HCA Has Got You Covered with PDGM

PDGM is coming January 1, 2020 – HCA has numerous education opportunities to help you prepare and progress!

Blueprint for OASIS Training & Certification, November 4-6
Training, Devens, MA

Experience the comprehensive and nationally acclaimed two-day Blueprint for OASIS Accuracy workshop and learn to confidently teach, audit, and collect OASIS-D items accurately. Through guided, expert instruction, and participation in problem-solving discussions and application scenarios, achieve mastery of the OASIS items, conventions, and the latest data collection rules.
Rather than provide opinions, assumptions, or unfounded interpretations, the “Blueprint” presenters will model reliance on CMS guidance documents and provide and demonstrate strategies for how to find defendable answers to your OASIS questions.

REGISTRATION
HCA Members: $429/Person
Non-Members: $549/Person

PDGM Comittee Meeting, November 18
Networking Meeting, 10:00-12:00, Milford, MA

Clinical Leadership Development and Care Coordination Under PDGM

PDGM introduces complex challenges and heightens the importance of efficient discipline utilization while maintaining quality care outcomes. The role that the clinical manager plays in this care management process can make or break success under the new model. This session will cover strategies for effective collaboration of care and agency leadership development in order to maintain focus on patient-centered quality care delivery.

Registration: FREE
HCA MEMBERS ONLY!!

PDGM Clinical Episode Management Webinar, November 21
Online Webinar, 2:00-3:30PM

Clinical episode management takes on an even more critical role under PDGM. This session will describe how effective clinical episode management is the foundation for improving both patient and agency
outcomes as well as improving regulatory compliance. We will review tactics for management of the 30 day payment period and explain the new LUPA thresholds and show that effective clinical episode management will be key to ensure patients are receiving appropriate, cost-effective, quality care. We will discuss strategic planning for implementation of clinical episode management best practices within the agency, and strategies to enhance communication and collaboration between all disciplines.

REGISTRATION
HCA Members: $79/Line
Non-Members: $159/Line

PDGM Billing Series, December 2, 3, 4, & 5
Online Webinar Series, 11:00AM-12:30PM

PDGM is fast approaching and a lot of changes are coming with it. HCA has partnered with Melinda Gabourey, CEO of Healthcare Provider Solutions, to put on a 4-part webinar series, each 90-minutes long! The series will run daily from 11:00AM-12:30PM.
Sessions include:
• PDGM Structure & Financial Impact
• PDGM Coding & OASIS Integrity
• PDGM Operational Decision Necessities
• PDGM Revenue Cycle Changes

REGISTRATION
HCA Members: $79/Line per Webinar -OR – $299/Line for Full Series
Non-Members: $149/Line per Webinar -OR – $549/Line for Full Series

2019 Financial Management Conference, December 10
Conference, Worcester, MA, 9:00AM-4:00PM

This years financial conference will cover topics on PDGM, VBP, Billing Compliance, and Managed Care. The following PDGM session will be by Mike Care of 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.

REGISTRATION
HCA Members: $149/Person
Non-Members: $299/Person

2020 Leadership Summit Pre-Conference, January 28
Conference, Boston, MA, 1:00-4:30PM

Vision Quest: Refining Your Personal Leadership Style for Success Under PDGM and After
We will start the summit with an interactive exploration of what industry and leadership issues you are hear to work on! After breaking it all down, we will engage in some self reflection on your leadership journey to date and how that has or has not got your prepared to meet today’s challenges. The session will continue with an instructional tutorial that will help to make you a better more confident and ultimately successful leader. Put it all together with a set of top industry experts on the journey to PDGM success.

REGISTRATION
Go to http://www.nehomehealthsummit.com for more information!

PDGM Impact on Therapy Practice, March 5
Online Webinar, 1:00-2:30PM

CMS has changed the PPS case mix system “to rely on patient characteristics to set payment for therapy and non-therapy services and should no longer use the number of therapy visits as a payment factor.” The practice patterns and therapy compensation creep associated with the PPS methodology up until 2020 will fit poorly with a case mix system not relying on a therapy visit number. However, practice pattern changes do not occur as abruptly as payment changes.
This session will review the new Patient Driven Groupings Model (PDGM) and how therapy can and should impact the groupings within their own agency. We will then apply reasonable and necessary plans of care to typical home health conditions and link them to the outcomes agencies strive to achieve. Participants will learn to prepare changes in practice and to demonstrate the value therapy services can bring to the home health agency.

REGISTRATION
HCA Members: $79/Line
Non-Members: $159/Line

Journey to PDGM Success Seminar by Axxess, November 5

HCA of MA Members receive a $50 discount on their registration.
Use code: HCAMA2020 at check-out!

For the most up to date information on all upcoming events:
www.thinkhomecare.org/education

Haunted by TPE? Don’t Let It Frighten You!

Many home health care agencies have contacted me over the past few weeks with questions about the Targeted Probe and Educate (TPE). Here are answers to many common questions.

