The Home health prospective payment system proposes case-mix methodology refinements and parameters are to be defined under the rule released last year for Home Health Groupings Model. Advancements in technology is leveraged to provide value-based service and reduce manual labor and burden. With numerous changes and regulations to transform home health system, EHR vendors should have a concrete understanding of the changes and should update their offerings and services accordingly.

1. Vijaya is a Healthcare Expert at Nalashaa and has experience in
business transformation, payer-provider integration, product
design & implementation and healthcare system evaluation &
selection. She has been actively involved in Meaningful Use,
PQRS, HHVBP, CPC+, CCM and MACRA implementations and
has extensive exposure to Clinical and Financial areas of the US
healthcare ecosystem.
Vijayalaxmi Kudekar
HOME
HEALTH
REGULATIONS
EHR vendors need to update offerings to
accommodate federal regulations and assist
providers with value-based care.

2. Overview
Starting January 1 2020, the Home Health Prospective Payment
System (HH PPS) may have a drastic change, which proposes
case-mix methodology refinements and parameters are defined
under the rule released last year for Home Health Grouping model
(HHGM).
This proposed rule; also called the Patient-Driven Groupings
Model for Medicare home health payments, primarily relies on
patient needs, rather than a therapy threshold to determine the
reimbursement. It helps advance the Trump Administration’s
Meaningful Measures initiative which represents a new approach
to quality measures that foster operational efficiencies, and
reduce costs of collection and reporting during quality measure-
ment.
As per the press release by CMS, the cost impact related to the
updated data collection processes is estimated to result in a net
$60 million in annualized cost savings to HHAs, or $5,150 in
annualized cost savings per HHA. This is because of the proposed
implementation of PDGM and the proposed changes to HH QRP
that will be effective from the beginning of the CY 2020.
Major highlights of the rule
Case-Mix Adjustment changes – including a change
in the unit of payment from a 60-day episode of care
to a 30-day episode of care.
Introduction of Home Infusion therapy - includes
“Remote Patient Monitoring” cost under Medicare
home health benefit
Changes in the Home Health Value Based Purchas-
ing (HHVBP) model
Changes in the Home Health Quality Reporting
Program (HHQRP) requirements
Promotion of Health Information Exchange
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3. Conclusion
While technology isn’t the complete solution for problems that HHAs face, it is certainly an
important lever that can be used to overcome their challenges while staying compliant with
regulations. It’s true that HHAs know their context and business better and understand the chal-
lenges too. However, many a time in the past, several industries have solved their challenges in
unconventional ways borrowing ideas or concepts from entirely disconnected industries.
Perhaps, new standardization and compliance requirements will help HHAs with interoperability
and quality of care for patients and reduce the burden of different regulatory submissions.
If you would like to bounce off your thoughts on this,
let’s have a conversation.
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engagement models, make us a great fit for developing the quality technology while reducing time to market and engineering costs.
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