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.

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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.

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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.

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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.

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Is Your Agency Prepared for Value-Based Purchasing?

It’s here! Last week the long awaited pay-for-performance model, now named the Home Health Value-Based Purchasing (HHVBP) model, was approved by CMS.  This five year pilot will begin in January 2016 and test tying patient outcomes to agency Medicare episode payments.  The pilot will target nine states, including Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska, and Tennessee. All Medicare certified agencies in these nine states must participate in the HHVBP pilot beginning on the January 2016 start date.

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September 2015 Newsletter

Should We be Worried About Our Field?

Let me start by saying, I love this field.  Home Care and Hospice is a critical sector of health care and a social pillar of our society.  I am awed by the leaders I work with and indebted to the hundreds of thousands of caregivers and support staff who make our agencies what they are today.  And, I am humbled and grateful that I have had the good fortune of being involved in a field I consider sacred and so important.

At the same time, I feel I have a responsibility, one garnered from nearly forty years in this field to honestly express what I see and feel related to how we as an industry are approaching our future.  From this perspective I want to respectfully say I believe that as an industry and as leaders, we are not doing enough.  We are not coming together to aggressively take responsibility for redefining, reshaping and re-energizing our field.  As an industry, we seem to be passively watching while others define us.

The fact is that the community will inevitably be the focus of healthcare in this country and world-wide.  There is no choice!  The aging of the population, the exponential growing numbers of seniors and the spiraling cost of health care make it imperative that the future of healthcare be provided in the sector that can provide the highest quality healthcare services for the highest number of patients at the lowest cost.

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Another ICD-10 Delay. What Now?

Question:  I understand that ICD-10 has been delayed again to 2015?  Our agency has done so much and paid a lot of money to begin preparing, what do we do now?

Answer:  You are correct. After last week’s approval in the House, the Senate voted yesterday to approve a bill that will delay the implementation of ICD-10 by at least one year. The bill now moves to President Obama, who is expected to sign it into law.

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CMS Seeks Agencies to Participate in Bundled Payment Initiatives

Question: Our agency has been a little slow finding ways to get involved in the new healthcare reform initiatives.  Any ideas on how we can get involved?

Answer: Fazzi has been involved in helping agencies prepare for the full range of healthcare reform initiatives.  We help agencies work on strengthening their operations and quality/financial outcomes as well as closely monitor new initiatives as they are released.

If you are serious about getting involved and want to be a leader rather than a secondary referral source (if you are lucky), now is your chance.  CMS has just announced that they are seeking agencies to participate in Models 1, 2, 3 and 4 of bundle payment initiatives.  Fazzi believes that Model 2 and 3 and particularly Model 3 are the options a well run home care or hospice agency can and should consider getting involved with.

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Home Care Staffing Ratios

Question: What are the ideal staffing ratios for the delivery of clinical services in home care?

Answer: It is a question we are asked all the time. While there are often differences based on unique realities in individual agencies, there are specific ratios that have consistently proven to be highly effective in service delivery. This comes from doing hundreds of operational reviews for agencies of all sizes as well reviewing best practice benchmarking using comparative data from nearly 500 agencies over the past ten years.

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New National Average Case Mix Weight

Question: We saw the Minute in the Morning email with a preliminary case mix weight of 1.3517, up from 1.27.  Can you tell me more about it and what that means for my agency?

Answer: The national average case mix weight was posted in the Proposed Home Health Prospective Payment System Update for CY 2014 as 1.3517.  We verified with the Department of Health and Human Services, Centers for Medicare & Medicaid that the number is preliminary based on 2012 final claims data for non-LUPA episodes.  This number will be updated with the remaining claims data for CY 2012 for the 2014 HH PPS Final Rule. Fazzi will be sure to keep you posted when this final figure is announced.

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