Recert Rates as an Indicator of Potential Benefit from Multi-Episode Patients
With the introduction of new Prospective Patient System (PPS) regulations, chronic or multi-episode patients have become a more profitable group for home health providers. Can your agency benefit financially from the multi-episode patient group? The answer to that question can be determined by looking at the recert rate in your service area.
What is the Recert Rate?
Typically based on annual numbers, the recertification rate of Medicare-covered home health services – the recert rate – is defined as non-initial patient episodes divided by initial episodes. Thus, the recert rate is a useful indicator of the incidence of chronic, multi-episode patients in a region.
As demonstrated in the above graph, Healthcare Market Resources, Inc. studied the 2006 Home Health Medicare Recert Rate at the state level. Using this data, we conclude the following:
- The national recert rate is 71%, however, there is considerable variation among the four quartiles.
- There is a tremendous variability among state recert rates, ranging from 24% in Maryland to 287% in Louisiana – a 10-fold difference.
What Regional Factors Affect the Recert Rate?
Reviewing this recert rate data drives home the point that it would be misleading for home health providers to only consider the national average of this metric. Numerous factors within each local market influence the recert rate including physician practice patterns, state Medicaid policy, and overall health of the elderly population. As these vary from region to region, so will the financial indicator outcomes.
In the state of Louisiana, for example, the high recert rate is affected by high illiteracy rates, poverty and poor diet, according to Louisiana Homecare Association Executive Director Warren Hebert. “All that Cajun food may be tasty, but it is not healthy,” he observes. “These factors result in a high incidence of diabetes and heart disease – both chronic conditions require skilled nursing care on a long-term basis.” Thus, the high recert rate in Louisiana is partially a result of the patient population unique to this state.
Click here to learn more about our Home Health Market Profiles, which can be used to determine recert rates in the counties that you serve, or call us today at 215-657-7373.