Home Health Care

The preferred option for seniors and their families who choose the convenience of quality health care at home.

Next for VBP: Urinary Tract Infections

heidi Home Health Care, Resources for Physicians Comments Off on Next for VBP: Urinary Tract Infections

 

Efficiency scoring measures will directly affect CMS reimbursement per DRG in a formulary scoring model.

Efficiency scoring measures will directly affect CMS reimbursement per DRG in a formulary scoring model.

Outcomes for urinary tract infections targeted by CMS are based on spending.

Urinary tract infections accounted for 56,900 readmissions of Medicare beneficiaries within 30 days of hospital discharge, analysts with the Healthcare Cost and Utilization Project determined recently, which ranks UTIs No. 6 in hospital readmissions for this population. Urinary Tract Infections Outcomes to be measured under VBP

In FY 2016, CMS will expand the number of infection measures under the outcomes domain, including two for surgical site infections and one for catheter-associated urinary tract infections.

The biggest changes for Hospitals in FY 2015, Efficiency Scoring:

*Spending per beneficiary, a care efficiency metric that will measure all part A and B spending in a patient encounter from 3 days post- admission to 30 days post-discharge, including care delivered in the post-acute arena.

*These efficiency scoring measures will directly affect CMS reimbursement per DRG in a formulary scoring model.

Your Patients Are At Risk

People shouldn’t die from a UTI, but if sepsis begins to take over and develops to severe sepsis and then to septic shock, this is exactly what can happen.

*Approximately 20 percent of hospital-acquired bacteremias arise from the urinary tract, and the mortality associated with this condition is about 10 percent.

• More than half the cases of urosepsis among older adults are caused by a UTI.

• Worldwide, one-third of people who develop sepsis die.

• Many patients who do survive are left with organ dysfunction and/or amputations.

How Home Health Can Help

Home health care services provide transitional care and overall care coordination for at-risk patients with chronic conditions such as urinary tract infections to reduce emergency care and improve outcomes.


Medicare Advantage Plans Overcharge for Home Visits

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Medicare made nearly $70 billion in “improper” payments to Medicare Advantage plans from 2008 through 2013, an investigation found.

Medicare made nearly $70 billion in “improper” payments to Medicare Advantage plans from 2008 through 2013, an investigation found.

Home Health Care News reports:

Health plans are cashing in on home visits, taking advantage of Medicare profits when the house calls unearth patients’ medical problems, according to a report by The Center for Public Integrity, a nonprofit investigative news organization in Washington, D.C., reports Home Health Care News.

Some senior citizens are finding that their Medicare Advantage health plans were eager to send a doctor to visit them at home, a service that is part of a burgeoning medical information and data analysis industry that’s thriving behind the scenes. Health plans profit because Medicare pays them higher rates for sicker patients, using a billing formula known as a “risk score,” The Center for Public Integrity reports.

Medicare made nearly $70 billion in “improper” payments to Medicare Advantage plans from 2008 through 2013, “mostly overbillings based on inflated risk scores,” the investigation shows.

Doctors and nurses who visit patients’ homes don’t offer any treatment during their visits, but report their findings to primary care physicians. And when a home visit uncovers a medical condition, health plans may raise a person’s risk score and cash in on thousands of dollars in added Medicare revenue, even if they don’t incur additional expenses when treating the patient. More than 70 health conditions may push up the risk scores, and thus the payments made by Medicare.  Read more


Paramedics Deliver Home Health Care Under Pilot Program

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The paramedic's role will evolve to someone who responds to emergency situations, as well as helps prevent them.

The paramedic’s role will evolve to someone who responds to emergency situations, as well as helps prevent them.

In a fundamental shift in how emergency medical services are delivered, several Massachusetts ambulance companies are branching into home health care, reports The Boston Globe.

Rather than just responding to emergencies and sending patients to emergency rooms, paramedics  – as part of a pilot program – are treating patients where they live.

The idea is to expand the paramedic’s role to a provider who not only responds to emergencies but also helps prevent them, treating patients with infections, minor wounds, injuries from falls, and problems associated with chronic diseases like diabetes and congestive heart failure. It could reduce unnecessary emergency room visits and hospital stays, which can cost thousands of dollars, according to The Boston Globe. Read more