Celebrating Two Retiring Home Care Icons

There are two people who have done more for home care and hospice than nearly anyone who has worked in our field. They are brothers. One retired a few years ago, the other will retire at the end of this year. They are Bill Simione and Bob Simione, two incredibly talented, dedicated, ethical and generous leaders from Simione Healthcare Consultants.

I have known Bill and Bob for nearly forty years. When I joined the field in 1978, both were generous with their time helping me to understand some of the unique idiosyncrasies of the field. When Fazzi got involved with the devastation from Hurricane Katrina, it was Bill and Bob who immediately offered to join with us in a fundraising webinar, one that raised over $60,000. They have been consistent maximum donors to the Home Care PAC. Both have been on the NAHC Board and various state Boards. Both have led the Financial Manager Association, the single most effective NAHC affiliated entity.

Bill and Bob have been important advocates for our industry, testifying numerous times on key home care bills. Both have provided insightful and comprehensive presentations to state and national associations. Both have provided invaluable services to agencies and have generously given their time to provide our trade publications with facts and insights that writers were able to share with readers throughout the country.

There is a tone in our field that is different than in most other industries. It is a tone where competitors, whether agency competitors or vendor competitors often come together to share insights that can be of benefit to others. Bill and Bob not only exemplify this type of support, I believe it was their early leadership in being open to helping others that set the standard for our industry, a standard that we continue to see today.

Bill Simioine and Bob Simione didn’t simply work in the home care and hospice field, they deeply cared about it. They are industry giants that represent the ethical and moral best of our industry. We all owe them our debt of gratitude for their decades of leadership and compassion. And, from all of us at Fazzi, our sincere thanks for helping to elevate the quality and esteem of our industry and of the thousands of home care and hospice agencies throughout the US. We are a better industry and better professionals because of all you’ve done.

Home Health Compare Quality Charts Updated – October 2016

The Home Health Compare results were updated on October 19, 2016.

Nearly all national averages for the Quality of Patient Care measures showed improvement with pneumococcal polysaccharide vaccine ever received and influenza immunization received for current flu season showing the most improvement. Only two measures remained the same; pressure ulcer risk conducted and depression assessment conducted. The data collection period for these measures is from April 1, 2015 to March 31, 2016.

All quality measures included under Value-based Purchasing showed improvement except for the Preventing Unplanned Hospital Care measures. The quality measures for acute care hospitalizations and urgent, unplanned care in the emergency room both worsened slightly this quarter (collection period January 1, 2015 to December 31, 2015).

All national averages for HHCAHPS measures remained the same as last quarter. The data collection period for these measures is from April 2015 to March 2016.

hhc-chart-10-16The Patient Care Star Ratings showed an increase of agencies in the 4.5 and 5 star rating categories, and an increase in the number of agencies with 1.5 to 2.5 stars. The number of agencies with 3, 3.5, and 4 stars decreased. The national average Star Rating remained the same at 3.0 stars.

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.

Hospitals and Home Care: Both Moving in the Same Direction 

As most of you know, Fazzi has just completed our fourth bi-annual National State of the Home Care and Hospice Industry Study. It is the largest and most comprehensive study in our field and while we are just beginning the tedious but critical job of in-depth analysis, it is clear that major changes are happening.

Consider outsource coding. It is clearly following the path of other critical tools used by home health and hospice agencies: IT systems, point of care systems, telehealth and OASIS scrubbing. Agencies started slow and then accelerated their adoption of these critical systems. Same for outsourced coding. Five years ago, few agencies outsourced their coding. Two years ago, in Fazzi’s 2014 State of the Industry Study, only 6.3% of agencies reported that they used outsourced coding services.

In our most recent study, the 2016 State of the Industry Study, we discovered that there is a radical shift in the use of outsource coding especially by medium to large agencies. The percentage of agencies larger than $500,000 who are outsourcing has more than tripled to 29.4%. The study also found that of those respondents who are not currently using outsource coding services, 11.2% of them plan to explore using these services in the next twelve months.

The home care and hospice field is, without a doubt, following the lead of the hospital and health system sector. According to Black Book Market Research, one of the hospital and health industry’s leading research publications, “outsourced coding, transcription, health records management and clinical documentation managed services are on a meteoric rise. 69% of hospitals now outsource CDI, audit, review and programming, up from 25% in 2014.” Of those using outsourcing, “84% expressed satisfaction and experience outcomes that exceed expectations.”

Continue reading “Hospitals and Home Care: Both Moving in the Same Direction “

Home Health Compare Quality Charts Updated – July 2016

The Home Health Compare results were updated July 18, 2016.

Nearly all national averages for the Quality of Patient Care measures showed improvement with only one measure showing a decline. The data collection period for these measures is from January 1, 2015 to December 31, 2015.

  • Overall Quality of Care Star Rating: Remained the same at 3.0 stars.
  • Managing Daily Activities: All measures showed improvement.
  • Managing Pain and Treating Symptoms: Four measures showed improvement and pain assessment conducted remained unchanged.
  • Treating Wounds and Preventing Pressure Sores: All measures showed slight improvement.
  • Preventing Harm: Depression assessment conducted remained unchanged. Influenza immunization received for current flu season showed a slight decline.

The data collection period for Preventing Unplanned Hospital Care is October 1, 2014 to September 30, 2015. The quality measure for acute care hospitalizations remained unchanged while urgent, unplanned care in the emergency room worsened slightly this quarter from 12.3% to 12.4%.

For HHCAHPS averages, the national score for patient willingness to recommend the HHA to family and friends decreased for the first time in a long time. If you have not already read our latest white paper, Key Drivers & Best Practices for Improving HHCAHPS Results, you may download it by clicking here. The remaining measures are unchanged. The data collection period for these measures is from January 2015 to December 2015.

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.

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

Auditor

Manager

PT

RN

Other

83%

74%

73%

71%

74%

Top Problem Areas

Neuro-Emotional/ Behavioral

Therapy Need/

Plan of Care

Respiratory Status

ADL/IADL

24%

52%

55%

59%

Scores by Type of Impact

Average Score on Items with Impact on
Quality

Average Score on Items with Financial
Impact

Average Score on Items Impacting Value-Based
Purchasing Measures

& Star Ratings

67%

65%

75%

 

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.

hhc-star-2016-04

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