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HOME HEALTH & HOSPICE SURVIVAL TEST
October 22 2015Carevoyant Users Conference
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AGENDAPurposeSpeaker BackgroundEnvironmental Context4 Survival Test questions
Home Health Hospice
Implications/Conclusions
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PURPOSEUnderstand how the healthcare delivery
landscape is changing for home health and hospice
Provide a self-assessment tool for organizations to gauge the prospects for future success in home health and hospice
Outline next steps for organizations based on results of tool
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SPEAKER BACKGROUNDOver 20 years in home care35 years of experience in planning and
marketingMBA from the Sloan School of Massachusetts
Institute of TechnologyPresident, Healthcare Market Resources,
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HEALTHCARE MARKET RESOURCES Leading market research firm serving post-
acuteHelps home health agencies, hospices and
SNF’s better understand their market, competitors and referral sources
Clients use our data in strategic/market planning, benchmarking, sales targeting and key account developmentReferral data on hospital, SNF’s and MD’s
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CHANGING LANDSCAPEReduced margins
RebasingCase mix creep adjustmentDifferentiated reimbursementShift to “managed care”Sequestration
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CHANGING LANDSCAPEPay for Value, not Volume
Demonstration projectsAccountable Care Organizations-Population
Health Management“Capitation” thru voluntary and mandatory
bundled paymentsPerformance Incentives/Penalties
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CHANGING LANDSCAPENarrowing provider referral lists
HospitalsSNF’sPhysicians
More data transparency & differentiationRe-admission ratesSTAR ratings
Increased regulatory scrutinyDrive unnecessary care and costs out of
system
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FOUR QUESTIONSOrganic Growth
Post-Acute Networks
Reimbursement Impact
Efficiency
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QUESTION 1 HOME HEALTHCan we grow organically?
How mature is my market?How concentrated is my market?Is there an opportunity to shift post-acute site
of care mix?Can we increase revenue per patient-less
LUPA’s, higher case weight & more re-certs
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QUESTION 1 HOSPICECan we grow organically?
How mature is my market?How concentrated is my market?What is median LOS for my market?What is my market’s non-cancer mix?What is my market’s site of care mix?What is utilization amongst underserved
population?Can my hospice use palliative care to capture
patients earlier in the disease process?What is managed care penetration?
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QUESTION 2 HOME HEALTHWhat is my role within post-acute networks?
How big is the post-acute market?How dominant are captive agencies at their own
facilities?How will proposed bundle payments for joint
replacements affect referral patterns in my market and at specific local hospitals?
How does your organization compare to its competitors to be asked to join these network(s)?
Will hospitals monitor referrals of owned MD’s?
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QUESTION 2 HOSPICEWhat is my role within post-acute networks?
How big is the post-acute market?How dominant are captive agencies at their
own facilities?Where do the hospitals in your market stand on
bundled payments, ACO’s & value-based purchasing metrics-mortality rates, re-admission rates and per beneficiary spending?
Is there inpatient & palliative care capacity to limit end of life expenditures?
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QUESTION 3 HOME HEALTHWhat is impact of reimbursement changes on
my agency, market and competitors?Shift in weighting for therapy casesDual eligible demonstration projectLimits on re-cert ratesCost re-basing & sequestrationIMPACT ActValue-based purchasing for Home HealthICD-10 Coding Transition
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QUESTION 3 HOSPICEWhat is impact of reimbursement changes on
hospice?Two tiered rates beginning 1/1/2016 under and over
60 days for routine home care(RHC)Added reimbursement in last 7 days for professional
visits to RHC patientsCompare LOS mix versus competitors to estimate
impact Hospices over the cap most affected(-5.4%) margins ;
current profits could be being re-directed to prior yr repayment plans.
MedPAC recommendation to move hospice to managed care
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QUESTION 4 HOME HEALTHIs your agency cost efficient?
Does it benchmark performance against local competitors?
Does it optimize visit levels by HHRG by disciplineDoes it analyze why LUPA’s occurred?Does it have practices in place to optimize episode
management Frontloading chronic disease, joint replacement and
surgical aftercare patients Appropriate use of nursing in therapy cases? Evaluation of therapy need based on clinical triggers
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QUESTION 4 HOSPICEIs your hospice cost efficient?
Compare visit levels per patient per week by discipline to competitors
New quality measure as visits in 2 days prior to death
Visits correlate to patient satisfaction levels, particularly near end-of-life(EOL)
Preponderance of short-stay patients
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IMPLICATIONSNeed to get a passing score(3 out of 4) to
have a chance to survive long termCannot rest on laurels; bar will get higherFailing scores seriously need to consider
HARD optionsMergerSalePhase-out
Passing scores or the prospect of one means you need to making changes NOW
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CONCLUSIONSValue-based purchasing is here to stay across ALL
segmentsHospitals will dominate post-acute landscapeMD’s and insurers will focus on pre-acute or
community-based referralsREFERRAL LISTS WILL SHORTENHospices and HH agencies will need to
differentiate themselves with outcomes/dataLow barriers to entry will prompt large post-acute
providers and short-term acute hospitals to add captive HH and hospice capacity
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FREE OFFERStart the process by answering Question 1 or
4Need to understand the maturity of your
market by understanding utilization level of home health and/or hospice
Need to understand if appropriate visit level are bing performed by HHRG
Hand business card and indicate on the back as to which report you want
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MARKET DECISIONS BASED ON DATA, NOT PERCEPTIONS
CONTACT INFORMATIONRich ChesneyPresident, Healthcare Market Resources1133 Dundee Drive, Ste. 100, Dresher, PA [email protected]