Report Descriptions: Home Health

Home Health | Hospice | Skilled Nursing Facilities

Home Health Market Profiles Reports

Our geography-based Home Health Market Profiles work together to support strategic planning, operational benchmarking, marketing, and sales management activities at all levels.

Executive Summary – Home Health Description
Market Share Report Description
Visit Activity by Discipline Description
Revenue Impactors and Dual Eligibles Description
Agency Demographics Description
Primary Diagnosis Description
HHRG Domain Scoring Description
Referral Source/Discharge Disposition Description
Key Indicators by Diagnosis Description
Financial Analysis Description
HHRG Provider Analysis Description

Executive Summary – Home Health

This report makes analyzing your market specific data easier by listing the most important indicators from across the entire report all on one page. Starting with the regional summary metrics, you can quickly see where your organization stands out versus its peers. If the report raises an issue regarding your agency’s performance in one area, then dig deeper by accessing the corresponding report in this market’s report set. And if further investigation is warranted, look for insight at the county level, as well. To help focus your analysis, the Executive Summary provides data on your agency, your top three competitors, and market norms. In addition, a county level executive summary is also included with the same metrics and provider selection methodology as the regional summary.

Outlined below are the key metrics included in the Executive Summary:

  • Discharges
  • Episodes
  • Revenues
  • Full Episode Revenues
  • LUPA Episodes
  • Average Case Weight
  • Total Visits
  • Skilled Nursing Visits
  • Therapy Visits
  • Home Health Aide Visits
  • Therapy Full Episodes
  • High Acuity Full Episodes
  • Cardiac Discharges
  • Neurological Discharges
  • Injury/Fracture Discharges

Market Share Report

This report gives overall market share in terms of discharges, episodes and revenues. Users of this report quickly see how concentrated their market is, who is getting the financially attractive patients, and how entrenched the competition is. In our Market Share Report, we track episodes because they are the best measure of an agency’s size. We also track episodes per discharge as a key to profitability, because we know that multiple episodes allow for certain upfront costs, such as intake and business development, to be spread over a larger revenue base. We track episodes and revenues by quarter so trends in an agency’s market share—gains or losses—will be apparent. Also, seasonality is calculated into the metrics, so that it is possible to see if an agency’s pattern is unique or reflective of the overall market. With our measurements in hand, an agency could determine that the best way to improve profitability and gain market share is by concentrating on patients with chronic conditions.

Visit Activity by Discipline

This profile tracks home health visits per episode by discipline and total.  With the new Medicare reporting requirements, this report provides detailed information, that is key in assessing operational efficiency and comparing it to competitive benchmarks.  Enhanced information includes: the use of therapy aides instead of therapists.  Use of aides may mean a lower level of care.  Also, the codes distinguish whether the objective is maintenance or progressive.  On the nursing side, the nursing codes have been expanded from one code to four codes, thereby providing information regarding what the nurse tried to accomplish during the visit – evaluation, observation and assessment and patient/family education.  And, PT, OT, ST has been expanded from 3 codes to 10 codes to incorporate more visit detail.

Revenue Impactors and Dual Eligibles

This profile identifies which patients – by provider and by county – are Medicare Fee-for-Service (FFS) and which are Dual-Eligibles. The report shows how much activity—discharges, episodes and revenues — were for dual eligible patients. In addition, it shows the level of dual eligibles in each geography (county and region)and can help assess the viability of personal care services to this population.

Although historically not significant, this data becomes critical with the implementation of the Affordable Care Act’s Bundled Payments for Care Improvement Initiative (innovation.cms.gov), which impacts more than 450 health organizations across all 50 states and a projected 195,000 Medicare FFS patients. As these Medicare FFS patients move into managed care plans, knowing what portion of the patient base is impacted becomes critical in establishing revenue expectations . Additionally, this report provides insight into which managed care organizations now become critical for relationship-development.

Agency Demographics

This profile tracks patient market share by demographics, including ethnicity, gender, age and by ‘reason for Medicare.’ It may be helpful to obtain census information on the geography served and to compare the ethnic mix in the demographic data to that in the report with a view of identifying underserved populations. You can use the profile to spotlight patient categories by key demographics, such as gender and age, to determine how they link to resource level required. Younger patients and male patients, because of the likely presence of a caregiver, are less likely to need home health aide services.

Primary Diagnosis

This profile portrays market position, based on discharges, within widely accepted primary diagnostic groups. It can be used to uncover marketing opportunities and clinical practice improvements by primary diagnoses. A mix of within groups outside the norm can be the result of market targeting or poor coding practice. If an agency has clinical specialty programs, this should be reflected in the market share with an appropriate diagnosis grouping (related ICD-9 codes), if the program is carrying its marketing weight.

