Colleen’s Corner: Targeted Probe and Educate (TPE)

Did you know that National Government Service (NGS) is focusing one of the home health Targeted Probe and Educate on therapy utilization?

Therapy TPE Audits Lead to Home Health Denials

Did you know that National Government Service (NGS) is focusing one of the home health Targeted Probe and Educate on therapy utilization?

NGS is auditing home health rehab service concentrating on medical necessity, the timeliness of the 30-day reassessments that is performed in conjunction with an ordered therapy service, and the required reassessment content by each rehab discipline. For many of the denials, the reasons stem from the therapist not comparing the present assessment results to prior assessment measurements and failing to document the effectiveness of therapy, or lack thereof, as required by regulation.

It may be beneficial to review with your therapy staff the key components to the therapy reassessment documentation as outlined by CMS.

  • Each rehab discipline must document measurement results of functional reassessment compared to prior measurements
  • Each must also document why therapy should be continued or, if applicable, discontinued
    • Document therapist’s determination of effectiveness of therapy
    • Why therapy is beneficial?
    • Why does the patient need more?
  • Remember the re-assessment is only one component of the home visit; there must be evidence of an ordered intervention as well.
    • Document treatment performed the day of re-assessment
    • Re-assessment without care plan interventions is a not covered service

Be Aware…

If measurement results do not reveal progress toward goals and/or do not indicate that therapy has been effective — then, to continue therapy — there must be consultation with the physician and documentation showing why the therapist and physician determined therapy should be continued.

Don’t forget to confirm continuation of the therapy with the verbal order!

I hope to hear from folks who are experiencing any of these issues with the therapy TPE.

Colleen's Corner: Quality Check

An Update on Quality Reporting Measures.

Did You Know?

The quality measure Improvement in Pain Interfering with Activity is being removed from Home Health Compare as of the April 2020 Compare Refresh. However, home health agencies are still collecting data for this measure through CY2020.

This quality measure will also be removed from the Quality of Patient Care Star Rating which will be calculated using seven measures beginning April 2020. Make sure to check how this will impact your agency’s star rating, so check out your Quality of Patient Care Star Rating Provider Preview Report in your agency’s CASPER Folders

The January 2020 Compare Refresh will be available this week, on January 23. CMS is no longer publicly reporting Emergency Department Use without Hospital Readmission During the First 30 Days of Home Health, and Rehospitalization during the First 30 Days of Home Health on Compare beginning with this January 2020 Refresh.

The OASIS Quarterly Q&As are scheduled to be posted on January 21, 2020.

Make your Star Ratings Rise to the Top

Provide focused education to your clinical staff with Blueprint for OASIS Accuracy training hosted by the Home Care Alliance on April 15-16, 2020 at the Sheraton Framingham Hotel & Conference Center, 1657 Worcester Rd, Framingham, MA.

Registration fills up fast so be sure to register early.

Click Here to Register

Announcing our "Home, Not Alone" Speakers Bureau Campaign

The Alliance’s Home Care Speakers Bureau can bring presentations on careers and other subjects to nursing schools, job fairs, or student assemblies.

Health care is moving out of the institutional setting and into people’s homes. Nursing and other allied health professional positions are following a similar path as the percentage of nurses moving into work a in hospital setting continues to decrease annually. Yet, newly graduated nurses often leave school not having been exposed to the nursing opportunities and high degree of complexity and independence in home health care practice.

Our Home, Not Alone campaign seeks to drive interest in, and confidence about, making a nursing career in home care or hospice.

Our dedicated speakers will bring presentations on careers and other subjects to nursing schools, job fairs, or student assemblies. Here is just a snippet of a presentation:

For more information about the program, visit the Home Care Speakers Bureau on our website.

Star Awards Shine Spotlight on Home Care’s Best

Last month, the Alliance recognized six outstanding individuals as our 2019 Home Care Stars. These are their stories.

Last month, the Home Care Alliance of Massachusetts gathered the industry at Granite Links in Quincy to honor six amazing individuals who represent the best of home care.

