Home Health & Hospice Week

Therapy episodes would get reimbursed less.

If your claims are dominated by episodes with high therapy, no recent hospital stays, or patients with behavioral health conditions such as schizophrenia, bipolar disorder or drug addiction, Medicare’s draft for HH PPS payment reform could be bad news.

In a new report on the Home Health Groupings Model plan for a pay revamp, home health agencies might first zero in on the chapter detailing the financial impact of replacing the current Home Health Prospective Payment System with the HHGM methodology.

While each agency’s reimbursement will depend on its patient mix, reform contractor Abt Associates found these trends when comparing reimbursement under the current system to payment under the HHGM methodology, according to a new report released by the Centers for Medicare & Medicaid Services (see story, p. 338). On average, episodes at:

• facility-based HHAs would receive a little more ($1,642.79 HHGM versus $1,428.48 current; impact ratio=1.150) while freestanding HHAs would receive a little less ($1,505.64 HHGM versus $1,529.19 current; impact ratio=0.985)
• non-profit HHAs would receive more ($1,715.47 HHGM versus $1,519.64 current; impact ratio=1.129) while for-profit HHAs would receive a little less ($1,454.20 HHGM versus $1,525.47 current; impact ratio=0.953)
• HHAs in the Northeast would receive a little more ($1,817.07 HHGM versus $1,644.02 current; impact ratio=1.105) while HHAs in the South would receive a little less ($1,374.23 HHGM versus $1,448.01 current; impact ratio=0.949)
• older HHAs would receive more and new HHAs would receive less — for instance, the impact ratio for HHAs certified in the 1960s is 1.124 ($1,793.88 HHGM versus $1,595.69 current) while the impact ratio for HHAs certified in the 2010s is 0.926 ($1,474.91 HHGM versus $1,593.19 current)
• rural county HHAs would receive slightly more ($1,324.39 HHGM versus $1,296.92 current; impact ratio=1.021) while urban county agencies would receive slightly less ($1,570.99 HHGM versus $1,578.29 current; impact ratio=0.995) Abt’s data analysis also showed:
• Episodes in the Wound and Complex nursing interventions clinical groups would receive more while episodes in the Behavioral Health clinical group would receive more than 10 percent less
• Institutional episodes would receive more ($2,070.10 HHGM versus $1,598.59 current if early with an impact ratio=1.295; $1,965.20 HHGM versus $1,615.46 current if late with an impact ratio=1.216) while community episodes would receive less ($1,246.44 HHGM versus $1,468.15 current; impact ratio=0.849)
• Episodes with no therapy would receive more ($1,353.93 HHGM versus $1,082.47 current; impact ratio=1.251) while episodes with therapy would receive less ($1,630.21 HHGM versus $1,812.47 current; impact ratio=0.899)
• Episodes would receive more if they were associated with parenteral nutrition ($1,698.98 HHGM versus $1,373.72 current; impact ratio= 1.164) or surgical wounds ($1,719.58 HHGM versus $1,563.40 current; impact ratio=1.100)
• Several other characteristics were also associated with higher payments under an HHGM refinement (e.g., poorly controlled cardiac dysrhythmia impact ratio=1.039; open wound/lesion impact ratio=1.084).