HHRG Domain Scoring

This report enables users to quickly see market share by patient mix across clinical, functional, and service domains by individual domain score. It categorizes Home Health Resource Group (HHRG) codes for each full episode by its clinical, functional and service domain score.. Agencies can tell if a competitor is focusing on a certain type of patient such as therapy patients. Also, agencies can tell if their patient population is clinically sicker or more functionally challenged by reviewing the portion of their full episodes that are weighted towards the higher clinical and/or functional scores. If the population is sicker or more limited, higher resource utilization and visit levels would result. This chart will also show if competitors are targeting post-acute rehab settings. And, the report highlights share of therapy cases and rehab setting referrals.

Referral Source/Discharge Disposition

This enhanced report details two different areas of interest – from where was the patient referred and where did they go upon discharge. The source of the referral information in the report can be very useful in understanding from where a competitor is getting business, while the discharge disposition information can be useful in determining levels of patient satisfaction (transfer to another agency), and other business opportunities (patients transferred to hospice versus patients expired on service). This information is now enhanced (at no additional cost) – rather than relying strictly on self-reported data which can be unreliable, we have changed the data source to utilize actual patient flow. There is a significantly higher level of accuracy as a result.  The data also incorporates a pre and post-acute element so you can determine at what point the patient initiated home health services and how much business came from hospitalizations and would be part of a post-acute network.  The referral data is based on type of facility and does not distinguish between local and more distant facilities that would have served the patient prior to home health or hospice. However, we find that more than 90% of activity is in the local geography.

Key Indicators by Diagnosis

This report is a further analysis of the Primary Diagnosis Report. With the Disease Grouping Analysis, the relative financial attractiveness of each segment can be seen. By portraying the key financial indicators for each disease segment, report users can determine the comparative performance on these indicators between diagnosis groups and judge their performance versus the competition and local market standards. This report, in conjunction with the Primary Diagnosis Report, can show how diagnosis mix is affecting key financial indicators.

Financial Analysis

This report presents an overall financial picture of the market and the competitors. You can make relative cost and profit comparisons among agencies. You can compare average visits per LUPA to local market standards. If visits per LUPA are high and there is a higher than normal percentage of LUPA episodes, then further investigation is warranted to determine if operational issues (delayed start-of-care and missed visits) are causing certain episodes to miss the full episode threshold.

HHRG Provider Analysis

This report analyzes all non-LUPA episodes that are billed by a HHRG code, and includes all outliers, PEPs and downcodes on the final claim for the episode. Users can see particular HHRG codes as a percentage of the total. Further, the report displays the average number of visits for each discipline, used in treating patients with that HHRG code. From that, the agency’s utilization of resources can be compared to the local market benchmarks.

Home Health Market Development Reports

Our Market Development Reports work together to help home health agencies develop a powerful territory sales strategy and prepare for sales calls to specific key accounts. The discharge reports help an agency determine their best prospects, and the DRG report helps you walk into your next sales hospital call with the details you need to demonstrate exactly how your agency can help. Each report is customized to your desired zip codes or institutions.

Medicare Hospitals Discharges Report Description
Medicare Skilled Nursing Discharges Report Description
Medicare Hospital Discharges by DRG Report Description
Hospital Readmission Report Description
Medicare Hospital Discharges to Nursing Homes Description
Medicare Enrollment Report Description
Medicare Skilled Nursing Facility Discharges to Hospitals Description

Medicare Hospital Discharges Report

This report details, by specific institution, information about Medicare patients who were discharged from that hospital and who reside in the geographic area studied. The report ranks in order the hospitals that have the most potential and warrant the higher levels of sales attention. Report users can compare average length of stay between similar hospitals and look for hospitals that seem to have longer lengths. This information can be the starting point for a discussion with hospital administration as to what they are doing to reduce length of stay and an offer by the agency to assist in that process. This report highlights a potential new source of referrals – hospitals that are servicing out-of-area residents.

Medicare Skilled Nursing Discharges Report

This report helps users identify specific skilled nursing facilities that are strong prospects, based on the number and type of their discharges. It details, by specific facility, the number of Medicare Part A patients who were discharged on an annual basis. Nursing home size is not always indicative of potential. The report keys on where the facility is located, not where the Medicare recipient resides. Skilled nursing facilities tend to draw patients from a limited area, and their discharged patients often have rehabilitation needs when they return home. Sales priority should be given to those SNFs that are highest on the rank order list.

