Home Health Articles and Information


Oct 1, 2019 12:13:00 PM / by Kristi Bajer, BSN, RN, COS-C

Cats and Home Health Have More in Common Than You Think

Hospitals made the change from volume to value when CMS introduced the DRG payment model. In short, each diagnosis fell into a payment amount the hospital received irregardless of the patient care provided. Suddenly hospitals who had been reimbursed by the number of days (volume) now had to work within a system that provided a higher margin for DISCHARGING the patient sooner! The results- the average length of stay went from 10-13 days down to 1-3 days. Because of Medicare’s success in the acute space, it was only a matter of time until these changes filtered down into post-acute care.

The IMPACT Act of 2014 started the post-acute move to value-based care. When PDGM starts in January 2020, high performing agencies will find they have unknowingly been working to incorporate PDGM standards, a little at a time for years. PDGM will likely have a positive effect on revenue for these agencies. Conversely, agencies holding onto the legacy practices of the last 20 years are already behind.

CMS has been “herding” home health into this model for several years. Regulation and program changes have slowly guided agencies to change their practices—mostly by incentive, and finally by penalty or audit.

Not convinced?

STAR SCORES - 5 STAR agencies are producing outcomes. The only way to do that is by DISCHARGING patients. Most 5 STAR agencies are under the CASPER reported 58 day average length of stay. In fact, most are closer to 30

APM - Being successful in alternative payment models require the outcomes produced by 5 STARS AND lowering cost per episode. Those who are thriving in APMs have implemented lower levels of utilization and shorter lengths of stay while pursuing acute care partnerships

VBP - A double edged sword. Increase in value (great outcomes/ low cost) and be rewarded, or continue legacy practices of long length of stay and high utilization and be penalized

Targeted Probe and Educate – These are usually by data, often looking for medical necessity and home bound status. Agencies still using diagnosis like “weakness” to justify home health episodes may now be in TARGETED probe and educate….. and under PDGM these episodes will not be billable

ZPIC / UPIC – If your agency continues to refuse to move forward; you will pay the price in audits, extrapolation, and possibly closure. Contrary to popular belief, these are data driven audits with triggers like; long length of stay and high utilization with low OASIS acuity.

If your agency is part of the “herd” implementing changes over the last few years, congratulations, you are on the right track… if not, you have some catching up to do, but CMS is herding you in the right direction. All you have to do is follow!


Tags: PDGM, RCD, PCR, Value-based care, Outcomes, Home Health, STARS

Kristi Bajer, BSN, RN, COS-C

Written by Kristi Bajer, BSN, RN, COS-C

Kristi Bajer BSN, RN, COS-C, brings over 10 years of real world experience as a clinician, director, and administrator in home health. She is a firm believer in diagnosis driven evidence-based care in home health. Currently, she assists agencies with external chart audits and Medicare appeals, as well as providing training and coaching on OperaCare implementation and building QAPI programs using data to drive success and protect agencies from government audits.