Delta Connect Blog

Latest MedPac Report provides new data on Home Health and Hospice

Posted by Crystal Parks on Mar 18, 2015 11:04:44 AM

MedPac released its latest report on Friday, March 13th.  The recommendations for home health and hospice are the same as previous years, which includes:

  • Recommendation for a per episode copay for home health episodes that are not preceded by hospitalization or post-acute care use.
  • Revision of the home health case-mix weight to no longer use the number of therapy visits as a payment factor but to instead rely on patient characteristics to set payment for therapy and non-therapy services.
  • Begin a two-year rebasing of home health rates and eliminate the market basket update.
  • Eliminate the update to the hospice payment rates for fiscal year 2016. 

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The report also contained new data for both the home health and hospice industries.

Home Health

The number of home health agencies increased in 2013 by 302 agencies to a total of 12,613. There were almost 1,700 more agencies in 2013 than in 1997 and almost all the new agencies are for-profits.

The number of home health episodes declined by 2% from 2011 to 2013. MedPac sites several reason for the decline, which include:

  1. increased program integrity investigations
  2. implementation of the face-to-face documentation policy
  3. reduction in hospitalizations

Although hospitalization rates were not provided for 2013, MedPac reiterated that non-profit agencies have a lower hospitalization rate than for-profit agencies. 

Hospice

Use of hospice services increased in 2013 among Medicare beneficiaries. Almost half (47.3%) of eligible Medicare beneficiaries elected hospice services. In 2013, 3,925 hospice provided care to Medicare beneficiaries, which is a 5.3% increase from 2012. The number of for-profit hospices increased while non-profit hospices decreased slightly from 1,318 in 2012 to 1,314 in 2013.  

MedPac anticipates that since the Affordable Care Act mandated quality reporting, reporting of the quality of hospice care is expected to be available in 2017 at the earliest. 

MedPac estimates that because of upcoming changes to hospice payment rates, the 2015 aggregate margin will be 6.6%, which would be a decrease from 10.1% in 2012.  

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Topics: Hospice, Home Health

Home Health Quality Increasing according to AHHQI Data

Posted by Crystal Parks on Mar 10, 2015 8:30:00 AM

The Alliance for Home Health Quality and Innovation's (AHHQI) Home Health Chartbook shows the percentage of home health recipients rehospitalized within 30 days of hospital discharge decreased by nearly 2% - from 19% to 17% - between 2011 to 2012 for the top 20 most common diagnosis. The overall rate across all post-acute care settings fro 30-day hospital readmissions remains higher at 18%.

The AHHQI Home Health Chartbook summarizes and analyzes statistics from a range of government sources. In addition to declining 30-day hospital readmission rates, the Chartbook reveals that the national averages for home health quality measures improved in 15 distinct areas of care.

Home health beneficiaries also continue to reflect an older, sicker and majority female population as compared with the general Medicare population. The number of home health recipients over the age of 85 increased from 24% in 2011 to 25% in 2012 and recipients with three or more chronic conditions increased just over 2% from 2011-2012. The proportion of female patients (compared to male patients) rose by nearly 3%.

The full AHHQI Chartbook may be found here

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Topics: Home Health Quality

Home Care Overtime Compensation Lawsuit Update

Posted by Crystal Parks on Mar 9, 2015 8:47:43 AM

As previously reported by the National Association for Home Care & Hospice (NAHC), the U.S. Department of Labor (DoL) appealed the decisions of the U.S. District Court that invalidated the new rules issued by the Department that would have redefined the “companionship services” (provided by private duty caregivers) exemption from the minimum wage and overtime compensation requirements under the Fair Labor Standards Act (FLSA). The court also invalidated the rule change that would prohibit the application of the companionship services and live-in domestic services exemptions to workers employed by home care companies. 

