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Winning the Gold with LUPA Management: Buzzworthy News from NAHC’s FMC

Our HealthPRO Heritage leadership team recently attended the National Association of Home Care and Hospice (NAHC) Financial Managers Conference (FMC) in Chicago. The FMC is where industry leaders of home care and hospice connect on industry trends and opportunities. All the buzz this year was centered around:

  • What we have learned from PDGM;
  • Management through the COVID-19 pandemic; and
  • Where we are headed with value-based purchasing.

Not surprisingly at the heart of the conversation was the information and data analytics related to LUPAs (Low Utilization Payment Adjustment) and utilization.

There were some very interesting insights in the data surrounding LUPAs, including:

  • With the predictive analytics, CMS was projecting a LUPA rate of 6.2%. Data presented from SHP at the conference indicated YTD LUPA rate at 9.1%.
  • By far the most common HHRG that is resulting in a LUPA in the first payment period is 1EA1 (Community, Early, Musculoskeletal Rehab, Low Functional Impairment, with No Co-Morbidity Adjustment.
  • The most common HHRG that is resulting in a LUPA in the 2nd payment period is 3IVB1 (Community, Late, MMTA – Endocrine, Medium Functional Impairment, with No Co-Morbidity Adjustment).
  • Some of the common trends in subsequent 30-day period LUPAs are as follows:
    • Had only 1 visit made in the period
    • Missed the LUPA threshold for the period by only 1 visit
    • Had higher comorbidity adjustments
    • Had higher functional impairment levels

A large percentage of LUPAs are preventable and avoidable under PDGM. However, as the management of LUPA episodes had always been a challenge under PPS, it is becoming quite clear that the added complexity under PDGM is a gold medal that has yet to be won by home health agencies. The key is for agencies to continue to deliver meticulously managed processes and workflows within each of the 30-day payment periods.

Through a collaborative approach with our partnered agencies, HealthPRO Heritage is measuring LUPA occurrence at less than half of the national average of 9.1%. This has been accomplished by executing a collaborative therapy management model that includes identifying:

  • Correct LUPA thresholds;
  • Clinically appropriate resource utilization;
  • Strategic scheduling;
  • Timely documentation;
  • Missed visit reduction work plans; and
  • Innovative case management.

HealthPRO Heritage can help your team improve patient care and minimize the sizable risk that LUPAs present to your agency. Contact us with questions or reach out for an additional perspective by emailing:  homehealth@healthpro-heritage.com.

Click here to read Part 2 of our Buzzworthy News from NAHC's FMC (including the hot topic of Strategic Scheduling).

Tags: Home Health Agency, LUPA, contract therapy