To be a breakout partner in the evolving health care landscape, clinical excellence is key, which is why home health care providers are continuing to spend time and resources bulking up their performance.
For Baton Rouge, Louisiana-based Amedisys (Nasdaq: AMED), focusing on improving clinical care has boosted its star ratings on Home Health Compare over the last few years. As of March 2018, Amedisys had an average rating of 4.22 stars for quality of patient care across its home health care centers. Compared to a year ago, the company’s star ratings were up 8%.
As the larger home health care providers continue to ramp up other service lines like personal care and hospice, defining and improving clinical outcomes is become increasingly important—particularly with more reporting requirements and potential partnerships on the line.
Expanding service lines
Amedisys, like its peers, has grown its hospice and personal care service lines over the last few years, with both segments seeing huge revenue jumps at the start of 2018 compared to the same time period in 2017. The company operates 426 care centers in 35 states and has more than 17,500 employees.
In recent presentations, CEO Paul Kusserow has noted the company sees “more juice in the orange” when it comes to acquiring more in the hospice sector and growing that business line.
The company has also put a pronounced focus on improving its clinical strength, from hiring a new chief clinical officer in 2016, Susan Sender, and pushing out disease-specific programs—with real results. Since launching a new heart failure program in 2017, Amedisys reduced 30-day acute care hospitalizations for high-risk patients by about 5%, while the 60-day rate went down about 8%, Sender told HHCN earlier this year.
For the core home health care business, improving star ratings through better clinical programs and results can be a singular focus. Home Health Compare, which is public to consumers, uses a star rating between 1 and 5 to show how agencies compare to others on measurements of performance.
“On the home health aides, it’s broad—it’s all about the star [rating] program from CMS,” Sender told Home Health Care News. “In July, our preview puts us at 4.38 star rating average. More and more [of our] centers are receiving five stars. We’ve experienced 12 consecutive quarters of improvement in the star ratings.”
The direction on driving up star ratings also fits in with the company’s success in value-based purchasing.
Since 2016, nine states—Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska and Tennessee—have been participating in a home health value-based purchasing pilot with CMS. Amedisys currently operates in seven of those states, and reimbursement for all HHAs in the pilot program face reimbursement adjustments based on quality performance. In 2018, a maximum payment adjustment of 3% was instituted, and the adjustments will continue to rise incrementally, up to 8%, through 2022.
“The metrics that go into the star rating program feed the value-based purchasing metrics,” Sender said. “There’s no separate effort for VBP from the clinical side. We’re improving, and a happy side effect is that the VBP [reward] climbs.”
The company has so far seen success in VBP, with the payment rewards boosting revenue, Kusserow said during the company’s first quarter earnings call in May. Amedisys saw an extra $1 million in payments as a result, with the potential for that reward to continue to increase.
Amedisys is striving for excellence beyond home health care, though the quality reporting requirements in hospice and personal care services are still somewhat in flux or simply different from home health. To make itself a standout, Amedisys is working on measuring more quality data points that can help further inform where improvements can be made to boost performance.
While there are not currently star ratings for hospice care, providers do have to follow quality reporting requirements, with data measures displayed on Hospice Compare that are visible to the public. In that area, Amedisys “exceeds the CMS composite score in all measures by about 5% [on Hospice Compare],” Sender said.
Part of Home Health Compare looks at scores form the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, and hospice similarly measures patient satisfaction through CAHPS. However, the hospice focus is different as a result of the nature of the care.
“On hospice it is essentially family satisfaction,” Sender explained. “The family measures the effectiveness of hospice, weather the loved one received good symptom control [and if] the hospice care about their goals.”
Amedisys is also taking steps to measure more data in hospice beyond the requirements, such as hospitalizations, according to Sender.
For personal care, the reporting environment is a different story altogether.
“On the personal care side, that is a little bit more loose in terms of [it being] the wild, wild west,” Sender said. “Many of our personal care agencies are funded or reimbursed through Medicaid. Many states have different requirements and there’s no real across-the-board measure.”
Instead, Amedisys measures its own internal client satisfaction survey and the number of times the patient was hospitalized over the course of a year. However, they have “nothing to compare it” to. So the company compares the data against itself to identify performance improvement.
Amedisys also looks at staffing across all its business segments, as high turnover rates can also have an impact on clinical quality.
“From a high level, we look at clinician turnover, satisfaction, and we do an engagement survey every year,” Sender said. “Every person that receives a paycheck from us receives a survey.”
Across the entire provider’s platform, looking out for the patient carries through service lines. And striving for clinical excellence with a patient-first approach can help achieve continued improving star ratings.
“It’s absolutely possible for any individual agency to get 5 stars,” Sender said. “I would never let my clinicians hear they can’t get 5 stars. That’s what we strive for. Will we get there? Our future will decide.”
Written by Amy Baxter