The huge growth of the home care industry in recent years has led to a Catch 22 situation. On the one hand, people are living for longer than ever before and the number of home health aides is growing at a rate far higher than the average for all industries. On the other, the increase in life expectancy means that the number of elderly people requiring home care has never been higher, and even the increase in home care workers isn’t enough to cope with demand. Also, the tightening of licensing regulations will shrink the pool of available caregivers.
In this infographic from Be Independent Home Care, we can see that the home care industry is at a crossroads and faces into a potentially troublesome future. By 2024, the number of home health aides is projected to have grown by 38 percent from a decade previously. By 2020, the global homecare industry is expected to produce revenues of $300 billion, compared to $180 billion in 2014. All the while, the senior citizen population in the U.S. has doubled from just four years ago, with one in five Americans now of senior age.
Where does the home care industry go from here? Quite simply, it needs to keep adding to the number of qualified caregivers – just at an even faster rate than at present. That won’t be easy considering that the current rate is well above the overall average, but unless that rate is maintained, demand will exceed supply and then there really will be a home care crisis. Here, perhaps, is the epitome of being a victim of one’s success.
By Jackie Birmingham, RN, MS, vice president, emeritus, of clinical leadership, Curaspan.
The Affordable Care Act calls for provider quality to be publicly reported and widely shared. As a result, the Centers for Medicare and Medicaid Services (CMS) extended star ratings to home health agencies (HHAs) on Home Health Compare (HHC) in 2015 to provide home health care beneficiaries with a summary quality measure in an accessible format.
By supporting consumer choice and encouraging provider quality improvement, public reporting will remain a pillar for improving healthcare quality. Currently, CMS reports 27 process, outcome and patient experience of care quality measures on the HHC website to equip patients and their families with the right tools to make choices about home healthcare.
Calculating the Two Types of Star Ratings
1) The Quality of Patient Care Star Rating – This rating probes nine specific evidence-based process and outcomes measures for each home health agency such as timely initiation of care, improvement in patients’ functional status and hospital readmissions. The measures are calculated into a composite score and star rating, which are typically calculated on a quarterly basis and include:
CMS rankings of all HHA providers reporting which is then divided into 10 ranked deciles for each measure.
Each HHA receives a score (.5 to 5) based on its ranked decile.
Each score is compared to a national agency average on that measure, and if there is a statistical difference, the score will be adjusted.
For each agency, adjusted scores are averaged to reach a composite score which are then translated into stars.
2) Patient Survey Star Ratings –These ratings incorporate the patient experience of care measures based on Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS). These surveys reflect patients’ views on a variety of issues including whether the staff checked patients’ prescriptions for side-effects and properly explained dosing instructions.
Errors in medical billing are a serious problem in healthcare today. By some estimates, as many as 80 percent of all submitted bills contain some sort of error, which leads to increased costs for Medicare, insurance carriers and patients, but can also lead to coverage denials, reduced reimbursements for providers, and in some cases, impacts on patient care.
While many organizations have placed a priority on avoiding billing errors, they still occur. And with the upcoming transition to ICD-10, home health and hospice providers are under even more pressure to get billing right the first time, every time. By most accounts, providers can expect to see a spike in rejected claims during the first few months of ICD-10 implementation; some estimate that as many as 10 percent of all claims will be rejected as coders get used to the new procedures. That’s bound to have an effect on payments and cash flow, so it’s vital that agencies work with their billing offices to identify common errors now, and look for ways to overcome them.
Preparing for the Transition
Ideally, home health agencies should be in the final stages of preparing for the launch of ICD-10 now. August 3 marked the beginning of the 60-day episode period that would end on October 1, when ICD-10 goes into effect. This means that agencies that are beginning care episodes now are required to submit RAPs in ICD-9, but code them in both ICD-9 and ICD-10, so that when the final bill is submitted to Medicare, it will be in the correct format. In many ways, this gives home health providers an advantage, since they will have two months’ worth of practice with the new codes on almost every chart, where most other providers are only practicing dual coding on some charts.
Because of the dual coding requirements, most home health providers have already switched to an ICD-10 compliant software solution. Now is the time to identify gaps in training, and adjust intake procedures, forms and other resources that affect how services are billed. Mitigating potential obstacles now will prevent denied claims later, and smooth the transition.
The Most Common Errors
While the new coding procedures will undoubtedly be a learning curve for many providers, you can reduce the overall number of denied or delayed claims by paying close attention to the most common errors and taking steps to avoid them. These include:
Guest post by John Olajide, president and CEO, Axxess.
The home health delivery model has become more prevalent in recent years as a cost-effective, patient-preferred alternative to traditional hospital and skilled nursing settings. Approximately 12 million U.S. individuals receive care from more than 33,000 agencies for acute illness, long-term health conditions, permanent disability, or terminal illness — according to a survey by the National Association for Home Care & Hospice (NAHCH).
Demand for home health services is seeing an increase as more baby boomers turn 65 daily and choose to receive their health care services at home. Recent surveys of older adults are showing a preference to receive healthcare in the dignity and comfort of their homes. As an example, surveys by the American Association of Retired Persons (AARP) consistently show that over 80 percent of older adults want to remain in their homes and communities throughout their lives. Several surveys show the same trend in the wider patient populations; and technology innovations are making it possible to deliver quality healthcare services to patients at home.
While the increased awareness in and recent growth of the home healthcare sector is promising for home health agencies, critical to their success is the adoption and integration of the right cloud-based technology to increase operational efficiency, ensure compliance with stringent regulatory requirements and improve patient outcomes.
Technology can also assist in preventing home healthcare fraud. While fraud can occur in all sectors of healthcare, home health is unique in that the caregiver visits the patient in the home. A common example of fraud in home health is when a caregiver submits documentation for visits that were not made and the home health organization, in turn, submits claims to insurance providers for such services without obtaining proof that such service was actually rendered. Home health agencies would be wise to protect themselves from the possibility of this type of fraudulent activity by a disreputable employee.