OASIS Alert

Keep yourself off your regional home health intermediary's hit list by comparing your utilization numbers to those of other agencies.

Comparison to all Medicare-certified home health agencies' visit figures - government data - is the best way to gauge your performance, notes consultant Beth Carpenter with Lake Barrington, IL-based Beth Carpenter & Associates.

While government data may not be as sophisticated as that furnished by benchmark vendors, it is provided at no charge. "If it's free, you should try to use it in some fashion," especially if you can't afford pricey benchmarking contracts, counsels consultant John Gaynor with Chicago-based Gaynor & Associates.

Keep in mind that making a direct comparison with data from intermediaries (see charts, "Utilization") might be more difficult than you think, warns consultant Mark Sharp with BKD in Springfield, MO. The data the RHHIs provide break visits down by date rather than by episode. Unless a provider's software produces the same data, it will be hard to make an apples-to-apples evaluation.

But these data provide some of the vital benchmarks HHAs can use to monitor their practice and evaluate both quality and financial success, recommends Chapel Hill, NC-based consultant Judy Adams with the LarsonAllen Healthcare Group. For example, government-provided visits stats have shown declining utilization across all disciplines, she notes.

Numbers for aide visits vary widely from state to state. Presence of a caregiver in the home and differences in urban versus rural resources play a part in the differences, suspects Gaynor. Adams finds home care providers divided into two opposing camps on aide use, she tells Eli. "HHAs either continue to utilize home health aides in a fairly substantial way or have severely limited their availability to home health patients," she says. That dichotomy likely accounts for some of the wide variation in aide utilization.

Therapy visits also may vary by size of the agency notes consultant Terri Ayer with Ayer Associates in Tucson, AZ. Larger agencies may have more therapists available because of location or pay and benefits, she says. They also may see more complicated patients, who require therapy services.

Agencies whose visits have remained consistent with pre-PPS patterns should have nothing to worry about from regulators, Ayer predicts. But if your numbers are out of line, your intermediary may ask for an explanation, and you risk losing reimbursement.

TIPS: Gaynor offers these suggestions for heading off problems: