information, studies, data, and other material that we hope is helpful to you and others in our field. We rarely ask for help. However, this is one of those occasions.

Fazzi is once again sponsoring The National Home Care and Hospice State of the Industry Study which focuses on the present and future of home care and hospice. This is our fourth. There is a National Steering Committee made up of leaders from all three accreditation groups, leaders of state and national associations, and leaders from agencies in every region. Like the three previous Fazzi State of the Industry studies, the results will be made available free to every agency in the country.

Here is What We Need…

To ensure the Study includes responses that you and others in our field are most interested in, a pre-survey request for suggested questions on specific topics is now online. The Online State of the Industry Input Survey is open to anyone involved with home care and hospice. The survey should take less than ten minutes.

Complete the Input Survey

I am hopeful that you can help with two things: 1) Participate in the online survey to provide input, and 2) Reach out and get others to do the same. Suggestions can be made on one, two, or all the themes that will ultimately be in the final survey.

In the past, our best questions have come from those who are closest to us, particularly you and others on the Fazzi Benchmark Email list. Please forward this email to your contacts. The Online State of the Industry Input Survey is available today through Friday, March 4, 2016. Your input will be very much appreciated. If you have any questions, please contact Kelly Dwight, kdwight@fazzi.com.

Thanks again,

Bob signature
Bob Fazzi,
Managing Partner

February 2016 Newsletter

The Threat (and the Opportunity) Is Real

Bob Fazzi

Each year we are faced with regulatory and reimbursement changes and challenges that make it more difficult or more expensive to provide services. Some are troubling and time consuming while others threaten the viability of some agencies. Every new challenge is often followed by cries that these are “industry altering” threats. Think about introduction of OASIS. RAC audits. Face to Face. Rebasing.

Don’t get me wrong, these are serious challenges but they don’t reach the magnitude of “industry altering.” Today, however, there is a real threat, one that has the potential of becoming the third home care challenge that could reach the status of industry altering. It is a threat that will start in nine states (AZ, FL, IA, MA, MD, NC, NE, TN, WA) and will ultimately expand to all fifty states. First, a little history.

Industry Altering Challenge I. The Medicare Denial Crisis

The first Industry Altering threat was caused by the service and payment denials of the late 80s and early 90s. Basically, agencies found that many of their services were denied. Denied meant no payments. No payments meant agencies could not pay bills and staff. Results: closures. Many closures.

Following a major lawsuit lead by the National Association for Home Care and Hospice, the problem was rectified, the definition of eligible services expanded and our industry began experiencing significant growth in numbers of agencies, patients served and revenues. Great stability for roughly 18 years…and then the second challenge emerged.

Continue reading “February 2016 Newsletter”

Home Health Compare Charts Updated

The Home Health Compare results were updated January 28, 2016.

  • This release includes the first reported Home Health Patient Experience of Care Star Ratings. The HHCAHPS Patient Survey Star Ratings reports patients’ experiences of care ranging from one to five stars. CMS reports approximately 6,000 agencies with patient care experience star ratings in this release. Four HHCAHPS measures can receive a star rating plus there is a summary star rating that reflects the average of the composite stars and global star.
    •  3 composites measures: care of patients, communication between providers and patients, and specific care issues
    • 1 global item: Overall rating of care provided by the HHA
    • 1 Survey Summary Star Rating

CMS has adjusted the Patient Survey Star Ratings results for patient mix. The adjusted results are publicly reported.

Continue reading “Home Health Compare Charts Updated”

December 2015 Newsletter

Message From Bob: I Feel Privileged!

Bob FazziAs I was preparing to write this column, I realized that I had two choices.  One option was to write about our predictions for 2016.  Let’s face it, with so much now occurring and about to occur, it would be a very juicy, interesting column.  Think of this as the “business” of Healthcare at Home option.

The other option, some would say the syrupy, reflective option, would be to look back and comment on the importance of home care and our role in making our communities, our state and our country a better place for all of us, not just our patients but their children, families and friends.  Think of this as the “mission” of Healthcare at Home.  I chose the latter!

We are so caught up with the challenges of face-to-face, STARS program, bundled payments, movement to ICD-10, CMS audits, cost reductions, etc., we seem to have no time to stop and reflect on how important we are for the millions and millions of patients in our home care, hospice and private duty programs.  There is not a community in this country where one of our staff have not been there at one time or another to serve a member of family in that community.

Every day, every hour, every minute someone in our field is serving a patient whose life is made better, more tolerable because we are there.  Every day, every hour, every minute there is a family who is experiencing a sense of reassurance because a caring person drove to their home and shared their talent and compassion to help their love ones.  And every day, every hour and every minute there is not a community in this country that is not made stronger because we are there.  We are a key component of the social fabric of this country.

Continue reading “December 2015 Newsletter”

November 2015 Newsletter

Message From Bob Fazzi

It’s time to take the future of home care seriously.  Here is why.

If you ask any one on your management staff who was working in home care on August 5, 1997 what happened on that date, most would tell you it was one of the worst times in the history of home care—the Balanced Budget Act went into effect.  Over 1/3 of all agencies were forced to close and home care lost 50% of its projected revenue as our industry moved from pay per visit to episodic payments.  The agencies that did not survive did not move quickly enough.

Value-Based Purchasing is just as serious and has the potential of being just as destructive. There will be agencies that come out ahead, and those that go out of business.  The difference is in how you prepare.

Continue reading “November 2015 Newsletter”