Home Health & Hospice Week

Know the background of your benchmarks before you make a change.

Don't let pay-for-performance drop off your radar screen amidst the flurry of activity surrounding HHABNs. If you do, you could also lose big bucks down the road.

History: Prior to the prospective payment system (PPS), home health agencies measured quality by process, which meant that the number of home health visits for a single case was indefinite.

In the 1980s, the focus shifted to outcomes, creating more patient participation and greater efficiency, according to a course titled, "The Future of Therapy in Home Health" by Cindy Krafft of Peoria, IA-based OSF Home Care, and Karen Vance of BKD in Springfield, MO, speaking at the American Occupational Therapy Association's Annual Conference in Charlotte, NC earlier this year.

Although changes have brought home health therapy to more cost-effective, goal-centered episodes, payers and policy makers are pushing to take it a step further to a pay-for-performance (P4P) system. "This isn't just a possibility; Medicare is doing research, and P4P may happen sooner than you expect," Vance said.

The bottom line: Documenting your skilled care will not be enough. You must show how your therapy counts for the patient.

Examine Industry Trends

The first step to becoming more accountable is knowing how your HHA compares to others.

Why: Under P4P, the top performing HHAs will get more money--and the poorest performing agencies will end up with less money, Vance pointed out.

Fortunately, you don't need to hire an analyst to provide simple benchmarks for your HHA. Medicare's Home Health Compare Web site publishes quality measures on every Medicare-certified HHA, Krafft said.

Note: Only Medicare HHAs that have been certified for a year or more are listed, according to the site.

How it works: Home Health Compare takes a selected number of OASIS questions and produces a report card on your agency, alongside others. But this site isn't for payers and providers only.

It's actually designed to help Medicare patients make a quality choice--and non-Medicare patients could also be looking at this when they choose providers, Krafft said.

Don't Jump To Conclusions

With Home Health Compare and other benchmarking tools available, you have good resources to begin comparing your therapy program and making improvements, but you must be cautious with the data.
 
Don't be ruled by the benchmark of the week," Krafft warned. You'll end up making unnecessary changes and then switching back. For example, benchmarks could be based on a certain case mix that differs significantly from yours. "Benchmarks can be a useful tool for finding areas needing improvement, but don't be afraid to ask questions," Krafft added.

Experts say: Also know that a differing benchmark isn't always a bad thing. For example, Krafft's agency uses more occupational therapy than the standard benchmark, but this works the best for her agency, and in the end, OSF's total use of therapy is slightly less than the national total.

Don't Get Stuck On The Discipline

If you have examined multiple areas of Home Health Compare, verified your benchmarks and find that your therapy services are producing lower-than-desired outcomes, consider altering your teamwork.

Try this: "Focus your goals on the client, not the disciplines involved," Vance explained. This means considering the right therapist for the case, regardless of whether they're a physical therapist or an occupational therapist.

"Everyone on the team has his or her own specialties, and you can't fall for the common assumption that PT deals with the lower body and OT deals with the upper body," Vance said. "Sometimes the therapists are the biggest barrier to patient care--we're talking about the patient's goals, not your goals."

When your home health agency optimizes each therapist's best skills and coordinates the best team, your outcomes have a strong chance of improving, which puts you in better shape for pay-for-performance.

Note: The Home Health Compare site is at www.medicare.gov/HHCompare/Home.asp.