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:
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?
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.
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.
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.
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.
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.
There are many ways that home health agencies will need to prepare their agencies for the radical changes coming from PDGM in January 2020. The Alliance is here to help.
Last month, the Centers for Medicare & Medicaid Services (CMS) issued its proposed rule for 2019 home health payment rates and policy changes, which includes significant provisions that will impact your organization, staff, and the patients you serve.
Between now and when the Patient Driven Grouping Model (PDGM) goes into effect on January 1, 2020, there are multiple ways that home health agencies will need to prepare their agencies for the radical change. (See Coding and Billing webinars coming in September, at the bottom of this page) At the same time, home care must take action to mitigate the impact of what PDGM will look like and how it will impact organizational viability.
Home care’s collective advocacy efforts have undeniably made a difference in the past, including putting a stop (at least in Massachusetts) to the Pre-Claim Review Demonstration and scrapping the Home Health Groupings Model thanks to more than 1,200 comments submitted to CMS last year. The more that CMS and lawmakers hear from home health professionals, the better our chances are at reducing the severe cuts that accompany PDGM in its proposed form.
As currently proposed, the 2020 rule will:
Reduce the Medicare base rate by 8.01% next year, which amounts to a $1.298 billion reduction in home health payments in 2020 alone. CMS proposes the reduction to account for anticipated changes in provider behavior that are unrelated to changes in patients served or services delivered that increase payments. This newly proposed “behavioral adjustment” reduction is up from the 6.42% reduction that CMS initially proposed, and the reduction would start before any actual behavioral changes occur.
Phasing out RAPS over 2020 with total elimination of RAPs in 2021. Next year, CMS proposed reducing RAPs from 60/50% to 20% for existing home health agencies (HHAs), while new agencies would get no RAP. CMS claims that RAPs create fraud risks.
Starting in 2021, a Notice of Admission (NOA) must be submitted Notice of Admission must be submitted within five days of the start of care. For every day late, CMS plans to reduce base-rate reimbursements for the unit of care.
The Solution: Pass S.433/H.R.2573
This month, Congress is in recess and back in the states, which presents a pivotal opportunity for home health industry professionals to engage with lawmakers about a key legislative priority – the Home Health Payment Innovation Act (S.433/H.R.2573).
This legislation prohibits CMS’s ability to adjust payment based on “behavioral assumptions” as opposed to observed evidence of behavioral changes, thus rescinding the proposed 8.01% adjustment.
Additionally, this important legislation would:
Achieve full budget neutrality over the period of 2020-2029.
Require behavioral adjustments based on real, actual changes in provider behavior in response to the new payment model.
Permit a phase-in of rate adjustments (up or down) when an annual adjustment would be greater than 2 percent. However, the phase-in would operate to ensure full budget neutrality by 2029.
Email your Members of Congress
It’s not too late to get members of Congress informed and engaged on this important legislation. You can send an email directly from HCA’s member advocacy center.
At this point, Congressman Jim McGovern is the only member of the MA delegation signed on as a cosponsor. We must do better.
Join home health industry advocates next month in Washington, D.C. for The Council of State Home Care Associations’ Third Annual Public Policy Summit and Advocacy Day! On September 9, participate in a full-day summit featuring speakers including Hillary Loeffler, Director of the CMS’ Division of Home Health & Hospice. On September 10, we be on Capitol Hill meeting with members of Congress to convey the critical need to pass S.433/H.R.2357.
Click here to submit comments to CMS in response to the 2020 proposed rule by 5:00 PM ET on Monday, September 9, 2019.
HCA and other industry organizations will provide more thorough comments on other problematic areas of the proposed rule. As previously stated, there is strength in numbers, so the more business-focused comments from providers – both large and small – are critical to giving CMS a full and clear picture of how devastating PDGM will be should it be implemented as proposed. Watch Update for draft comments.
HCA of MA is providing 4 unique opportunities at free or discounted rates to learn comprehensive elements of the new Medicare Patient-Driven Groupings Model (PDGM) being introduced this January.
HCA of MA is providing 4 unique opportunities at free or discounted rates to learn comprehensive elements of the new Medicare Patient-Driven Groupings Model (PDGM) being introduced this January.
PDGM: 4-Part Preparedness Series: August 6, 7, 13, & 14 Online Webinar Series
Is your agency prepared for the all the changes that will come with PDGM? This 4-part webinar series with Melinda Gaboury will give you the essentials your agency will need to prepare for PDGM. This series will cover coding changes, OASIS integrity, financial structure changes,LUPA’s, changes revenue cycles, and more! • August 6th – PDGM Structure and Financial Changes • August 7th – PDGM Coding & OASIS Integrity • August 13th – PDGM Operational Decision Necessities • August 14th – PDGM Revenue Cycle Changes Instructor: Melinda Gabourey, Healthcare Provider Solutions
REGISTRATION HCA Members: $379/Line for Full Series HCA Potential Members: $599/Line for Full Series
2020 Home Health Final Rule: September 11 Online Webinar
The 2020 Home Health Proposed Rule will be a seismic change in home health care. Learn from experts in the industry to help understand the propsed rule and its impacts. Topics will include a review of Medicare’s new payment rates for home health, changes in use of PT assistants, and informed feedback to provide to CMS by the comments deadline of September 9, 2019, and more!
