Home Health Agencies across the country face continuing payment cuts in all aspects of their payer mix.  Medicare, Medicare Advantage, Medicaid and commercial payers continue to cut rates and in the case of payers that require reauthorization, a decrease in the number of visits they will approve.  Many agencies have taken on the mentality that we will do what we have to do to survive “today”!  This thought process has them in a situation where they are ignoring the reality that lies before them.

Home Health Compare, Quality of Care Star RatingsValue Based Purchasing, Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) are all part of the push toward Paying for Quality of Care in the home health setting.  In addition to these programs primarily affecting Traditional Medicare episodes, there has been more and more evidence that these outcomes can be used against you in other payers.  For example, payers that are reducing the amounts that they will pay you for home health if the agency’s Quality of Care Star Ratings is less than 5 Stars!

Ignoring the situation will not make it go away!  Believing that I will just take what I get paid and survive is not going to work!  Agencies must make a concerted effort to ensure that they are getting paid all that they can and they are moving toward the best quality of care.  The majority of home health agencies in the country are providing amazing Quality of Care to patients!  No one would dispute that, but documentation of that patient care does not support that quality of care and outcomes are being achieved.

So if you choose not to ignore the situation, what do you do?  Agencies need to develop a strategy of facing this current state of home health head on.  That strategy must include putting together a team to assess the situation that you currently find yourself in and develop a pointed plan to get you to where you need to be.

The following are some steps to take in the process of developing your own strategic plan:

  1. Owners/Leadership/Upper Management must spearhead the culture change in the agency toward Quality Care.
  2. The team needs to consist of individuals that are committed to the agency and to the team and are ready to move forward and make the agency the best it can be.
      a. The team needs to consist of individuals that are committed to the agency and to the team and are ready to move forward and make the agency the best it can be.
  3. Everyone in the agency must take ownership and be prepared and anxious to move forward toward the change to a Culture of Quality.
      a. Staff members that are not on board with change will have to be dealt with, even if that means they no longer work there.
  4. Agencies must establish: Where you are Today and Where you need to GO! In that process, you will discover the deficits or gaps that exist that must be corrected/bridged.

For agencies that are not in the nine states, currently subject to the Value-Based Purchasing Pilot, do not think that you are not affected. The Quality of Care and HHCAHP Star Ratings are already causing reimbursement issues, as stated above and that will only continue and the number of payers will increase that are applying that course of action.

Over the next few weeks this blog will continue with more insightful thought about steps to take in making sure that your agency is moving in the right direction.