Home Health & Hospice Week

Subsequent SOC episodes have different diagnosis about ¾ of the time, data reveal.

The Centers for Medicare & Medicaid Services used these 2012 statistics when promulgating the new switch from requiring face-to-face encounters and documentation for initial versus start-of-care episodes:

• The average number of days between a partial episode payment (PEP) episode and a subsequent episode of care was 17.5 days.

• Subsequent episodes initiated with a SOC OASIS represented 12.7 percent of all home health episodes.

• However, only 2.2 percent of episodes were PEP episodes.

• About 60 percent of the time there was a hospitalization between a PEP episode and the subsequent episode of care.

• When comparing the primary reason for home care (primary diagnosis OASIS item M1020) at the ICD–9 three-digit category level, subsequent episodes initiated with a SOC OASIS had a different primary diagnosis than the previous episode about 73 percent of the time.

• The subsequent episode’s primary diagnosis was different from the previous episodes’ primary diagnosis about 70 percent of the time when the subsequent episode was with the same HHA, and 80 percent of the time when the subsequent episode was with a different HHA.

• For subsequent episodes that followed a PEP, episodes initiated with a SOC OASIS had a different primary diagnosis than the previous episode about 72 percent of the time — about 66 percent of the time with the same HHA, and 76 percent of the time with a different HHA.

• When there was an intervening hospitalization between the PEP episode and the episode that followed, clinical levels matched in 53 percent of instances and functional levels matched in 63 percent of instances.

• When there was an intervening hospitalization between the PEP episode and the episode that followed, clinical levels were higher in 24 percent of the episodes that followed PEP episodes and lower in 22 percent of episodes. Functional levels were higher in about 20 percent of episodes that followed PEP episodes and lower in 17 percent of episodes.

• In 2013, 12 percent of home health patients receiving home care needed urgent, unplanned care in the emergency room and 16 percent of home health patients had to be admitted to the hospital. 

Source: CMS 2015 home health prospective payment system final rule, Nov. 6 Federal Register, https://federalregister.gov/a/2014-26057.