Dramatic Change in Outlier Calculations - 11/10/2016

CMS is completely changing the methodology it outlier payment policy.  It is changing from a cost per visit approach to a cost per unit approach.  This means that visits with more minutes will count more toward outliers than visits with less time per visit.  The unintended (or intended) consequence of this approach is to dramatically decrease the outlier payments of daily visit diabetic and BID diabetic patients who cannot self-inject insulin.  CMS has tried for many years to reduce the cost of these patients. 

We performed a simple analysis of the impact on outlier payments for these patients and found payments for daily diabetic patients decreased by 40% and the BID diabetic patient’s payments decreased by 57%.  These are dramatic cuts for these patients and will force the home health agencies that are already losing money on these patients to lose even more.

We intend on providing more information on this at our upcoming conference in January in Las Vegas.

To view the rule please go to:

https://www.gpo.gov/fdsys/pkg/FR-2016-11-03/pdf/2016-26290.pdf

Final Home Health LUPA Payment Rates 2017 11/8/2016

Home Health episodes that have four or less visits are paid a LUPA rate instead of an episode rate.  Listed below are the National LUPA Payment Rates.  Remember these rates will be adjusted for each home health agencies wage index.

Listed below are the LUPA Payment Rates Per Discipline

Discipline	Urban Agencies Submitting Quality Data	Urban Agencies Not Submitted Quality Data
SN	$141.84	$139.07
PT	$155.05	$152.03
OT	$156.11	$153.06
SP	$168.52	$165.23
MSW	$227.36	$222.92
HHA	$64.23	$62.97

Discipline	Rural Agencies Submitting Quality Data	Rural Agencies Not Submitted Quality Data
SN	$146.10	$143.24
PT	$159.70	$156.59
OT	$160.79	$157.65
SP	$173.58	$170.19
MSW	$234.18	$229.61
HHA	$66.16	$64.86

LUPA Episodes are paid a higher rate for the first visit of the episode.  Listed below are the payment rates for the first visit of LUPA episodes

Discipline	Urban Agencies Submitting Quality Data	Urban Agencies Not Submitted Quality Data
SN	$261.71	$256.60
PT	$258.93	$253.89
SP	$274.11	$268.76

Discipline	Rural Agencies Submitting Quality Data	Rural Agencies Not Submitted Quality Data
SN	$269.57	$264.29
PT	$266.70	$261.51
SP	$282.35	$276.83

To view the rule please go to:

https://www.gpo.gov/fdsys/pkg/FR-2016-11-03/pdf/2016-26290.pdf

Final Home Health PPS Rules & Rates For 2017 - 11/7/2016

We just returned from a 10-day cruise from New York to Ft Lauderdale.  Our trip started with 2 nights in New York which included seeing the Broadway Play “Beautiful” (Story of Carol King), visit to Ground Zero, trip to the top of Freedom Tower (Amazing), and Harbor Cruise to see the Statue of Liberty and other sites.  The cruise had stops in St. Martin, Antigua, and Bonaire.  While we were away many things happened including the release of the Final Home Health PPS Rules & Rates for 2017.

The final rules reduced the cut in home health payments from $180 million to $130 million. 

The national standard 60-day episode rate is the basis for all home health payments.  Home Health agency patients living in rural areas have a 3 percent add-on which is scheduled to expire on January 1, 2018.  Home health agencies that do not submit quality data will have the above rates reduced by an additional 2 percent.

2017 National Urban Agency Rate $2,989.97

2017 National Urban Agency Rates (not submitting quality data) $2,931.63

2017 National Rural Agency Rate $3,079.67

2017 National Rural Agency Rate (not submitting quality data) $3,019.58

Individual home health agency rates will be adjusted by geographic location of the patient’s residence.  Individual episode rates will be adjusted by case-mix.

Other items changed in the final rule are LUPA Rates, Medical Supply Rates, Case-Mix Weights, HHVBP Model, and Outlier program. This is the first of several email alerts that will be published this week.

To view the rule please go to:

https://www.gpo.gov/fdsys/pkg/FR-2016-11-03/pdf/2016-26290.pdf