Cats and Home Health Have More in Common Than You Think


Published: 11/20/2017

Hospitals made the change from volume to value by decreasing the length of patient’s hospital stays, using DRG’s, and abiding by standards like penalties for 30-day readmissions. Because of Medicare’s success in the acute space, it was only a matter of time till these changes filtered down into post-acute care.

While HHGM has yet to be finalized, high performing agencies have been unknowingly working to incorporate HHGM standards, a little at a time, for years.  HHGM will likely have a positive effect on revenue for these agencies. Conversely, agencies holding onto the legacy practices of the last 20 years are already behind. The final rule stated CMS is holding off on making HHGM final for now, but insiders agree - it is still coming.

CMS has been “herding” home health into this model for several years.  Regulation and program changes have slowly guided agencies to change their practices—mostly by incentive, and finally by penalty or audit.

Not convinced?

  • STAR SCORES -  5 STAR agencies are producing outcomes.  The only way to do that is by DISCHARGING patients.  Most 5 STAR agencies are under the CASPER reported 58 day average length of stay.  Most are closer to 30 days!
  • APM -  Being successful in alternative payment models require the outcomes produced by 5 STARS AND low cost per episode.  Those who are thriving in APMs have implemented lower levels of utilization and will pursuing acute care partnerships.
  • VBP -  A double edged sword.  Increase in value (great outcomes/ low cost) and be rewarded, or continue legacy practices of long LOS and high utilization and be penalized.
  • Probe and Educate -  CMS looked at all agency’s F2F documentation, educating home health to provide services only where medical necessity and homebound status were clearly demonstrated.  Some agencies are still using terms like “weakness” to justify home health episodes…. these agencies are now in TARGETED probe and educate…..
  • ZPICs – If your agency continues to refuse to move forward; you will pay the price in audits, extrapolation, and possibly closure.  Contrary to popular belief, these are data driven audits with triggers like; long length of stay and high utilization with low OASIS acuity.

If your agency is part of the “herd” implementing changes over the last few years, congratulations, you are on the right track… if not, you have some catching up to do, but CMS is herding you in the right direction.  All you have to do is follow!

Kristi Bajer is the VP of Clinical Operations at OperaCare LLC.  A data driven automated QA platform which ensures compliance and revenue integrity.