As part of its ongoing mission to increase transparency and better inform health care stakeholders, the Centers for Medicare & Medicaid Services (CMS) has rolled out the fourth version of a massive data set highlighting utilization, payment and demographic information culled from thousands of home health providers.
Released on Tuesday, the Home Health Agency Public Use File showcases data from 10,138 home health agencies, nearly 6 million claims and $18 billion in Medicare payments. Information on submitted charges and chronic condition indicators is also included in the sprawling file, which covers calendar year 2016.
“Liberating data will drive innovation throughout the entire health care system and create new tools and solutions that will allow the system to deliver value to patients,” CMS Administrator Seema Verma said during a July speech at the Commonwealth Club of California.
Although the Home Health Agency Public Use File contains an enormous amount of payment and utilization information related to home health services, it does not touch on quality of care provided by agencies.
Additionally, data are not risk adjusted, meaning the file largely does not consider differences in underlying disease severity among patient populations.
High-level takeaways
Home health agencies provided care through a total of 5.9 million non-LUPA episodes in 2016, a Home Health Care News initial review of the CMS data found. The average number of total visits per non-LUPA episode was just over 18, with skilled nursing visits taking up a large chunk of that.
The median total charge that home health agencies submitted for non-LUPA episodes was $832,415, according to the data, while the median total Medicare payment amount for non-LUPA episodes was $837,771.
The raw total charge amount that all home health agencies submitted for non-LUPA episodes was roughly $19.8 billion.
Home health providers are hit with a Low Utilization Payment Adjustment claim, or LUPA, if they provide four or fewer visits during a 60-day care episode to any category of patient. There were a total of 550,789 LUPA episodes in 2016, according to the CMS data.
The Patient-Driven Groupings Model, if finalized as it currently stands, would drastically change how LUPAs are handled.
The typical home health patient in 2016 was about 76 years old and female, according to the CMS data. The vast majority of patients served by home health agencies that year identified as white, with the second and third largest demographic groups of patients identifying as black and hispanic, respectively.
An average of 36% of all home health patients served in 2016 had Alzheimer’s disease, while an average of 70% had hypertension.
The full data set and corresponding downloads can be accessed here.
Written by Robert Holly
