Home Health & Hospice Week

The findings of a Centers for Medicare & Medicaid Services demonstration project on bundling payments may be good for home care providers.

"Evidence supports the potential for development of a common payment system for the three inpatient [post acute care] settings: LTCHs, IRFs, and SNFs," says the CMS report on the Post Acute Care Payment Reform Demonstration. "Evidence supports modeling home health routine service use separately from the other PAC settings."

Unique: "The pattern of resource intensity in the home health setting is significantly different than seen in the three inpatient PAC settings," CMS notes in the report. "This may be due in part to the different nature of providing care and staffing in a home based setting compared to an inpatient setting."

The demo used the CARE tool to assess patients across all care settings. Even though a post acute payment system covering all the settings may not work, CMS would still like to see the CARE tool used in home care.

"A revised home health payment system could be developed using the same underlying definitions of patient acuity measures as used in the other PAC settings, even if the exact way that the acuity measures are weighted in the payment system differs," CMS explains in the report. "This revised system would use patient acuity measures based on the CARE tool which provides standardized patient assessment information across settings. A revised HHA payment system using CARE measures of patient acuity would provide greater comparability of population acuity, needs, and resource use treated in different settings and at different points in their trajectory of care following a hospital stay in addition to allowing better understanding of cross-setting resource needs and use."

The report is online at www.cms.gov/reports/downloads/Flood_PACPRD_RTC_CMS_Report_Jan_2012.pdf.