Healthcare Provider Solutions



This Monday Minute provides thoughts about the potential impact of the proposed case-mix weight changes on overall reimbursement in 2022.

Hello everyone, and welcome to our Monday Minute. Today I’d like to talk with you about a significant change that has occurred in the Home Health Proposed Rule. And if finalized will be a very significant change that I fear many have overlooked or might have minimized the impact that this change could have on home health reimbursement in 2022. I have a couple of screens that I want to share with you today. The first screen you see outlines the changes in the increase and decrease in Case-Mix Weights with 223 HIPPS codes having an increase in Case-Mix Weight, with the average increase being 4.6%. The largest increase with the HIPPS code you see on the screen, a 20% increase.  209 HIPPS codes will have a decrease in Case-Mix Weight with that average decrease being 4.9%. The greatest decrease being the HIPPS code you see on the screen, with that decrease being 22.57%. I have taken those two HIPPS codes with the Orange County Florida CBSA code, and as you can see that change is going to cause about a $600 difference in reimbursement with the increased one, the highest increase one, and the biggest decrease about a $200 dip in reimbursement.

These are the 12 clinical groupings as you see on the screen.  Each of them has 36 HIPPS code possibilities, that would go into the calculation of the eventual HIPPS code. Each of these 36, as you can see, outlined whether they will increase or decrease in Case-Mix Weight based on that Proposed Rule. Wounds being the highest, with surgical aftercare, and endocrine actually has 29 categories that will increase with 7 decreases. Then we have musculoskeletal rehab, behavioral health and MMTA – GI/GU, which will each see 18 of their categories increase and 18 of their categories decrease.

What I want to make sure everyone is clear about, is that as this transition occurs you have probably heard and as we said in a Monday Minute earlier, the base rate is going to increase for next year. Many, have in the past, relied on the fact that the increase in base rate has to mean an increase in payment. The reality is the wage indexes also are looked at every year.  In most years wage indexes will all change, some increase some decrease. In addition to the wage index and base rate changes this year, as you just saw, significant changes in Case-Mix Weight, and on top of that many of the aspects of the building of the PDGM HIPPS code are also changing, including the points that go into the calculation of the functional score, which is a very significant piece of the HIPPS code. So again, my concern is that you look at the base rate, you see the base rate is going to increase and you don’t take into account all the many aspects of the HIPPS code, leading to the Case-Mix Weight that are being made in this proposed rule. And so you have to look at it as an entire picture. Hopefully, as you begin budgeting for 2022, you have someone that digs really deep into these calculations and if nothing else, looks at your top 15 or 20 HIPPS codes from last year and exactly how all these changes would impact those HIPPS codes and give you, what we hope to be a realistic outcome, as a result of those calculations.

I want to thank you for participating today. Thank you as always for being on the front line and taking care of patients during this public health emergency. I have so enjoyed seeing many of you in conferences this summer. And hope to see a large majority of you at the October NAHC conference in just a few weeks. Thanks and have a great week.