CMS released the 2021 home health final rule on Thursday, October 29, 2020. HealthPRO Heritage at Home sorted through the mixed bag and found more treats than tricks!
There were minimal changes compared to the home health proposed rule that was released in July 2020. Probably the best news in the rule was the 1.9% aggregate increase (or $390 million) in reimbursement that agencies will realize in 2021. Although the increase was less than the original 2.6% increase that was in the proposed rule.
Other highlights from the final rule are as follows:
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PDGM,
Home Health Agency,
COVID-19
CMS began enforcement of Review Choice Demonstrations (RCD) on August 3, 2020. Home health providers in North Carolina and Florida were able to select their initial choice between August 3, 2020 and August 17, 2020. Home health in all demonstration states (Illinois, Ohio, Texas, North Carolina, and Florida) with billing periods beginning on or after August 31, 2020 will be subject to review under the choice selected.
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While the medical industry learns to operate during COVID-19, HealthPRO Heritage at Home believes there has never been greater demand for home-based care options or recognition of the power and benefits of care delivered in the home, whether in person or through telemedicine.
The nationwide outbreak of COVID-19 has had a major impact on our healthcare system, and home health agencies across the country have been working hard to continue providing quality health care and services to their patients. Alongside the cost pressure of the 2020 Patient-Driven Groupings Model (PDGM) pressures, Medicare (CMS) continues to grow, with around 10,000 new individuals added to their roster every day.
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HealthPRO Heritage at Home: PPE/Safety Update
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PDGM,
Home Health Agency,
COVID-19,
Coronavirus
Amidst the COVID-19 crisis, HealthPRO Heritage has organized a multi-faceted approach to preparedness and promotion of safe treatments to our patients, and implementation of strict precautions to prevent the risk of the virus spreading. Our Physical, Occupational, and Speech Therapists remain available and ready to serve the immediate patient care needs of our agency partners, many of whom are reporting staffing challenges.
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COVID-19
The Patient Driven Grouping Model (PDGM) was implemented January 1, 2020 and changed reimbursement models of Medicare home health services from therapy utilization driven to patient characteristics. While this has allowed for a focus from quantity to quality, some home health agencies are restricting therapy visits and placing their quality measures, Star Rating, and most importantly patient outcomes at risk. CMS calculates Star Ratings through several areas therapy may influence including, ambulation, bed transfers, bathing, discharge location, and rehospitalizations.
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Home Health,
Senior Living Community,
PDGM,
Patient-Driven Grouping Model,
Home Health Agency
In the past years, overutilization of therapy had been a concern for CMS as most agencies were using therapy as a driving force for reimbursement under the previous prospective payment system and had identified significant overutilization of therapy visits by as much as 30-40%. However, audits revealed that nursing visits were also over utilized along with therapy. One would assume that nursing should be equally held accountable under PDGM for patient improvements as well and not assume that they get a free pass. However, there has been no reduction in the nursing salaries, workforce, or in their allowed patients visits thus far under PDGM by most agencies. Nursing visits were never a factor contributing to reimbursement, yet are still valued as an integral contribution to a home health episode. Therapy should not be different. PDGM does eliminate therapy-visit volumes as a determining factor in calculating reimbursements, but that does not mean that the need for therapy has changed. Therapists are strategically positioned to promote, enhance, and improve a patient’s functional abilities in the realm of home health; however, there are barriers to their services because of some agency practices. This may include reduction in therapy visit utilization, frequency or restricting disciplines.
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Home Health Agency
Review Choice Demonstration came to Ohio September 30th, 2019 and hot on its heels is PDGM. The more prepared you are for all of the changes that come, the better poised your agency will be in the coming months and years.
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Home Health Agency
PDGM Implementation is Tomorrow!
In 2019, we've published extensive break-downs of the things you may need to know about therapy in Home Health Agencies and Senior Living facilities.
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Home Health,
PDGM,
Patient-Driven Grouping Model,
Home Health Agency,
CMS Update 2020
HealthPRO Heritage at Home is fully prepared to bring its expertise and resources to home health agencies looking to strategize and succeed under PDGM. Among the many offerings to agencies are [+ downloadable checklist*]:
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PDGM,
Home Health Agency