Fifty-six percent of home health episodes of care analyzed by Abt Associates and MedPAC fall under the Medication Management Teaching and Assessment category (MMTA). Using resource utilization analytics, they estimate this type of 30-day episode -- whether services include PT, OT, ST, MSW, HHA or Skilled Nursing -- will average $1,095.00 to $1,321.00 per episode. It is safe to say this payment rate will bring about the closure of 30%-50% of today's home health providers, just as it did during the IPS to PPS transition in the late 1990’s. Fear not, CMS will add some type of margin to the final mix.
Q. So what needs to happen to make HHGM a reality?
A. Nothing but the scheduled implementation.
To be sure, change in and of itself is neither good nor bad. Getting nurses on board, however, will be your biggest hurdle. Surviving HHGM will require making big changes to your basic operational processes, which means big changes to familiar staff routines.
The 30-day episode
The current standard, one clinician per OASIS with up to several days to complete it, QA it, lock it, and send it will no longer be sustainable. The entire home health industry must embrace collaboration and data analysis in order to meet a new standard: to complete OASIS during the time the patient is assessed. HHAs taking up as much as 20% to 25% of the 30-day episode to produce the plan of care will simply not survive.
No More Therapy Reimbursement
Agencies soon will not be able to rely on a little extra money in their episode payments from therapy services. Margins must be made instead by data driven utilization decisions and efficiency, which again means completing the OASIS during the assessment visit, not hours, or days, later. It will become essential to increase productivity through the practice of live, interactive QA and developing evidence based, disease focused care plans.
Certainly, HHGM will fundamentally change the way we deliver care. The question is how hard will we make it on ourselves before we accept the need to innovate and renovate the systems of the past twenty years. In part 2, we will propose the preferred methods of adapting to the requirements this new payment change.
Michael McGowan is a former OASIS instructor for CMS Region 9. He is the CEO of OperaCare and lives with his wife and daughters south of Albuquerque, NM. To see a video demonstration of the collaborative OASIS assessment described in this article, click here. Michael can be reached at firstname.lastname@example.org
©2018 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. email@example.com