Serving the home health, home care and hospice industry since 1999.

by Michael McGowan and Kristi Bajer, BSN, RN

Recently, while talking to a HHA owner about HHGM and the 30-day episode, a comment was made that showed the depth of misunderstanding the industry has over the new payment model.

"The 30-day episode won’t affect us. We will just recertify twice as much!" The comment is real. Obviously, I will not identify the speaker.

Medicare has been trying to push the home health industry into shorter lengths of stay for years. STAR scores are a great example of that nudge. Here is the bind HHAs find themselves in.

  1. Outcomes are not attainable without discharges.
  2. Participation in Home Health Value-Based Purchasing plans, Alternative Payment Methods, or as preferred providers with Accountable Care Organizations, requires consistently high patient outcomes.
  3. Short LOS leads to better outcomes; long LOS leads to higher margins.
  4. Looming payment system changes will be especially harsh on HHAs that insist on enhancing their profit margins by LOS. Changes will favor those focused on efficient, data driven care.
  5. Hundreds of HHAs, therefore, are today facing their final two years of existence.

30-Day Episode Will Change More Than You Think

  • HHAs aiming to keep their LOS practices unchanged will be forced to perform twice as many OASIS visits.
  • RN/PT productivity will need to double to maintain the status quo.
  • A 60-day LOS will cost at least another OASIS visit, taking another $250-350 from your bottom line.
  • Only the first 30-days are considered “early” episodes; the second 30-days will have a decreased reimbursement.
  • HHAs still embracing the "one clinician back and forth OASIS correction model" will be losing a large part of the episode without a plan of care.
  • Data mining by CMS will increase exponentially. Shorter episodes will allow the CMS FWA infrastructure to double their efforts.

The volume to value change is already affecting the home health industry. Those HHAs thriving in HHVBP states have LOS closer to 30 days. These HHAs are not looking at total census as their measure of success. Rather, they are working to increase their unduplicated census. To achieve this, HHAs must use data to drive care decisions, evidence-based practice to produce care plans, and base their utilization decisions and lengths of stay on OASIS acuity.

By increasing the number of patients who are admitted, then meeting their outcomes and discharging them as soon as appropriate and safe, these agencies have already embraced the key to operating a successful HHA now and continuing to thrive when the HHGM future arrives.


Michael McGowan is the CEO and Kristi Bajer, BSN, RN, the VP of Clinical Operations for OperaCare LLC.

©2018 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. One copy may be printed for personal use; further reproduction by permission only.