(L-R: Nicole Geddes, Me McBride, Vinette Tyme, Gerry Sanderson, Robin Pelletier, Sandy Hurley)

Since 1989, this fantastic event has celebrated the hard work of individuals and organizations who exemplify home care’s best values. More importantly, awardees are nominated by their colleagues and supervisors; winners are then selected by the Alliance’s Membership Committee.

Here’s a look at this year’s awardees, with excerpts from their nominations:

Me McBride, South Shore VNA, Aide of the Year

Imagine being the family member of a once-strong, determined man whose mind has been crippled by Alzheimer’s. You pray for help, and your prayers are answered in the form of an “earthly angel” named Me McBride.

She enters your home and takes charge with compassion and experience but — most of all — with respect for your loved one. For Me, the patient always comes first.

Vinette Tyme, HouseWorks, Aide of the Year

Vinette is a passionate home health aide, often described by colleagues and clients alike as “a dream” to work with, due to her dedication and exceptional skillset. She has an innate ability to anticipate clients’ needs and form personalized and effective strategies that work for them.

No task is too big or too small for her.

Gerry Sanderson, RN CDP, NVNA and Hospice, Clinician of the Year
Gerry Sanderson, RN CDP

Gerry has cared for hundreds of patients and families in the South Shore and her devotion to her patients is second to none.

Her approachable and positive demeanor is reflected in the way her patients interact with her, creating a safe and nurturing environment for all involved.

Nicole Geddes, LPN, Aberdeen Home Care, Clinician of the Year

Nicole delivers care, no matter what. If there is a need, she is there. She’s a roll-up-your-sleeves nurse, willing to jump-in and help an aide when needed or to manage a crisis in the middle of the night, on a weekend, or on Christmas Day.

She knows what to do and does it with tremendous skill.

Robin Pelletier, RN BSN, Southcoast VNA, Manager of the Year

Robin has successfully led Southcoast VNA’s Supportive Care Center since October 2016, where she guides an interdisciplinary team of 75 people. Her greatest accomplishment has been the extraordinary growth and quality of hospice services, doubling Southcoast’s average daily census and average length of stay.

Sandy Hurley, Commonwealth Clinical Services, Home Care Champion

Sandy embodies everything we value about nursing in the community. She is best known for “doing what needs to be done” from home visits, to setting up clinics, to teaching high school students about healthcare, to playing the piano at just about any function.

This year, Sandy extended her professional talents and skills to the mountains of the Dominican Republic, helping provide over 100 patients a day with health assessments, medications, and critical supplies.

As 2019 comes to a close and the industry prepares for a historic year of changes, the Star Awards allows us to pause and remember the dedicated workforce that makes home care such a success.

Congratulations and thank you to the 2019 Star Award Winners.

OASIS-D1 Guidance from Qualidigm

Changes to the OASIS data set will be incorporated into OASIS-D1 effective January 1, 2020. To help home health agencies understand these changes, Qualidigm has itemized the list of data set changes in a one-page document and four 90-second videos.

A number of changes to the OASIS data set have been made and will be incorporated into OASIS-D1 effective January 1, 2020 (click here for data submission specifications). These changes align with the new Patient-Driven Groupings Model (PDGM). Under this new model, OASIS accuracy will continue to be important with Functional Impairment Level derived directly from OASIS items.

To help home health agencies understand these changes, Qualidigm has itemized the list of data set changes outlined in this one-page document.  Additionally, Qualidigm recently released its Quality Quick Minute video series focused on the OASIS-D1 changes. The videos series is comprised of four brief, 90-second information videos outlining these changes to assist with preparation in anticipation of the January 1 effective date.

The OASIS-D1 Quality Quick Minute video series includes the following:

  1. OASIS-D1 Changes Overview
  2. Optional Items
  3. Follow-Up Timepoint Items
  4. M0090 Date Assessment Completed

All four videos can also be accessed from the home health section of the Qualidigm website at www.qualidigm.org/our-services/home-healthcare-consulting/.

