Now that we know the Patient-Driven Groupings Model (PDGM) will officially start January 1, 2020, it’s time to dig a little deeper into understanding how the case-mix weights of the 432 PDGM groups were established.

The CY 2019 Home Health Payment System Rate final rule was published last week and, as expected, the Patient-Driven Groupings Model (PDGM) will be implemented for 30-day periods of care starting on or after January 1, 2020. In our blog we provide a summary of changes to the model, such as the expansion of clinical groups from six to twelve, as well as home health PPS Case-mix updates and significant HHVBP changes confirmed in the final rule.

We are excited to announce the release of the Hospitalization Patient Detail report to our SHP for Agencies customers. This powerful new report provides a complete picture of the home-health stay for any patient, including: hospitalization risk, transfer history, and discharge details, with one row of data for each SOC/ROC to any available Transfer/Discharge. Also included are indicators for 30-Day Rehospitalizations, 60-Day Hospitalizations, Emergent Care, Hospitalization outcome details, and more.

In the CY 2018 Home Health Proposed Rule, CMS is dramatically changing the scoring methodology for the pilot program known as the Home Health Value-based Purchasing Program (HHVBP). What is striking to me is that these changes are being made during the fourth year of the five-year program, where up to 7% of Medicare revenues are at risk.

In the CY 2019 Home Health Proposed Rule, CMS shared a level of detail not seen before – an agency specific list of how agencies will fare under the changes they are proposing. Wow. CMS shared the agency revenue impacts of the Patient-Driven Groupings Model (PDGM) versus the current 153-group PPS reimbursement revenue. The range of the revenue impact is quite wide. Looking at the SHP national database for CY 2017, about 17% of the 3.6MM payment episodes in our database had a primary diagnosis code that would be considered a QE under PDGM.

SHP is pleased to announce Brightree recently incorporated our OASIS Integrated Alerting functionality into their iPad point-of-care app. This enhancement gives our joint customers the tools they need to improve speed and efficiency, while continuously providing high-quality care to patients.

SHP recently made improvements to the hospice portion of the Dashboard to include a new widget and two new preconfigured views that display quality measures for all of the same data types as the Hospice Scorecard, including: Provider, Case Manager, Team, Primary Diagnosis Category, and many more. Aside from the ability to group by all of our standard data types, the new widget can also be configured to report on all 22 of the HQRP and CAHPS quality measures available in our reporting.

With the OASIS-D assessment form going into effect on January 1st, 2019, SHP is pleased to provide home health agencies with a complete side-by-side comparison of the OASIS-C2 and expected OASIS-D assessment forms. This easy-to-follow guide is an excellent reference for anyone who works with OASIS Assessments and will improve accuracy, help reduce coding errors, and potentially reduce the number of returned claims.

The annual SHPBest recognition program was created to acknowledge home health and hospice providers that consistently provide high quality service. SHP would like to congratulate the 2017 SHP Best-of-the-Best winners, who have been recognized for achieving the highest overall HHCAHPS patient satisfaction or CAHPS Hospice caregiver satisfaction scores of all eligible SHP clients during the 2017 calendar year.

July usually starts the month off with fireworks, but this year the proposed rule was issued on July 2nd with its own bang at just under 600 pages. The big news - Home Health Groupings Model (HHGM) is now the Patient-Driven Groupings Model (PDGM). Below are a few other highlights from the proposed rule related to the Home Health Value Based Purchasing (HHVBP) program, Home Health Quality Reporting Program (HHQRP), new Home Infusion Benefit and the changing HH PPS case-mix weights (CMW).

CMS announced on their Medicare Learning Network (MLN) national call a proposed change to the Quality of Patient Care (QoPC) Star Ratings starting next year. CMS has proposed to eliminate the “Drug Education on all Medications Provided to Patient/Caregiver” measure and add the “Improvement in Management of Oral Medications” measure to the QoPC algorithm. What seems to be overlooked with these subtle changes is how often Star Ratings by provider change each quarter.

With the second performance year (CY 2017) of HHVBP over, I wanted to see how the year over year measure outcomes changed across our SHP national database. Comparing the same agencies year over year it appears both HHVBP states and Non-VBP states improved about the same on their average outcomes and process measure scores with little change in the HHCAHPS scores. Notice that with a few exceptions, VBP agencies had better outcomes than their non-VBP state agency peers. I expect CMS has noticed that too. In deciding what scores you want to target, it is best to know what percentile rank you want to realistically achieve.

Amedisys has been steadily expanding their breadth of care into markets across the continuum. Part of the company’s strategy of adding personal care services to improve care involves enhancing overall capabilities through new technologies. In 2016 Amedisys announced it would partner with Strategic Healthcare Programs (SHP) to help achieve this goal.

On April 28th, CMS issued the FY 2019 Hospice Payment and Quality Reporting proposed rule. Along with the typical annual payment updates, there were new proposals to the Hospice Quality Reporting Program (HQRP) for consideration, but no mention of the Hospice Evaluation and Reporting Tool (HEART).

The Centers for Medicare and Medicaid (CMS) penalizes hospitals for Medicare readmissions. Hospitals have difficulty tracking and managing patients after discharge. At Strategic Healthcare Programs (SHP), we look at millions of records each year from the Home Health Agency Outcome Assessment Information Set (OASIS) to correlate the patient characteristics that led to a transfer or discharge to an acute care hospital (readmission). With CMS incentives increasingly directed at reducing readmission rates, hospitals can maximize their Medicare reimbursement by selecting a post-acute care (PAC) home health care provider that uses actionable, real-time analytics.

On February 28th CMS ended the month hosting their regular Home Health Open Door Forum with some very notable updates to the home care industry. With little fanfare and during the Q&A portion, CMS responded to a question regarding the timing of the new OASIS forms as OASIS-D!

The partnership between NHIA and SHP supports the association’s longstanding Data Initiative effort created to collect and report patient outcomes data in a standardized manner and to provide the industry with the tools needed to establish national benchmarks for home infusion quality. Utilizing its web-based, automated, real-time data solution for home infusion pharmacies, SHP will work with NHIA to collect, aggregate, and report data from any eligible provider that can be used to establish future national standards for the field.