Amedisys CEO: Cracking the Code on Star Ratings, Weathering Pre-Claim

When it comes to some of the major recent programs rolled out by the Centers for Medicare & Medicaid Services (CMS), including star ratings and pre-claim audits, the leader of one of the nation’s largest home health providers is projecting confidence.

Every Amedisys Inc. (Nasdaq: AMED) care center is on track to achieve at least a four-star rating by the end of 2017, CEO Paul Kusserow said Wednesday at the Baird 2016 Global Healthcare Conference in New York City.

“Stars is really a function of documentation … about 80% is having the right documentation,” he said.

Baton Rouge, Louisiana-based Amedisys has the scale to implement the technologies for quality documentation and can roll out the training needed across its care centers, he added. Amedisys delivers care to about 380,000 patients annually across the country.

While confident Amedisys already is “cracking the code” on stars, Kusserow and other leaders also are focused on identifying best practices of the company’s five-star agencies and disseminating these. There are correlations between the quality of leadership and the turnover rate at care centers, and their star ratings, he noted.

“We’ve done a lot of work on turnover and human capital, because we’re fundamentally a staffing business,” he said. “We have to attract and employ the best people, and build up the IT to give them the special sauce to do [their work].”

On the tech front, Amedisys discontinued efforts at an expansive home-grown platform shortly after Kusserow took the helm, and has been implementing the Homecare Homebase product. That implementation is on schedule, with the whole company anticipated to be transitioned by Nov. 1, Kusserow said Wednesday.

Getting Through Pre-Claim

The pre-claim demonstration that kicked off in Illinois last month has generated enormous backlash within the home health sector. Agencies in Illinois say that the requirement to submit claims for review upfront poses a huge burden, that the Medicare Administrative Contractor (MAC) tasked with reviewing them is not performing well, and that the delay in payments is untenable.

“I’ve spent a lot of time in Washington over the past three months trying to understand pre-claim,” Kusserow said. “In general, I don’t view it as a positive for our industry.”

However, he is circumspect about pre-claim overall, suggesting that the problems encountered so far could dissuade CMS from rolling out the demonstration to other states, as planned.

“I’m curious whether it’ll make it out of Illinois,” he said. “…We’ll see how CMS assesses this.”

Noting that the pre-claim effort is part of a paperwork reduction effort and yet is generating so much paper as to “clog the system,” Kusserow said he nonetheless is sure that Amedisys has the size and resources to survive pre-claim. But the story could be different for smaller providers.

“We have the systems and methodologies to get through it,” he said. “I think it’ll be the mom-and-pops … that’ll ultimately be penalized for this.”

Industry efforts to curtail pre-claim are focused in part on this aspect of punishing the industry as a whole for the actions of a few providers. In particular, the pre-claim demonstration is targeting states where there are counties with a high prevalence of fraudulent activity, suggesting CMS could act with greater precision.

“We say to CMS, go to those [fraud-heavy] counties … why go to town on the entire industry?”

Written by Tim Mullaney