Preventable Hospitalizations Down Among American Seniors

According to a new report by the United Health Foundation on the state of seniors’ health, preventable hospitalizations have dropped. The third edition of its annual America’s Health Rankings Senior Report show “encouraging news for senior health nationally,” but also indicates the setbacks seniors have faced compared to previous years.

Among the major gains is a 6.8 percent reduction in preventable hospitalizations, a measure that’s also dropped 11 percent since 2013. Reasons for the reduced hospital admissions and readmissions include the push for better population health management and the shift from fee-for-service model to value-based payments.

The report also found a 9.3 percent increase in the number of home health workers year over year, and a 38 percent increase in seniors who choose hospice care at the end of their lives. These findings are supported by a recent report that indicated nursing homes may replace hospitals as the major providers of senior care – a trend that is fueled by the increased interest in palliative care.

Click here to see the report.

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OSHA Revises Guidelines For Preventing Workplace Violence

The Department of Labor, Occupation Safety and Health Administration (OSHA) has issued a revised version of their Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers. It has been updated from OSHA’s 1996 and 2004 voluntary guidelines.

The new guidelines state that healthcare and social service workers face a significant risk of job-related violence. The Bureau of Labor Statistics (BLS) show that 27 out of 100 fatalities in healthcare and social service settings that occurred in 2013 were due to assaults and violent acts. Between 2011 and 2013, workplace assaults ranged from 23,540 and 25,630 annually, with 70 to 74% occurring in healthcare and social service settings.

The new guidelines are based on industry best practices and feedback from stakeholders, and provide recommendations for developing policies and procedures to eliminate or reduce workplace violence in a range of settings.

Click here to see OSHA’s revised guidelines.

Click here for more info on preventing workplace violence.

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CMS Clarifies Ordering & Certifying Documentation Requests

CMS has issued Change Request (CR) 9114 that provides instructions and clarification on their existing policy for ordering and certifying maintenance requirement.

In May 2010, CMS issued an interim final rule (CMS-6010-IR) and on April 27, 2012, a final rule (CMS-6010-F) which established Medicare Ordering and Referring, and Documentation Maintenance Requirements.

CMS required that any provider and supplier that furnishes covered home health services, items of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), clinical laboratory, or imaging services, is required to maintain documentation for 7 years from the date of service, and that the provider give access to that documentation upon request. This requirement also applied to a physician ordering/certifying home health services, items of DMEPOS, clinical laboratory, or imaging services.

In the CR, CMS clarifies the term “access to documentation” to mean that the documentation is actually provided or made available in a the manner requested by CMS or a Medicare contractor. CMS provides examples of sufficient and deficient access to documentation in the CR.

Click here to view the CR.

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Tiptastic Tuesday: CMS Issues Urgent Announcement Regarding The HHPPS Grouper

Last week, CMS was notified by jHAVEN and ASAP that certain HIPPS scores being generated within the ASAP were incorrect. The contractor, 3M, analyzed the issue and discovered that certain changes were necessary to ensure proper scoring for XML users. Flat file users do not have to download the corrected grouper. Testing has been completed with a new grouper released on the CMS website. Providers that utilize an XML formal must upload a new grouper. The file is posted on the CMS website. Click here to see it.

2015 OIG Work Plan Highlights: Home Health Services

HMS recently blogged about the 2015 Office of Inspector General (OIG) Work Plan. The 2015 Work Plan covers a broad range of topics related to CMS programs, organized by provider type. Here are some highlights from the home health services section:

The OIG will review compliance and various aspects of the home health prospective payment system (HHPPS), including the documentation required in support of the claims paid by Medicare. The OIG will determine if claims were paid in accordance with federal laws and regulations. The OIG notes that that a pior report found that one in four home health agencies had questionable billing. Due to their record of fraud, waste, and abuse, the OIG has designated newly enrolled home health agencies as high-risk providers.

The OIG will also examine records of home health agencies that employ individuals with criminal convictions. Most states have laws prohibiting healthcare entities, including home health agencies, from employing certain individuals with certain types of criminal convictions.

Click here to see the plan.

Tiptastic Tuesday: When Should Home Health Agencies Begin To Use The OASIS-C1/ICD-9 Data Set?

We have recently received information from the National Association for Home Care & Hospice regarding the use of the OASIS-C1/ICD-9 data set. The M0090 date for all assessments (SOC, ROC, Recertification, Other Follow-Up, Transfer, Death at Home and Discharge) determines which version of OASIS must be completed.

If the M0090, Date Assessment Completed is 12/31/2014 or before, use the OASIS-C data set. If the M0090, Date Assessment Completed is 01/01/2015 or after, use the OASIS-C1/ICD-9 data set.

Note:  If an assessment is completed on or before 12/31/2014, utilizing the OASIS-C data set and the assessing clinician chooses to reassess one or more OASIS items on or after 01/01/2015 during the allowed timeframe for data collection (for example: within 5 days after the SOC, within 2 days of the ROC or DC), this would change the M0090 date and the OASIS-C1/ICD-9 data set must be completed instead of the OASIS-C.