OASIS Alert

Inside the mind of CMS.

Q: Do you know why M0175 works the way it does? Our agency doesn't think it make much sense to get one point if the patient had no hospital stay, but no points if the patient was discharged from a hospital within 14 days of admission to home health. We find the patients who are admitted after a hospital stay are usually sicker.

A: The underlying rationale for this point system was that the patient who was in an acute care hospital before being admitted to home care has received some degree of treatment and is stabilized -- at least at a minimum level, explains clinical consultant Judy Adams with the LarsonAllen Health Care Group.

On the other hand, the patient coming from the community has a new health care need that hasn't really been addressed yet, she says.

"This was a much debated and protested issue when the prospective payment system final rule was published," Adams tells Eli. But the pilot project ABT Associates conducted for a year before PPS was implemented showed that patients who were referred to HHAs from hospitals required fewer resources to care for them than did patients admitted from the community, she reports.