Medicare Hospital Discharge by DRG Report

This report reveals how many patients a hospital discharges to home health care, community (self care) or to a medical facility, and it also reports these discharges by Diagnosis Related Group (DRG). You can use the report to value the referral potential of individual discharge planners, determine the market for specialty care programs, understand institutional and physician referral preferences for different patient populations based on their assigned clinical areas, and base your key account strategies on facts, not perceptions. The report also presents the first-ever ‘best practices’ for nationwide hospital discharge practices, against which local market performance and individual hospital performance can be benchmarked. Available separately for every acute care, rehabilitation, long-term acute care (LTAC) and psychiatric hospital in the United States, each report is customized for a single Medicare provider number. To optimize ease of use and convenience, only the most important DRGs are shown within the appropriate Major Diagnostic Code (MDC). The report also shows the hospital’s actual length of stay (LOS) for each key DRG and major diagnostic group along with the expected length of stay, based on the severity mix. One can quickly see if the hospital is challenged in orchestrating a timely discharge. Since LOS is also revealed for home health patients, it will be apparent if these patients are treated differently. You will also get a new Bonus Report — Hospital Readmission Rate Analysis.

Hospital Readmission Report

As a result of the Patient Protection and Affordable Care Act (PPACA), hospitals have become much more interested in preventing readmissions of Medicare patients to their facilities. Research indicates that many of these hospital stays could have been avoided, particularly for key diagnoses. Thanks to the PPACA, hospitals will face significant financial penalties in 2012 if they do not achieve required readmission levels within 30 days of discharge from a hospital for key DRG groups – pneumonia, heart attack/acute myocardial infarction (AMI), and chronic heart failure (CHF).

Home health agencies and hospices can play a major role in helping hospitals lower their readmission rates. Patients under their care are much less likely to go back into the hospital than those who are home unsupported. To aid home care organizations working with acute care facilities, the Hospital Readmission Report details for a chosen hospital: its 30-day Medicare readmission and morbidity rates, these rates for its region and state, as well as the rates at the national 25th, 50th and 75th percentiles, and a best-cases benchmark. With this information, users can understand the perspective of their local hospital as it prepares to avoid these onerous penalties.

Medicare Hospital Discharges to Nursing Homes

This report reveals how many patients a hospital discharges to skilled nursing facilities (SNF) and other sites of care, and it also reports these discharges by Diagnosis Related Group (DRG). You can use this information to value the referral potential of individual discharge planners, determine the market for specialty care programs, understand institutional and physician referral preferences for different patient populations based on their assigned clinical areas, and base your key account strategies on facts, not perceptions. Available separately for every acute care, rehabilitation, long-term acute care (LTAC) and psychiatric hospital in the United States, each report is customized for a single Medicare provider number. To optimize ease of use and convenience, only the most important DRGs are shown within the appropriate Major Diagnostic Code (MDC). This report also shows the hospital’s actual length of stay (LOS) for each key DRG and major diagnostic group, along with the expected LOS. One can quickly see if a hospital is challenged in orchestrating a timely discharge. Since LOS is also revealed for skilled nursing patients, it will be apparent if these patients are treated differently.

Medicare Enrollment Report

This report shows enrollment trends over a 4-year period for both Medicare managed care and traditional Medicare on a county-by-county basis within a state. Most organizations find that traditional Medicare patients are a financially attractive patient group. Because of Bush Administration policies, Medicare managed care enrollment has risen throughout the country in varying degrees. Thus, in many markets there may be a stagnant or declining pool of these more desirable patients. Understanding the trends in how seniors in your service area choose to participate in the Medicare program can have a significant impact on your organization’s marketing direction. In addition, you can use the information in this report to calculate market penetration at the county level. By comparing your organization’s market penetration to national norms and top percentiles, you can see how much growth potential is available in your market and whether you should focus marketing efforts on finding new patients or taking market share away from competitors.

Medicare Skilled Nursing Discharges by Hospital Report

SampleThis report helps users identify specific skilled nursing facilities that are strong prospects, based on the number and type of their discharges. It details, by specific facility, the number of Medicare Part A patients who were discharged on an annual basis.

Other Reports

Vendor Reports

Whether you are a vendor selling to the home health, hospice and skilled nursing market or a trade association / advocacy group looking to get a handle on the providers in the marketplace, the Post-Acute Prospect Report can help.  We offer a standard Listing Report, an Enhanced Listing Report and Customized Reports which can be specially developed to target your specific information needs.  More information.

Quality Measurement Reports

The home care market is no longer about what you can do; it’s about what you did. We offer the Quality Measurement Report which helps you prove you are better than the competition. The Home Health Quality Measurement Report highlights the areas in which you outperform your local competitors and lets you monitor how your competitors are doing via their PEPPER metric compliance. Leverage these data points to create opportunities for referral source meetings and market a consistent message of performance superiority.

Merger & Acquisition Reports

Whether you’re looking for merger & acquisition targets in a given geography, trying to determine where to target your market expansion efforts, or conducting due diligence, we have three different report sets that can help.  More information.