Robust Technology Platforms and Medicare Home Health Providers | Healthcare and Technology news | Scoop.it

The home care industry, in its various forms, represents an $82 billion market with a population of potential customers that is growing by the minute. In fact, within the next five years, 20 percent of Americans will be eligible for Medicare services and many of them will avail themselves of home health services that will be funded by Medicare. Last month, the Centers for Medicare and Medicaid Services (CMS) released the 2015 Home Health Final Rule (Final Rule), which sets forth the details of the second year of payment rebasing under the Patient Protection and Affordable Care Act (ACA) together with other new rules, clarifications of previous rules and discussions of things to come. CMS makes it clear that its goal is to more closely align payment for services with the cost of providing them.

Interestingly, while physicians and hospitals were included in CMS’ meaningful use EHR Incentive Programs that began in 2011, home care providers were excluded from incentive opportunities. However, even in the absence of financial incentives for technology adoption, implementation of robust technology platforms capable of gathering, organizing, processing and protecting patient health and financial information is still crucial. Consider the following top five reasons for why technology adoption is not optional for Medicare certified home health providers.

  • First, there are 1,836 potential Health Insurance Prospective Payment System (HIPPS) Codes that form the basis for Medicare home health reimbursement. There are 3,273 counties represented for which an applicable wage index has been established for purposes of calculating reimbursement. That yields a potential universe of payment values in excess of $6 million.
  • Second, even the most straightforward of the episode payment calculations has at least three steps and the most cumbersome, outlier calculations, has over a dozen. Imagine trying to manually arrive at accurate calculations for each episode.
  • Third, newly proposed Medicare Conditions of Participation place increasing emphasis on the quality and coordination of patient care supported by detailed clinical records. Significant survey emphasis for home health providers is now being placed on reconciliation of medications as well as the adequacy of other clinical documentation. Technology greatly assists in creating efficient ways of achieving the desired end result of coordinated, cohesive and locatable clinical documentation.
  • Fourth, in order to justify payment, home health agencies must be able to schedule visits based on physician ordered care plans, record when visits are made or missed, and aggregate visit notes that are responsive, in the main, to ordered interventions. And, not incidentally, visit times must be translated into unit-based increments for claim submission purposes.
  • Finally, as the 2015 Final Rule demonstrates, the calculation rules and values change every year.

The operational needs and payment changes put into place for home health agencies are significant and have far reaching implications not only for agencies, but also for the whole industry. As the importance of post-acute care modalities grows in a countrywide effort to regulate costs and improve health outcomes, strong home health providers will play a key role in our general success in this area whether or not they are incentivized to adopt technology through meaningful use programs.

In order for home health agencies to continue building business momentum while ensuring top-quality care and health outcomes, they will need to be able to fully and quickly implement new regulations that change each year and adapt operational procedures correspondingly. Calculations, functions, decision support tools, up-to-the minute informational dashboards and reports will be a must for any home health provider that expects to thrive in what will be a very challenging and intricate operating environment. Fortunately, just as intricacy in processes will increase, there is also an increasing amount of cost-efficient and cloud-based technology alternatives available to providers to enable them to manage effectively the required details of providing home health services.