The Final Rule was released on November 1, rushing in like our current winter season- some like snow some do not! Whatever your preference this will have a lasting impact in our beloved industry, and for many, reduce patient access to care at home.
In summary, the CMS rule will provide a 0.8% increase in payment. However, deep cuts are hidden in the details. On top of the permanent rate cut in 2023 of 3.95% CMS added another reduction of 2.89% for prospective payment adjustments. When combined; the total payment increase is only 0.8% as the adjustment is not applied to the LUPAS.
CMS published a fact sheet where they describe the reasons for the prospective payment adjustments (2.890%), as a result off assumed behaviour changes and PDGM implementation. The final rule has added changes to the PDGM case mix weights and LUPA thresholds. CMS now requires Home Health agencies to meet or exceed 90% for all required OASIS submissions.
Changes to clinical groupings is seeing an overall decrease in 7/13 measures ranging from 0.2%-1.9% with the greatest decrease being in the MS rehab grouping. HHRG scores saw a majority decrease ranging from 0%-5% with only 12 measures seeing the greater than 5%.
The rule describes the CME perception that huge profits are being made at the expense of patient care. Agencies are struggling to recruit and retain staff and the cost of expenses continue to rise to meet market demands. In addition, agencies are going to need to be ready for proposed payment reductions based on their perfomance.
CMS has revised the baseline year being used to determine payments as 2023 from 2022.
Takeaways from the rule
- PDGM recalibrations of case mix weights
- Payment increase of 0.8%
- Revision of VBP measures to start in 2025 CY
- Change to VBP baseline year to 2023 CY for performance year 2025 CY.
CMS has targetted adding new elements for future initiatives
- cognitive functioning and behavioral health
- performance measures focused on stabilization and maintenance in chronic diseases
- social risk factor assessment
- focus on COPD patients
- monitoring of utilization of Home Health aides
Key reminders from the 2023 Final Rule
OASIS for ALL payers will begin January 2025
Reporting purposes will utilize all data starting July 2025.
As care delivered in the home is the future of healthcare and agencies operate on a fixed income they are being asked to do more with less. Excellence in staffing management, document oversight and review will all be key factors in an agencies survival.
For more information on our services, reach out to us today and discover how we can assist you on your health journey.