In the first year of the Patient-Driven Grouping Model (PDGM), which coincided with the COVID-19 crisis, the frequency of low utilization payment adjustments (LUPA) for many home healthcare providers increased.
In part, there are far more LUPA variables to track with the new payment model. Occasionally, the increase was also associated with home care patients who unexpectedly reduced scheduled visits due to fear of COVID-19.
For some, avoiding LUPA by reaching a certain visit threshold may seem like a relatively simple process. But home healthcare providers in weeds are telling another story.
“This is probably one of the bigger challenges under PDGM,” Nick Seabrook, managing director of BlackTree Healthcare Consulting, told Home Health Care News. “Under the Future Payment System (PPS), there was a single threshold. I had to manage 5 visits, which took over 60 days. Currently, the threshold I try to manage is 432. Yes, it’s been over 30 days. I think these two factors are actually pushing LUPA up. “
Based in King of Prasha, Pennsylvania, BlackTree Healthcare Consulting offers home care providers billing, OASIS, and other services, among other post-acute care providers.
Home care companies were worried about LUPA before the launch of PDGM, but the Medicare & Medicaid Service Center (CMS) didn’t think it really was that much of a problem.
“One of the elements of that behavioral coordination was the assumption that LUPA management would be good,” Seabrook said. “But I think it was a short-sighted view on their part. I just know it’s more sophisticated than before.”
Evergreen Health Home Care, a hospital-based home health and hospice provider in Washington, was hit hard by the LUPA struggle in 2020. It was one of the first providers in the country to treat COVID-19 patients with a pandemic that exacerbated the PDGM problem. ..
Brent Korte, Chief Home Care Officer at Evergreen Health, hopes that this issue will continue to improve over time. But the struggle taught both him and his organization what it takes to prevent LUPA.
“We need to have an up-to-date understanding of where each patient is lined up with LUPA,” Korte told HHCN. “And we didn’t have it, and it was really disarmament. It caused a lot of extra work on our side, as a general organization. We then did a lot of extra work. Hopefully, I’m not just distracted by the pandemic, I’m going to focus more on actually working on PDGM and bounce back to the rest of 2021. “
It ’s not just distracting
Pandemics don’t just distract you from the usual home care challenges. It had a concrete impact on LUPA.
Sudden hospitalization due to unplanned complications, staff shortages associated with quarantine protocols, and cancellation of visits due to patient anxiety can all overwhelm the organization’s LUPA mitigation efforts.
For example, if you miss a visit on Tuesday, even supplementing it immediately the next day can lead to a new 30-day LUPA. In addition, access to patients in the facility was a challenge for 2020, making the scheduling process more difficult.
“If you can’t see the patient one day and you have to see the patient the next day, it can cause LUPA, which is very big. [challenging]”Corte said. “Our number of cases has also increased, which means that especially our nurses and physiotherapists [do more].. Meanwhile, the pandemic caused a significantly more acute flood of patients who would otherwise have been admitted to a skilled nursing facility. “
Seabrook points out that the coordination of behavior by CMS did not reflect the reality set by Evergreen Health and other providers across the country. The coordination was a positive move on the part of government agencies and was not responsive.
“We wanted the CMS to be, in a sense, responsive or positive in trying to change our rewards,” Corte said. “For some providers, behavioral coordination itself caused behavioral coordination.”
Given the current vision of home care patients, Evergreen Health hopes to reduce LUPA rates to single digits by the end of this year.
“Achieving the LUPA single digit number is a major goal if we can understand the extent of the patient’s illness due to the pandemic and how their eyesight has improved in the last 14 months and meet their needs. “Corte said.
Find out what works
For what went well, educating each clinician about LUPA helped keep Evergreen Health’s head on the water.
Understanding what triggers LUPA and how to fix it is one thing for agency leaders, but without top-down continuity, operational problems can occur.
“What really works is for clinicians to understand the implications and ensure that they understand the adjustments they make,” Molly McDonald, clinical quality coordinator for Evergreen Health’s home care and hospice business, told HHCN. It was. “Patients start service and try to plan it more than once. It requires constant readjustment.”
In certain cases, healthcare providers couldn’t know what the patient’s HIPPS code was within 10 days, which is now one-third of the time, according to Seabrook.
“Quality staff reviews OASIS after the provider goes through the normal QA process and OASIS is complete,” says Seabrook. “They provide feedback to clinicians, clinicians make their changes, and now they lock OASIS and you have that HIPPS code. You potentially have 10 of that period. You’re looking at the day, and that HIPPS code is trying to determine what that LUPA threshold is. Before you finally find that threshold, you’re one-third of the time period. “
COVID-19 is still affecting the LUPA issue across the home health sector. As the crisis subsides, some of the pain associated with PDGM’s pain will subside.
Nevertheless, LUPA management continues to demand diligence for providers to boost their bottom line.
“The problem will get better,” McDonald said. “But when it comes to this COVID overlay, we continue to emphasize everything we have done and the importance of ongoing PPE, infection control, and promotion of vaccination, at home and institution. You can continue to see the patient. If you don’t, that’s the real problem with LUPA. “
Home medical care LUPA challenges continue as the pandemic subsides
Source link Home medical care LUPA challenges continue as the pandemic subsides