Home Health & Hospice Week

If you can't explain why your utilization differs from that of home health agencies in your state, you could wind up on the regional home health intermediaries' hit list.

RHHI Palmetto GBA recently issued statistics on visits per beneficiary by each of the six home health disciplines for the last quarter of 2002 (see chart). These are some of the vital benchmarks HHAs can use to monitor their practice and evaluate both quality and financial success, recommends Chapel Hill, NC-based consultant Judy Adams with the Larson Allen Health Group.

"It's always good to have this information and compare yourself," agrees consultant John Gaynor with Chicago-based Gaynor & Associates. But the comparison shouldn't stop with merely noting the similarities or differences between your data and the benchmark data, Gaynor urges.

If you see significant differences between the two, sit down and list five "identifiers" about your HHA - things that set you apart from the norm, Gaynor suggests. Perhaps your agency serves more wound care patients than is typical, or offers programs for other specialties. After listing those characteristics, see if they would explain the differences in utilization.

For example, if your HHA offers a special post-operative program, it would make sense that you furnish more therapy than the typical agency. "It's worth taking the time to figure this out," Gaynor stresses.

If you can't come up with a solid justification for why your utilization varies from the norm, then consider making some changes, Gaynor proposes. You might need to tweak your case management system or implement more claims review.

It's likely that the RHHIs are tracking these differences even more closely than you are, and bringing your utilization in line, when clinically appropriate, could keep you off their hit lists. "I don't want to be on that short list," Gaynor quips.

Even if the differences are justified, you might want to work on better documenting the services that are out of the normal range. If your utilization varies greatly, the RHHI could call you on the carpet to explain why and you could risk losing reimbursement, Gaynor warns.

Making a direct comparison with data from Palmetto and other intermediaries might be more difficult than you think, however, warns consultant Mark Sharp with BKD in Springfield, MO. The Palmetto data lists all visits furnished in October, November and December 2002, but doesn't separate them out per episode.

"The calculation of the average spans all episodes any one beneficiary might have" within the quarter, explains a Palmetto spokesperson. "The average visits per beneficiary for this report is calculated by dividing the total number of claim lines by the total number of beneficiaries within state and discipline for a given time frame."

"It would be more useful to know the visits for an entire length of stay," Sharp insists. Unless a provider's software produces the same data, it will be hard to make an apples-to-apples evaluation.

While government data may not be as sophisticated as that furnished by benchmark vendors, it is provided at no charge. "If it's free, you should try to use it in some fashion," especially if you can't afford pricey benchmarking contracts, Gaynor counsels.

In addition to providing comparisons for HHAs, the data also points to some trends in the industry overall. The visit numbers for the three types of therapy, skilled nursing and medical social work remain fairly similar over the 16 states Palmetto serves. But numbers for aide visits vary widely from state to state, with Illinois at a low of 13.23 visits per beneficiary and Louisiana at a high of 24.25 visits.

Variation in aide utilization is a carry-over from pre-prospective payment system days, notes Sharp. Presence of a caregiver in the home and differences in urban versus rural resources play a part in the differences, suspects Gaynor.

Adams finds home care providers divided into two opposing camps on aide use, she tells Eli. "HHAs either continue to utilize home health aides in a fairly substantial way or have severely limited their availability to home health patients," she says. That dichotomy likely accounts for some of the wide variation in aide utilization.

Government-provided visits stats also have shown declining utilization across all disciplines, Adams notes. That trend is likely to give the Centers for Medicare & Medicaid Services ammunition to reduce reimbursement rates in the future. It also will make it harder for agencies to achieve optimal patient outcomes, she fears.