CMS Home Health Initiatives Gaining Traction

Since November, the Centers for Medicare & Medicaid Services (CMS) has rolled out regulation upon regulation affecting home health care, altering the landscape for agencies across the country.

CMS first finalized a rule to incentivize hospitals to work with other post-acute providers for knee and hip replacement procedures through bundled payments for 67 hospital locations. January ushered in the first “Patient Survey Star Ratings” for Medicare-certified home health agencies—scores meant to reflect patients’ experiences—along with the implementation of newly proposed payment policies that tie Medicare payments to higher quality performance in its so-called home health value based purchasing pilot program in nine states. Most recently, CMS announced a proposal in February for a Medicare Probable Fraud Measurement Pilot in five states, which would require preauthorization before agencies see patients.

Whether or not agencies are currently affected by such measures, they need to pay attention and prepare for implementation nationwide, Barbara McCann, Chief Industry Officer for Interim HealthCare Inc., said Wednesday during the 2016 Illinois HomeCare & Hospice Council Annual Conference & Expedition in Lombard, Illinois. Her presentation, titled “Finding the Faults in Our Stars,” focused on finding strategies to improve star ratings, promoting higher care standards and getting ahead of the curve when it comes to CMS initiatives.


“If you don’t feel comfortable with it now, you’re going to be very uncomfortable with it for the next decade,” she said.

Tracking predictable costs related to joint replacements is necessary to show savings, McCann said. Additionally, agencies should focus on establishing a strategy to standardize evaluations of patients, as star ratings depend upon them.

“We need to introduce standards of practice, because this is only the beginning,” McCann said.


Still, agencies can prepare and continue to face uncertainties. Across the nine states that are now two and a half months into the value-based purchasing pilot, McCann said there are more questions than answers, little to no feedback on how things are going and, in some cases, no benchmark that agencies can reference, as two measures have not been publicly reported to date.

Confusion abounds for the measure relating to discharge to community, for example, because not only has it not been publicly reported, but it is calculated differently across star ratings, how payments will be administered in value-based purchasing, on the Outcome and Assessment Information Set (OASIS) and more.

There is no one single strategy to find success in the changing home health climate, McCann said. In the end, the reality of value-based purchasing and other regulations will teach agencies where their measurements don’t match up. Finding balance between old practices still in play currently and new ones as they come to fruition, though, and making sure that all employees within an organization are aware of and understand changes and impending policies are keys to rise to the challenges presented.

“It’s systems that fail, not usually people,” she said.

Written by Kourtney Liepelt

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