CMS has published the Final
Rule for Home Health Prospective Payment System update for 2014. It will impact
home health payments for the next four years.
The current year impact will reduce home health payments by 1.5 percent
or $290 million, but the future impact will be much worse.
There are many moving parts
to this rule. We will cover some of the
basics in this update, but will follow it with other updates this week to
provide more detailed information. Below
is a brief analysis of the episode rate.
To provide a better comparison we have one column with the new
adjustment for episode case mix standardization and another column without the
case mix standardization. (Episode standardization will move the average episode
case mix weight from 1.3464 to 1.0000 by reducing all case mix weights by 34.64
%.)
|
Description
|
With
Case Mix
Adjustment
|
Without
Case Mix
Adjustment
|
|
2012 National
Standardized 60 Day Episode Rate
|
$2,138.52
|
$2,138.52
|
|
Inflate Case Mix Adjustment
(x1.3464)
|
$2,879.30
|
$2,138.52
|
|
Reduce for Nominal Case
Mix Growth 2013 (x.9868)
|
$2,841.29
|
$2,110.29
|
|
Payment Update Percentage
for 2013 (x1.013)
|
$2,878.23
|
$2,137.72
|
|
Outlier Adjustment
(Divide by .975)
|
$2,952.03
|
$2,192.53
|
|
Outlier Adjustment (x
.975)
|
$2,878.23
|
$2,137.72
|
|
Standardization Factor
(x1.0026)
|
$2,885.71
|
$2,143.28
|
|
Rebasing Adjustment 2014
(Remove $80.95)
|
$2,804.76
|
$2,062.33
|
|
2014 Market Basket
Adjustment (x1.023)
|
$2,869.27
|
$2,109.76
|
Our Calculation of Real Decrease Percentage in Home Health Episode
Payment Rates
|
Description
|
With
Case Mix
Adjustment
|
Without
Case Mix
Adjustment
|
|
2012 National Standardized
60 Day Episode Rate
|
$2,138.52
|
$2,138.52
|
|
2014 Market Basket
Adjustment (x1.023)
|
$2,869.27
|
$2,109.76
|
|
Decrease
|
N/A
|
$28.76
|
|
Percent Decrease
|
N/A
|
1.34%
|
Remember your episode case
mix rates will be decreased by 34.64% so for example C1F1 with 0 to 5 therapy
visits will go from 0.8186 case mix rates in 2013 to 0.6080 in 2014. There are positive adjustment to LUPA payment
rates and negative adjustments to Non Routine Medical Supplies.
Your episode rates will be
reduced by $80.95 for rebasing in 2015, 2016 and 2017. You will also have a reduction inflation
factor adjustment of 1% in 2015, 2016, and 2017.
We sent a Newsletter in the
summer titled “It is Time to Step Up or
Fall Behind”. We stated that your
home health agency is currently going up the down escalator. The current momentum of the health care
industry is constantly pushing your company down, just like a down escalator is
constantly moving down. To step up to
the next stair, you adapt and embrace the changes or place your head in the
sand and move further down the escalator.
If you would like to step
up instead of falling behind register for our webinar titled “Home Health PPS Final Rule 2014”. This will be held live on Wednesday December
4, 2014 at 3:00 – 4:00 PM EST. It will
cover the following items:
1.
CMS
Rebasing of Home Health Payments
2.
The Home
Health Episode Payment Rates
3.
The LUPA
Payment Rates
4.
Medical
Supply Payment Rates
5.
The Home
Health Agency Case Mix Changes
6.
The Home
Health Wage Index
7.
The 170
Codes Removed from the Home Health PPS Grouper
8.
Changes
in Home Health Quality Reporting Requirements
Richard Dixon will be the
presenter of this webinar. You will have the opportunity to ask
individual questions and obtain the answers. To keep the webinar on time
we will address you questions and answers via email after the event.
The webinar will be
held live, but you can also review the Webinar at a later time because it will
be recorded. Your registration fee is only $149 for your entire company. The registration fee also will
include handouts that you will receive via email.
To attend the exciting new
webinar follow the link below for the Registration Form and fax it back to us
at (888) 577-6932. We have a very short time frame to register attendees
so we request you not use the mail. We do accept all major credit
cards. Once you register you will not be able to cancel since you or any
of your employees can view the recording of the webinar at your leisure.
For more information use
the temporary link below (The final link will be available on December 2, 2013
when proposed rule is published in the Federal Register):
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