Many home health care agencies (HHAs) have contacted me over the past few weeks with questions about the Targeted Probe and Educate (TPE), so I thought I would review the rules because I am sure others have the same questions. NGS has contacted HCA to let us know that there are new TPE audits in Massachusetts: high therapy utilization, long lengths of stay, documentation supporting homebound for Heart Failure, COPD, Diabetes and Dementia, and medical necessity.

How Will the HHA Be Notified:  Agencies will receive a letter from NGS stating the focus of the targeted probe. Expect to receive between 20–40 ADRs, although every agency targeted so far has received a request for the 40 records. If you are currently in a TPE audit you will not be chosen for another. If for some reason you receive another TPE please contact Colleen Bayard because agencies should only be under one targeted probe and educate for home health at a time.

Additional Documentation Request: The Medicare system will generate ADRs and you have a total of 45 days to respond with the requested medical records. Note: It is best to send in at least 30 -35 days, as NGS considers their time to acknowledge receipt of the documentation into their system as part of the 45-day timeframe. If your ADR is one day late it is considered “no response” and counts as an error.

Calculation: NGS calculates the Percent Error Rate (PER) by taking the dollars Medicare would have paid the HHA versus the dollars denied obtaining a percentage. The PER must be 15 percent or below for the HHA to be released from the next round of TPE.

Results Letter: At the conclusion of a round of review, you will receive a letter outlining the TPE process, the reason for denials including the Medicare regulations, denial rates (PER), release or retention from medical review and offer for one-on-one education information.

Education: Agencies will be notified of one-on-one education between NGS medical reviewers and the provider. It is very important to accept the education from NGS at the end of the audit; accepting the education demonstrates that you are trying to improve documentation and will help with the second round of TPE.

Combating Loneliness, Making a Difference

In home care, we see how debilitating loneliness can be to patients and clients. One local organization, FriendshipWorks, is looking to light candles in the darkness of social isolation.

So much of what we are about in home care is connecting those who might otherwise go without it to the care they need. Every home care nurse, therapist, or aide has been in a home where she/he might be the only person that patient/client has seen in days. We see loneliness, and we see how debilitating it can be.

Many studies have proven what a home care nurse knows from first-hand observation: Loneliness can be bad for someone’s health. On a national level, AARP has recognized what its  medical director, Dr. Charlotte Yeh, calls the “power and presence of loneliness” in its Connect2Affect campaign.

Through some of our home care colleagues, I have recently been introduced to one local organization looking to light candles in the darkness of social isolation. For 35 years, FriendshipWorks has been training volunteers to provide companionship and emotional support to older adults across Greater Boston. They provide what more than one study has called “The Healing Power of Presence.”

Considering how the organization’s volunteers accompany their older friends to critical medical appointments, FriendshipWorks is a vital resource for many of Boston’s academic medical centers.

Matt Fishman, Vice President for Community Health at Partners HealthCare, sees the difference FriendshipWorks volunteers make. “While it may be less quantifiable than some of our other metrics impacting patient outcomes and healing, we can see the reduced anxiety associated with having someone to take you and be there with you for a medical appointment, especially when you might be receiving a difficult diagnosis or set of instructions,” Matt says. That a less-anxious patient is definitely a patient more able to engage and have a quality experience, is central to the work of Christine Dempsey in “The Antidote to Suffering.”

Experienced home care executives, Andrea Cohen, Founder and CEO of HouseWorks, and Denise McQuaide, President and COO of Benchmark Wellness Management (formerly, president of Care Group Parmenter Home Care & Hospice), are co-hosting a 35th anniversary event on Nov. 21 to support FriendshipWorks. If you would like to get on board this important cause and enjoy the great entertainer Darlene Love in an intimate setting, you can get all the info you need here.

Any ideas or experiences about the interest of loneliness and health and healing, send them along to me. Happy to continue to share.

Blueprint for OASIS Accuracy Returns This November

Staying on top of OASIS coding is never easy, and PDGM will bring additional challenges in 2020. Join us November 4-5, 2019 in Devens for an intensive, two-day, workshop & exam from OASIS Answers. Though open to all, Alliance members can attend at a significant discount.

Staying on top of OASIS coding is never easy but – with the new PDGM standards arriving in a few months – 2020 is going to be a real challenge.

That’s why we’re pleased to offer Blueprint for OASIS Accuracy, a two-day, data-collection workshop in Devens, Massachusetts on November 4-5, 2019.

Register for OASIS

This workshop — designed by OASIS Answers — provides a comprehensive look at the OASIS items including the OASIS-D1 revisions and OASIS-related PDGM information effective January 1, 2020. The course awards 13 CEUs. Attendees can also take an optional exam at the same location the following day (registration and payment for the exam is entirely separate from the workshop).

Though the program is available to all, members may attend for just $429.00 per registrant, a discount of $150 off the non-member rate. If you’ve been thinking about having the Alliance join, this will give you immediate return on your investment.

Return to www.thinkhomecare.org.

