Market Research Letter: September/October 2009
Providing insights for home care and hospice
September/October 2009
In This Issue
Feature Article: Outlier Payments – A Major Source of Abuse in the Healthcare System
Metrics Matter: Using Days Per Discharge to Measure the Profitability of Medicare Hospice Patients
Ask the Home Care Data Guru: How can I assess the Medicare hospice referral potential of a home health agency??
This summer we’ve certainly heard a lot about healthcare reform. In this month’s feature, we use Healthcare Market Resources data to identify and quantify a major source of abuse and waste in the current healthcare system — outlier payments made under the home health benefit. You’ll also find important information about the new Medicare policy proposals designed to address the potential abuse related to outlier payments.
Feel free to contact me at 215-657-7373 or info@healthmr.com to talk about this topic, plus the ways Healthcare Market Resources can help your business succeed in today’s challenging healthcare environment.
Rich Chesney
President, Healthcare Market Resources, Inc.
Feature Article: “Outlier Payments – A Major Source of Abuse in the Healthcare System”
In this month’s feature, we use Healthcare Market Resources data to help identify a major source of abuse and waste in the current healthcare system — outlier payments made under the home health benefit. In addition, we discuss the new policy proposals by the Centers for Medicare and Medicaid Services designed to help address potential fraud and abuse regarding outlier payments.
Read more.
Metrics Matter: “Using Days Per Discharge to Measure the Profitability of Medicare Hospice Patients”
When it comes to measuring profitability of Medicare hospice patients, the days per discharge is an especially important metric. Considering most hospices get paid for their patients based on a daily rate, the longer patients stay on hospice service, the more profitable they are. Additionally, upfront and back-end costs associated with each patient are spread over greater reimbursement as the patient’s length of stay (days per discharge measure) increases.
Read more.
Ask the Home Care Data Guru
Looking for some hard-to-find data? In Ask the Home Care Data Guru, we share questions from our subscribers – and our answers. Send us your question today!
Q: How can I assess the Medicare hospice referral potential of a home health agency?
A: Begin by considering the number of patients who die on service at an agency, plus those who are referred to hospice, to be the end-of-life potential population. Our research indicates that some home health agencies in Florida – which is probably the most clinically sophisticated hospice market – have 60% of this end-of-life segment referred to hospice. If you subtract the number of hospice referrals for a given agency (as indicated on their claims’ discharge disposition) from this 60% figure, you arrive at the uncaptured hospice opportunity.
Read the entire answer.