Top 5 Things to Consider in Preparation For 2023
Author: Harper Dion
Posted: January 3, 2023
With 2023 on the horizon, a plethora of changes are set to hit the post-acute landscape. A new payment rate update will increase in the aggregate by 0.7% for home health agencies (HHA’s)1. This increase in funding is reliant on agency compliance with updated documentation processes, which when formatted correctly, increases agency funding and success. Although these changes increase success within agencies, improper preparation can stagger revenue flows, decrease employee satisfaction, and negatively impact holistic agency productivity. Reviewing the CY2023 final rule from CMS1, we have found five things to watch out for in the coming year.
Home Health Value-Based Purchasing (HHVBP)
Value-based purchasing links provider payments to improved performance by healthcare agencies. An agency acting in accordance with the new policy will benefit from full funding from the updated payment rate. The updates to HHVBP have expanded its reach, mainly focusing on baseline year updates2. CMS added definitions for HHA baseline year and the model baseline year. The baseline year has been changed from CY2019 to CY2022, meaning 2023 is the first year where improper practices will be recorded and penalized2. CMS training in 2022 acts as a sort of test run. Agencies must fully implement CMS training and adhere to the standards, any lapse of performance will be subjected to budget cuts of up to 5% in CY2025. Implementing CMS training to understand adherence to HHVBP is the baseline, fulfilling these needs not only ensures an agency is providing excellent care, but also ensures avoidance of future budget cuts.
OASIS-E
Data collected for HHVBP adjustment happens through the Outcome and Assessment Information Set (OASIS). A new update to this set, OASIS-E, is also scheduled to begin in 20231. With 27 new items added, this is another area that requires operational excellence to enhance operations and outcomes. The new items come with a restructuring of the assessment. This structural update groups together similar areas, expanding the focus of data collection. Standardizing patient data elements, the updated model also adds new assessments for mental status, mood, and behavior. With data collection beginning on January 1, 2023, it is of utmost importance to be prepared. MHA recommends coordinating with your EMR vendor to familiarize staff regarding how the changes will be represented within your system. From there, a focus on training, featuring new items, result analysis, and care plan implementation are logical next steps. This update comes with a restructuring along with many new items, but with proper preparation, the model will record better data that can ultimately increase the quality of patient care and overall agency satisfaction.
LUPA Management
Another key area of adjustment lies within the Low Utilization Payment Adjustment (LUPA) threshold3. Failure to reach the LUPA threshold within billing has always been detrimental within post-acute and can be a major driving factor in reimbursement rates. CY2023 comes with a modified LUPA threshold, making it essential for your agency’s team to have up-to-date knowledge regarding the threshold. Consulting your EMR provider to understand the new rules, then assisting staff on thresholds and recalibrated case-mix weights is an essential step for success. Dedicating heavy consideration towards LUPA management is one of the most important steps to safeguard your revenue streams. An unprepared agency may face decreased reimbursement rates. Focusing on staff knowledge allows your agency to formulate a LUPA management plan. From there you can adhere to the threshold, ensuring revenue and reimbursement remains constant.
Centralization
With a vast array of administrative changes, employee burnout is not uncommon. As stated before, proper implementation will ultimately increase agency success and productivity; yet for caregivers, their passions lie within patient care. Countless hours spent on optimization of backend tasks and data collection will come with the risk of decreased satisfaction and eventual burnout. A key response to this issue is the centralization of back-office tasks. Dedicating focus towards removing unnecessary workflows will help streamline the essential backend tasks while increasing productivity and ensuring compliance with new legislation. A full centralization ensures professionals with paramount expertise in the backend dedicated to these tasks, allowing more time for caregivers to focus on care. In turn, every aspect of your agency will be prioritized on their area of focus. This crucial step will decrease burnout, while further optimizing holistic positive outcomes.
Automation
Once centralization has been established, a key turning point is the use of Robotic Process Automation (RPAs). Any task within an agency that happens routinely can be answered with efficient automation. RPA technology completes backend tasks on a regular schedule, without human error or burnout. Implementing this technology to deal with backend tasks not only fights burnout but gives more time for employees to familiarize and update processes in accordance with CY2023 rulings. Automation is an essential step in achieving operational excellence when adhering to previously mentioned areas of focus. A full implementation of backend RPA can optimize holistic agency performance, ensuring all processes are properly documented. For 2023, automation is one of the most essential pieces in an operation. Preparing your staff for final rule changes is an essential first step. You can then identify areas for RPA, move staff back to their areas of focus, and create a seamless backend operation.
Familiarizing your agency with LUPA management, HHVBP, and OASIS-E changes are essential to avoid budget cuts and drops in productivity. Centralizing processes, then embracing automation is the answer to current issues within the post-acute industry. With 2023 on the horizon now is the time to assess your agency and make sure you’re prepared. MHA can assist with a holistic assessment; our experts look at these areas and provide guidance so your agency can achieve unprecedented success even amid the upcoming changes. For more information, contact us at [email protected], or visit us at www.maxwellhca.com.
Resources:
1. “Expanded Home Health Value-Based Purchasing Model: CMS Innovation Center.” Innovation Center. Centers for Medicare and Medicaid Services, November 23, 2022. https://innovation.cms.gov/innovation-models/expanded-home-health-value-based-purchasing-model.
2. “Fact Sheet CY 2023 Home Health Prospective Payment System Rate Update and Home Infusion Therapy Services Requirements - Final Rule (CMS-1766-F).” CMS. Centers for Medicare and Medicaid Services, October 31, 2022. https://www.cms.gov/newsroom/fact-sheets/cy-2023-home-health-prospective-payment-system-rate-update-and-home-infusion-therapy-services-0.
3. “Outreach & Education.” CMS. Centers for Medicare and Medicaid, May 25, 2021. https://www.cms.gov/Outreach-and-Education/Outreach-and-Education.