Certified Home Health agencies have 14 months to prepare for a new payment system. Operational changes will be required but which ones? How soon should they begin? Will revenue increase or decrease?
FocusChart, a Michigan-based software developer, has released a free tool that analyzes an agency's current data under PDGM rules to forecast gain or loss and point administrators toward recommended operational changes. FocusChart is not a new company but a re-branded one that may be remembered as GLMI or Great Lakes Management, out of Battle Creek.
The analysis can be run on the data of any home health company with a Medicare ID number. It looks at relevant, publicly-available claims records to display episodes, nursing/therapy visit ratio, and current revenue. It compares the number of current 60-day episodes to the number of episodes that already happen to end within 30 days, then runs that data through the new rules.
We were given a product demonstration that showed results from a typical home health agency. It had submitted claims totaling $2,984,334.55 year-to-date. Their FocusChart forecast, assuming no operational changes, is for $2,799,051.04, a full six percent less, under PDGM. Company VP Bud Dunn explained that this is almost entirely attributable to therapy utilization.
This is the tool's most useful feature. It assigns each agency a rank by comparing revenue derived from therapy visits to nursing visits. The sample agency ranked in the lowest 25th percentile, which explains the forecast of a large revenue decrease. They will have to rethink their use of therapists. Were they providing it based on patient need? Or was it to boost revenue? With therapy no longer a factor in episode payment under PDGM, the FocusChart analysis made clear that operational and philosophical changes will be required of this sample agency.
"Knowing this information now, with 14 months to go to make those changes, is far preferable to procrastinating and trying to change a company's entire care culture in a few weeks," asserted Dunn. "We thought this information would be so important, we decided to make it free, not just for our EMR clients but for the entire industry."