Marissa Moncata
Senior Business Analyst, Consulting Services
Qualidigm
MMoncata@qualidigm.org

2019 Our Time to Shine Winners Announced

The Home Care Alliance of MA will honor excellence in home care when we present the 2019 Innovations Showcase and Star Awards at the “Our Time to Shine” celebration on Tuesday, November 19, at the Granite Hills Golf Club, Quincy.

The Home Care Alliance of MA will honor excellence in home care when we present the 2019 Innovations Showcase and Star Awards at the “Our Time to Shine” celebration on Tuesday, November 19, at the Granite Hills Golf Club, Quincy. 

What a better way to show your staff appreciation during home care month then treating them to an afternoon of celebration, food and a special inspiration keynote by Tim Cunningham, an intrepid survivor and best-selling author.

Together, we can celebrate our people and our pioneers by recognizing how they make life better for thousands of patients and their families. In celebrating individual achievement, we shine a light on our collective accomplishments.  

2019 Star Award winners are:  
Champion
Sandy Hurley, President/Administrator, Commonwealth Clinical Services, Winthrop  

Clinicians of the Year:
Nicole Geddes, LPN, Aberdeen Home Care, Danvers
Gerry Sanderson, RN CDP, NVNA and Hospice, Norwell  

Manager of the Year:
Robin Pelletier, Director of Supportive Care Services, Southcoast VNA, Fairhaven  

Aides of the Year:
Me McBride, CHHA Team Leader, South Shore VNA, Rockland
Vinette Tyme, Care Coordinator, HouseWorks, Newton  

Innovation award winners:  
Connected Home Care
, Concord:  Oz Documentation System
O’Connell Care at Home, South Hadley: Advanced Internal In-Service Training
Maxim HealthCare Services, Plymouth: Novice Nurse Program  

Join your peers on November 19 as we celebrate these honorees! Learn more at http://www.thinkhomecare.org/shine

Tickets are just $40 or $275 for a table of 8!

2019 Financial Management Conference Announced!

Join us on Tuesday, December 10th at the Beechwood Hotel in Worcester, MA for our Annual Financial Management Conference. Take a deep dive into the current trends and issues happening in the Home Health industry as you prepare for 2020.

Join us on Tuesday, December 10th at the Beechwood Hotel in Worcester, MA for our Annual Financial Management Conference. Take a deep dive into the current trends and issues happening in the Home Health industry as you prepare for 2020. This is the perfect conference for CFOs, CEOs, and Clinical Directors!
 
The 2019 Agenda Includes:
Hindsight is 2020: Hone into Home Health & Hospice Payment Compliance in the New Decade, Kathleen Hessler, Simione Healthcare Consultants
The HHS Office of Inspector General (OIG) continues its intense oversight and scrutiny of the Medicare home health and hospice programs by analyzing the rich sources of data available to them. With increase in survey and audit activity —including Targeted Probe and Educate (TPE), UPIC and SMRC audits, learn what your agencies need to do to ensure payment compliance in the new decade. The session will cover types of government audits, recommendations for internal-self monitoring, as well as what to do if your agency identifies an overpayment.

HHVBP Trends & Data, Chris Attaya, SHP Data
As we close out year 2 of the Home Health Value-Based Purchasing
Demonstration, Chris Attaya will take a deep dive and identify the latest updates and trends in HHVBP and Star Rating measure scores. Attaya will also discuss data points specific for Massachusetts state agencies.

PDGM Check Point, Mike Carr, Axxess
PDGM is almost here, now is the time to ensure you are ready for the changes. This session will review where you should be, and how to get there if you’re not. Carr will provide a high level overview of PDGM as well as understanding how past performance will be impacted by PDGM. Other elements to be discussed include technology challenges, therapy impact, and measures for survival.

Making Home the Center of Care: Opportunities & Challenges of Public Priorities, Mike Canter, Carecentrix & Reactor Panel
Recent public policy trends focus on cost containment, integrated care, and quality outcomes. Home care is in a unique position to thrive in this emerging environment. Is your agency poised to seize the opportunity?

Register Here