HHAs are Experiencing New Round of Targeted Probe and Educate

National Government Service (NGS) announces two new rounds of Targeted Probe and Educate (TPE) for home health agencies

Last month, the National Government Service (NGS) notified the Home Care Alliance of Massachusetts about two new rounds of Targeted Probe and Educate (TPE):

High therapy utilization. NGS will be reviewing documentation to ensure all CMS requirements have been met on therapy assessments and 30-day reassessments, as well as, medical necessity.

Documentation supporting homebound criteria. The second edit is specific to four diagnoses: Heart Failure, COPD, Dementia, and Diabetes and if the documentation confirms homebound status.

Many HHAs have contacted me over the past few weeks with questions about the TPE, so I thought I would review the rules because I am sure others have the same questions.

How Will the HHA be Notified: You will receive a letter from NGS stating the focus of the targeted probe: high therapy or homebound for one of the four diagnoses listed above. Expect to receive between 20–40 ADRs, although every agency targeted so far has received a request for the 40 records.

Additional Documentation Request: The Medicare system will generate ADRs and you have a total of 45 days to respond with the requested medical records. Note: It is best to send in at least 30 -35 days, as NGS considers their time to acknowledge receipt of the documentation into their system as part of the 45-day timeframe. If your ADR is one day late it is considered “no response” and counts as an error.

Calculation: NGS calculates the Percent Error Rate (PER) by taking the dollars Medicare would have paid the HHA versus the dollars denied obtaining a percentage. The PER must be 15 percent or below for the HHA to be released from the next round of TPE.

Results Letter: At the conclusion of a round of review, you will receive a letter outlining the TPE process, the reason for denials including the Medicare regulations, denial rates (PER), release or retention from medical review and offer for one-on-one education information.

Education: One-on-one education between NGS medical reviewers and the provider. It is very important to accept the education from NGS at the end of the audit; accepting the education demonstrates that you are trying to improve documentation and will help with the second round of TPE.

If you have any questions or concerns about TPE, it would be great to hear from you. Good Luck!

The Alliance Revamps Its Advocacy Action Center

The Alliance’s redesigned Advocacy Action Center makes it easier for members to communicate with their elected officials on the pressing issues facing their agencies.

HCA CapitolFor the first time in many years, the Alliance has redesigned its Advocacy Action Center website, offering members an enhanced advocacy experience so they can easily communicate with their elected officials on the pressing issues facing their agencies. This  post will highlight some of the key changes so that you are prepared to take action and make a difference!

Main-Page Scrolling Advocacy Feature

The main Advocacy Action Center page now features a scrolling banner of key advocacy initiatives that the Alliance and its members are working on. The banner has a functioning link which you can click on to bring you directly to the action center to quickly send an email to your elected official.

Main-Page Buttons

Under the scrolling banner, you will see three buttons linking to sub-pages. This organizes the Advocacy Action Center into three easily accessible topics: Legislative Priorities, Testimony/Comments, and Facts & Figures. Note: The Facts & Figures sub-page is currently being updated.

Legislative Priorities Sub-Page

Among the biggest of changes, is our newly designed Legislative Priorities page. For the first time, members now have a centralized landing page which organizes all of the Alliance’s legislative priorities in one place. You’ll see the page is split in half, organized by State and Federal priorities.

You’ll also see that each legislative issue has a brief overview of the issue and the solution that HCA supports. Underneath each blurb are links to download the fact sheets for, or take action on, the issue!

We hope that you will find our new advocacy center easier to use so that you can engage with your elected officials, while focusing on running your agency!

Mobile Integrated Health and Community EMS: An Update

At the most recent HCA of MA Board of Directors meeting, Scott Cluett, Director of the DPH Office of Emergency Medical Services provided an update on the role out of Mobile Integrated Health and Community EMS in MA. Both programs were created by a 2015 act of the MA legislature, following a trend in many states to use EMS personnel to deliver care outside of the emergency transport role. Applications for MIH programs were released in December 2018, with a few coming online mid 2019. MIH programs must, in their applications: “identify and validate one or more gaps in service delivery using data and a corresponding community health needs assessment. Each application must also describe how the proposed MIH program will address identified gaps in service delivery and provide improvements in quality, access, and cost effectiveness, an increase in patient satisfaction, improvement in patients’ quality of life, and an increase in interventions that promote health equity, including cultural and linguistic competencies…”Coordination of care is explicitly required with MIH applicants either having named health care partners or a plan for primary care coordination.

Community EMS programs must be founded in partnership with a local municipality and focus on prevention if illness or injury. So far 11 cities and towns have launched programs with the most common services offered being fire burn prevention and education, home safety evaluations, sharps awareness (and at least in one community sharps disposal) and naloxone training.

The change in state law that allows EMS personnel to treat in lieu of transfer is just beginning to be understood. How it may be incorporated into home care and hospice patient care management remains to be seen. Cluett’s short presentation, along with the pertinent regulations, can be found here.

Return to www.thinkhomecare.org.