Home Health & Hospice Week

Big swing in impairment levels noted post-PDGM.

Ask and ye shall receive, at least when it comes to more home health statistics.

In a March 29 Patient-Driven Group Model webinar required by law, the Centers for Medicare & Medicaid Services and its PDGM contractor Abt Associates offered justifications for the -7.85 percent permanent adjustment it calculated in the 2023 rule.

Reminder: CMS implemented half of that cut, 3.925 percent, this year (see HHHW by AAPC, Vol. XXXII, No. 1).

In explaining its rationale for the figure, CMS and Abt offered these stats:

• While there are more 30-day therapy-only periods in 2021 compared to 2018 (17.8 percent vs. 13.5 percent), “there are fewer therapy visits on average,” according to the webinar presentation.
• The number of 30-day periods of care was smaller in 2021 at 3.04 per beneficiary than it was in 2018 (3.13) and 2019 (3.12) with simulated periods.
• Visits per 30-day period declined from 9.86 in 2018 to 8.22 in 2021. CMS doesn’t mention telehealth visits, which of course would not figure into the statistic.
• LUPA periods were up from 6.7 percent in 2018 to 7.8 percent in 2021.
• Four clinical groups saw a decrease in 30-day periods from 2018 to 2021: MMTA — Endocrine, MMTA — Other, Neuro Rehab, and Wounds. The other eight clinical groups saw increases.
• The share of periods with a “high” comorbidity adjustment rose from 9.2 percent in 2018 to 13.5 percent in 2021; with no comorbidity adjustment fell from 55.6 percent to 49.6 percent in that time. For the “low” comorbidity adjustment, the peak was actually in 2019 at 38.0 percent, up from 35.3 percent in 2018 and back down to 36.9 percent in both 2020 and 2021.
• Community-Early periods were down from 13.5 percent in 2018 to 11.6 percent in 2021, but Community-Late periods were up from 61.1 percent to 63.9 percent in that time period. Institutional-Early periods were the same in 2018 and 2021 at 18.6 percent, but they bumped up to 20.0 percent in 2020. Institutional-Late periods decreased from 6.8 percent in 2018 to 5.9 percent in 2021.
• “Low” functional impairment periods fell significantly from 33.9 percent in 2018 to 23.2 percent in 2021, while “Medium” periods fell modestly (34.9 percent to 32.6 percent in the same period) and “High” periods increased from 31.2 percent to 44.2 percent.

Source: www.cms.gov/files/document/2023-medicare-hh-pps-behavior-change-60-day-episode-webinar.pdf.