Home Health & Hospice Week

SNF rating system and hospital P4P show what home care has in store.

Your OASIS data will be more important than ever when two new initiatives for other provider types hit home health agencies.

The Centers for Medicare & Medicaid Services will start rating skilled nursing homes on a five-star scale, the agency has announced. The "ground-breaking ranking system" will "provide patients and their families an easy to understand assessment of nursing home quality, making meaningful distinctions between high performing and low performing homes," CMS explains in a release.

CMS will post the ratings on Nursing Home Compare by the end of the year. "Nursing Home Compare's new rating system will ... provide an incentive for nursing homes to strive toward earning a five-star rating by providing an environment of better quality care," CMS Acting Administrator Kerry Weems says in the release.

Similar ratings for HHAs on Home Health Compare may not be far behind, predict industry veterans.

P4P: Some of the political excitement for pay for performance seems to have died down, but that doesn't mean it's going away.

The third year of Medicare's "value-based purchasing" demonstration for hospitals shows that P4P incentives seem to increase care quality. Scores for quality standards have improved remarkably over the three years of the program.

For example: The composite quality score for patients with heart failure increased from 64 to 89 percent over the course of the demonstration. Patients with pneumonia saw a jump from 69 percent to 90 percent.

The top-performing 112 hospitals earned $7 million in incentive payments for "substantial and continual advancement in quality of care," CMS notes. The agency is now calling for the P4P program to apply to all hospitals paid by Medicare.

Once that is achieved, the agency is likely to call for the same for other providers like HHAs, experts forecast.

• Get ready for hospitals' post acute transfer rule to take an even bigger bite out of your post-hospital referrals. CMS wants to expand the transfer timeframe from the current three days to seven days, the agency says in its inpatient prospective payment system rule for hospitals published in the April 30 Federal Register.

That means if the hospital discharges a patient before the average length of stay for that patient's DRG, Medicare will pay a prorated per diem amount instead of the entire DRG payment. Currently that proration applies only when the patient begins home care within three days of hospital discharge, but CMS will now make that within a week.

Background: Starting in 1999, when CMS cut hospitals' payment rates for certain patients referred to home care upon discharge, home health agencies saw physicians reduce their referrals for those patients. And then when CMS expanded the proration from 30 to 182 DRGs in 2005, [...]