The Court of Appeals for the District of Columbia has set a briefing scheduled for the parties that will be completed in early April. Oral argument before a three-judge panel has been scheduled for May 7, 2015. With such scheduling, it is very possible that a decision could be issued before the court goes on its July recess. Still, the timing of when a ruling will be issued is very hard to predict.

NAHC’s reply brief is due on March 30. Thereafter, it is expected that numerous parties will submit amicus briefs in support of NAHC’s position. Among the expected amici are disability advocacy groups, state Medicaid programs, members of Congress, and business groups.  Among other things, those amici will address concerns that DoL supporters did not. Specifically, these supporters will argue that Medicaid rates control worker compensation and that these rates are not rising to cover the cost of overtime. As a result, worker compensation is likely to suffer as employers restrict working hours to stay within the financial constraints imposed by Medicaid rates. Restrictions on work hours negatively impact home care consumers as they increase the number of workers needed to care for patients and trigger worker dissatisfaction and turnover. A number of state Medicaid programs are restricting or planning on restricting working hours to avoid overtime costs.

A full discussion of the lawsuit and its ramifications will take place at the upcoming NAHC March on Washington. On March 23, a panel consisting of representatives from NAHC and the other plaintiffs in the lawsuit, the Home Care Association of America and the International Franchise Association will be joined by our legal counsel in the lawsuit. For more details, please click here

 

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Topics: home care, Private Duty

Second CMS Call for Feedback on Home Health Eligibility Templates

Posted by Crystal Parks on Mar 4, 2015 4:54:50 PM

On Wednesday, March 11 from 1:00 - 2:00 p.m. Eastern Time, the Centers for Medicare and Medicaid Services (CMS) will host its second call to review and obtain feedback on the draft templates to assist home health agencies in documenting a beneficiary's eligibility for home health services. 

Participants may access the call by dialing: 1-800-603-1774; Conference ID #: 78964233. 

The Centers for Medicare & Medicaid Services (CMS) is considering developing a voluntary paper clinical template that could be completed by physicians during their face-to-face examination of a Medicare patient. Once a physician/practitioner has completed the template, the resulting document would become a progress note or clinic note that would be part of the medical record. 

According to CMS, in fiscal year (FY) 2014, the Comprehensive Error Rate Testing (CERT) program found that more than half (51.4 percent) of the home health claims were paid improperly. Of the 1308 CERT-reviewed claim lines in error, approximately 90 percent were found to have insufficient documentation errors. The Majority of these errors were due to inadequate documentation supporting the face-to-face requirement.

In addition to developing a paper clinical template for documenting a home health face-to-face examination, CMS is developing an electronic clinical template.  To see information about the electronic clinical template, see home health (HH) electronic clinical template.  

The first draft of the paper clinical template is available for download on CMS' website.

Since the use of the template will be voluntary, how many physicians/practitioners do you think will use it?

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Topics: CMS, Face to Face, Home Health

Updates to the Hospice CAHPS Survey

Posted by Crystal Parks on Feb 18, 2015 3:09:51 PM

Updates to the CAHPS Hospice Survey were posted to the CAHPS website.

According to NAHC, updates have been made to the CAHPS Hospice Survey Quality Assurance Guidelines V1.0 Technical Corrections and Clarifications Document. The updates were made on February 13, 2015.

The CAHPS Hospice Survey Project Team posted an updated CAHPS Hospice Survey technical corrections and clarifications to the CAHPS Hospice Survey Quality Assurance Guidelines V1.0 document. These updates include: clarification of decedent/caregiver eligibility requirements and several minor wording revisions to the English and Spanish versions of the Telephone Script. This document may be accessed by clicking here, or by going to the hospice CAHPS survey webpage: www.hospicecahpssurvey.org

At this point in time, hospice providers should be contracting with an approved Hospice CAHPS vendor to complete a dry run of the Hospice CAHPS survey process.  The dry run must be completed in at least one of the first three months of 2015 - January, February and/or March.

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Topics: Hospice CAHPS

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