Data can be helpful, but frustrating as well

Prioritize analysis to focus on problems

If information is power, and data are information, then home health managers may be the most powerful people in the world. Or should we say, home health managers are the most overwhelmed people in the world?

One way to transform yourself from overwhelmed to powerful is to understand the data available to you and prioritize the information you need to evaluate and successfully manage your agency, according to experts interviewed by Hospital Home Health.

"There are several core, key indicators from a home health Medicare perspective," says Mark Sharp, CPA, senior managing consultant at BKD, a Springfield, MO-based accounting and consulting firm. By focusing on these key indicators, a manager can identify opportunities for improvement, he adds.

"The first key indicator is the case-mix weight," says Pamela Teenier, RN, BSN, MBA, CHCE, director of Medicare operations for Gentiva Health System in Corpus Christi, TX. Because the case-mix weight is composed of 23 different elements, it is important to look at each element to see if your agency falls above or below the average, she says.

Getting down to the element is important because you can’t just tell your staff members they need to improve the case-mix weight, Teenier says. For example, if your agency is below the benchmark for vision, be sure the vision assessment question is filled out appropriately, she explains.

Another reason to look at specific elements is the fact that a case-mix weight for therapy might be high for your agency due to the type of patients you have, says Teenier. A high therapy score might make your overall case-mix weight appear to be on target, but the one high score masks low scores in other areas, she explains.

"It’s also important to look at your reimbursement per episode," Sharp points out. While cost per visit is the standard unit of service used by most agencies, it is more important to look at the whole episode. Although you need to know the cost per visit to estimate the cost per episode at the start of care, care plans are designed to cover entire episodes, he adds.

If you evaluate your profit-or-loss margin on an episodic basis, you can better identify case management practices that will improve productivity of your staff, Sharp says. For example, between visits, a therapist can call patients to remind them to do the prescribed exercises each day, he suggests. "This reminder may speed up the patients’ recovery and get them discharged earlier."

Teenier also advocates a close look at utilization management. If your agency’s number of visits per episode exceeds the benchmark level, there are several steps to take, she suggests.

"Evaluate telemedicine as one way to decrease visits without compromising outcomes," she says. Another tactic to monitoring utilization management is to put an internal authorization process into place, Teenier recommends.

This approach requires a field staff member to get authorization from a supervisor to add extra visits to the number of visits identified in the initial care plan, she explains. While extra visits will be approved if necessary, the need to get authorization and provide an explanation of the need usually makes nurses evaluate case management methods up front, Teenier adds.

Are your adjustments high?

Adjustments, such as low utilization payment adjustments (LUPA), should be monitored carefully, Teenier explains. If a published benchmark for LUPAs is 10% and your agency has more than 10%, you are providing care in fewer visits than other agencies. "If this is the case, you might claim to have a stellar staff, but you need to consider other reasons as well," she says.

Another area that causes a significant adjustment is when a patient meets the high therapy threshold, which is 10 or more physical, occupational, or speech therapy visits, and for various reasons, 10 or move visits were not provided, Teenier says. Avoid therapy downcoding by making sure you do not predict more visits than needed at the beginning of the episode, she suggests.

Even if your agency has few LUPAs, be sure the episodes that include only five or six visits are legitimate, Teenier warns. With the LUPA threshold at four visits, the Centers for Medicare & Medicaid Services will look at episodes with only one or two visits over the LUPA threshold. "Make sure that those visits are not added just to avoid a LUPA," she adds.

Software and national benchmark companies can provide the benchmark information you can use to evaluate your data, says Sharp. You can also use Medicare’s annual cost report to gather benchmark data.

"You can find benchmark information in a number of publications, at conferences and seminars or through state associations," says Teenier. Even if you are a small agency without the budget to subscribe to ongoing benchmarking services, it is important to evaluate your information regularly against some industry benchmarks, she adds.

If you use the annual Medicare cost report to provide your benchmarks, don’t evaluate your information only once each year, points out Sharp. By the time the annual cost report is produced, the information included may be as old as 18 months, he explains. "Looking at information once each year, using old data, is not timely enough to make changes that are effective." For this reason, evaluate your data at least monthly or quarterly, he suggests.

Smaller agencies may not accumulate enough data to produce accurate results on a monthly basis, but quarterly reviews of the data are essential for any size agency, Teenier notes.

Whatever time frame you use to perform your evaluation, be sure to prioritize the data you analyze, says Sharp. "Start at the highest level of data, focusing on the few key indicators that can affect performance, then dig further when those indicators are out of whack." By focusing on indicators that don’t meet benchmark parameters, you can use your time more effectively, he adds.

Teenier also points out that home health managers need to realize that the volumes of data reports won’t identify the solutions but will identify the areas in which opportunities for improvement exist.

She admits data can be frustrating because "data don’t provide answers; they just raise more questions."

[For more information about data management in home health, contact:

Mark Sharp, CPA, Senior Management Consultant, Hammons Tower, 901 E. St. Louis St., Suite 1000, P.O. Box 1190, Springfield, MO 65801-1190. Phone: (417) 865-8701. Fax: (417) 865-0682. E-mail:

Pamela Teenier, RN, BSN, MBA, CHCE, Director of Medicare Operations, Gentiva Health System, 13806 Debloom St., Corpus Christi, TX 78418. Phone: (361) 949-0399. Fax: (913) 814-5501. E-mail:]