PDGM Bootcamp: September 24, 9:00-4:00 Methuen, MA
Home Health Care Clinical Managers/Supervisors of Clinical Services, Quality Management staff and Clinical Educators will play a key role in the successful implementation of the new Medicare Patient Driven Groupings payment Model (PDGM). In this interactive session, attendees will learn the four key elements of the PDGM scoring system: admission source and timing, clinical groupings, functional levels and comorbidities. Managers will leave with specific techniques for obtaining accurate information to support coding, scoring and billing. All, while using the least resources to produce the best outcomes. Areas covered include: optimizing complex care, episode utilization and case management, interdisciplinary teamwork, care coordination and collaboration. The session will also describe key PDGM measures and monitoring techniques to optimize efficiency, achieve success and prevent pitfalls.
PDGM Education by the National Association for Home Care Online Webinar Series/ Videos
In a partnership with the National Association for Home Care, we are pleased to extend a special NAHC discount on several PDGM educational offerings all members of HCA of MA!
PDGM Video If you’re familiar with PDGM but aren’t sure what the first steps are, this 5 ½ hour introductory course is for you. Leading industry experts will equip you with what you need to know to about the most significant change to impact home health in decades.
Webinar Series If you want a deeper understanding of PDGM and how certain components will affect your business, this seven-part series is what you’ve been looking for. These webinars will focus on all parts of your agency, including risk factors, documentation review, clinical management and more. If you can’t attend the live webinar, don’t worry each of them will be recorded and available on- demand. You and your staff will have unlimited access.
Lots of member interest in HCA’s July QI meeting to discuss medical record audits and upcoming proposed rule changes.
With the sundry of regulation changes in the home health industry over the past few months, the July 24th Quality Improvement (QI) meeting had over 45 members participating in-person and by phone. The numerous medical record audits plaguing the industry dominated the meeting’s discussion.
Multiple agencies have received letters from C2C Innovation Solutions informing them that some claims under appeal have been selected for potential reopening as part of the Medicare Appeals Demonstration. The C2C auditors are conducting the analysis of claims previously adjudicated unfavorably by the Qualified Independent Contractor (QIC), that are currently pending at the Office of Medicare Hearings and Appeals (OMHA) and may be resolved favorably by the QIC.
Other audits that agencies are experiencing are new Targeted Probe and Educate (TPE) audits. These medical record requests are for 5-7 visits and lengths of stay greater than 90 days. No agency is in the third round of the Face-to Face TPE.
One agency reported at the meeting that they are facing three audits simultaneously; a hospice General Inpatient care (GIP) Targeted Probe from NGS, a home health PERM request for Face-to-Face (awaiting ALJ) and eight GIP Post Payment Review by Noridian.
During the meeting there was a lot of member engagement related the 2020 Proposed Rule; the proposal to require OASIS for all payors and the 8% behavioral adjustment. Agencies also discussed strategies for management with PDGM and the process for completing OASIS B-1 for January 1st episodes. PDGM will be a standing QI agenda item.
The HCA is planning to host a PDGM Networking Meeting to help our members with the transition to this new payment model. We are hoping to begin the meetings in September and have a guest speakers and consultants to assist with planning for this historic payment change. Stay tune for further details.
Home Health Care Clinical Managers/Supervisors of Clinical Services, Quality Management staff and Clinical Educators will play a key role in the successful implementation of the new Medicare Patient Driven Groupings payment Model (PDGM). In this interactive session, attendees will learn the four key elements of the PDGM scoring system: admission source and timing, clinical groupings, functional levels and comorbidities. Managers will leave with specific techniques for obtaining accurate information to support coding, scoring and billing. All, while using the least resources to produce the best outcomes.
Areas covered include: optimizing complex care, episode utilization and case management, interdisciplinary teamwork, care coordination and collaboration. The session will also describe key PDGM measures and monitoring techniques to optimize efficiency, achieve success and prevent pitfalls.
PROGRAM OBJECTIVES (At the completion of this session, participants will be able to….)
Describe key elements of Medicare’s PDGM payment model
Explain the impact of the new regulations on clinical operations and clinical managers
Identify key clinical operations changes that will be required for PDGM success
Create an initial action plan for successful PDGM implementation
ABOUT THE SPEAKER: Barbara Katz, RN, MSN is an experienced clinician, manager, trainer and health care consultant. Barbara has been a hospital registered nurse, an APRN in internal medicine, a site manager for a Kellogg Foundation self-care education grant, a training manager and a manager of clinical operations for a network of medical practices. She has been Vice President for Clinical Program Development in a large home health care agency where she founded a family caregiver support network. Barbara provides training in leadership for value based payment, patient self-management support, family caregiver support, process improvement tools and techniques, population health strategies, the use of data in daily work, communication, teamwork and motivational interviewing.
“To get others to be involved: This conference was an eye opener to areas we need to improve upon and the tools provided will help in the process. This really brings it all together and a better understanding of PDGM.”
“This was excellent very informative. Made PDGM clear & understandable. Great tips to get started & to stay on task. Barb is a great presenter & her use of handouts was helpful.”