Case Study Mary Jones is the health information supervisor atSomewhere Home Care, which is Medicare-certified. As required byMedicare, her agency and staff members have been completing andsubmitting OASIS-C1 data. The staff has been accessing patient datathrough the OASIS-C1 reports, as well as monitoring and documentingvisit patterns and frequency by the agency. In addition, thepersonnel have been monitoring the cost of supplies utilized perpatient. In reviewing the financial data, Mary’s director hasindicated that the agency has performed marginally under theMedicare prospective payment system. The staff would like toimprove financial performance, and has met with the leadership teamof the agency to discuss a possible plan of action. Although someinsurers still pay by the visit, Medicare patients are the largestgroup in the agency’s payer mix, and Medicare pays a set amount ofmoney for providing care over a 60-day period rather than aper-visit fee. Mary has some statistics available to her to assistthe director with formulating a plan. These include: The number ofpatients the agency has had in each HHRG classification over thepast 3 years The number of visits (by clinician type; i.e., RN,LPN, HHA, PT, OT, SLP) made to each patient for each 60-day episodeof care The average number of visits to patients in each HHRGclassification Financial data, including reimbursement amounts foreach HHRG and the agencyspecific costs per each type of visitPrimary diagnosis for each patient OASIS C1 outcome reports printedfor OBQI/OBQM, showing how the agency has performed in outcomes,compared to other agencies in the country Payer mix report, showingthe percentage of patients the agency has in each payer source(i.e., Medicare, Medicaid, commercial insurance, private pay,etc.). At Somewhere Home Care, 65% of the patients are covered byMedicare.
Investigation into care plans and visit patterns indicate widefluctuation in visit patterns among clinicians. Patients within thesame HHRG category—who basically should be similar—have widelyvarying visit ranges.
Read the case study in this chapter and answer the followingadditional questions in two to three sentences.
Are there any new trends in home health that the director shouldconsider?
