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Those parts of his county belonging to the County of Hanau-Münzenberg, which included Hanau, were inherited by the Landgrave of Hesse-Kassel. Due to dynastic troubles within this family the County of Hesse-Hanau was created a separate state from the Landgraviate until 1786. Even after that it became – after Kassel – the town second in importance within Hesse-Kassel. During the Thirty Years' War Hanau was taken by the Swedes in 1631.
There will be no comorbidity adjustment if there are no documented secondary diagnoses that fall into either the low or high comorbidity adjustment. The number was doubled in the final rule, expanding the classifications from six to 12 with the addition of seven Medication Management, Teaching and Assessment subgroups. As you have seen there is a detrimental impact of on the agency hence it important to understand factors that are currently causing LUPAs with your PDGM committee. This PDGM committee should randomly review a percentage of LUPA episodes with varying diagnoses each month for the next three to four months. When you talk about LUPA, It is one of the contractual adjustments that currently make up the Medicare-certified home health prospective payment system. However, PDGM provides an introduction towards building a better management team complex structure of visit requirement variables that Medicare home health care providers will need to navigate.
Other Payments and Adjustments
However, the real significance of the LUPA comes into play in terms of how we are reimbursed for patient care. To determine the visit threshold, select the appropriate year for your date of service and HIPPS code. The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled "I ACCEPT". If you do not agree to the terms and conditions, you may not access or use the software. Instead, you must click below on the button labeled "I DO NOT ACCEPT" and exit from this computer screen.
It is important that you prepare in order for your agency to be ready for the implementation of this new payment structure. This preparation includes conducting an intense review of your current LUPAs and understanding the impact that 30-day periods of care will have once PDGM is implemented in 2020. Home health providers will need to adapt to a lot of changes when the Patient-Driven Groupings Model begins in January 2020.
Services
New LUPA episodes, which will be evaluated annually by CMS, will range from two- to six-visit thresholds and vary across clinical groupings. There will be a different visit threshold for each of the new 432 home health resource groups . In addition, there will be a potential to have a LUPA in each 30-day payment period within the 60-day episode of care. Diagnoses that are high risk for hospitalization such as heart failure, COPD and diabetes are prone to LUPAs. As home health providers know, low-utilization payment adjustments can have a detrimental impact to an agency both clinically and financially. Clinically, it is difficult to obtain best patient outcomes with very few visits and financially, in some cases, a LUPA can be the difference between a $2,600 payment for an episode of care and an adjusted payment of $300.
Threshold; agencies will be facing thresholds of up to 12 visits over 60 days for some HHRGs. There has been an acute care stay within the 14 days prior to the start of that period. Almost all second and subsequent 30-day periods will be classified as Community, even if they are contiguous. The above questionnaire in the review process will help you to analyze your results and identify whether the LUPA could have been avoided. You need to dig deeper to understand trends in avoidable versus unavoidable LUPA cases.
Additional Resources
A 30-day period of care will be classified as a Community Admission if the patient has had no acute or post-acute stay within the 14 days prior to admission. Under PDGM, the 60-day certification period will remain the same. The initial certification will consist of two 30-day periods of care, and the recertification will be valid for two additional 30-day periods. The Centers for Medicare & Medicaid Services has a triple aim for patients to have positive care outcomes, a positive experience of care, and a low per capita cost of care.
The PDGM will allow HHAs to designate one principal diagnosis and up to 24 secondary diagnoses. This is in contrast to the five secondary diagnoses currently allowed on the OASIS assessment. According to CMS, the comorbidity adjustment can increase payment by up to 20%. Because clinicians can document a greater number of secondary diagnoses under PDGM, CMS assumes that more 30-day periods will receive a comorbidity adjustment than if only OASIS codes were used for payment. Thorough assessments, ongoing reassessments and accurate documentation are critical to this assumption. It’s possible that the first 30-day care plan with the additional visits might produce better outcomes and the second 30-day period may not be needed and a LUPA can be avoided.
The second 30 days had a LUPA threshold of 2 and the agency made 1 visit and discharged the patient. As a walked through this with the client, the light bulb went on. They hadn't paid attention to the LUPA threshold ahead of time. PDGM classifies each 30-day period as either a community admission or an institutional admission. A 30-day period of care will be classified as an Institutional Admission if the patient has had an acute care stay or post-acute care stay within the 14 days prior to HHA admission.
Outlier payments currently are made for 60-day episodes of care with estimated costs that exceed a designated threshold amount. Under PDGM, periods with estimated costs of care that exceed a specific outlier threshold will receive an outlier payment for that 30-day period. Outlier Payment calculations will remain the same as they are currently. If you remember, one of the biggest changes in PDGM is around LUPA. Previously, agencies had to have more than 5 visits in an episode to avoid LUPA.
Previously, OASIS had to be completed, which meant that agencies would know the diagnosis group, HIPPS code, and ultimately the LUPA threshold before the RAP could be submitted. They have a patient, dropped the RAP, but don't know what the LUPA threshold is when developing the Plan of Care . If the agency knows what the LUPA threshold is, they can plan right up front. For example, a patient could have a LUPA threshold of 4 in the first 30 days and 2 in the second 30 days. Agencies now know that you have to have more than 4 visits to avoid what we call LUPA land in the first 30 days.
One way to analyze the risk for LUPAs within the second 30-day period would be to look at your organization’s 2017 data. This will give insight into which 30-day periods and what types of episodes would fall into LUPA categories in a PDGM environment. This type of impact analysis can help agencies understand their strengths and weaknesses moving forward.
After this change, Hanau for the first time also extended to the south bank of the Main river. If your doctor or referring health care provider decides you need home health care, they should give you a list of agencies that serve your area. They must tell you whether their organization has a financial interest in any agency listed. PDGM, however, introduces Building a Better Management Team complex structure of visit requirement variables that Medicare home health providers will need to navigate. Like so many other aspects of PDGM, agency owners and managers should pay attention. The new PDGM system is designed to allocate resources correctly to the population groups that historically require the most resources.
Patients often require frontloading of visits at the beginning of an episode to prevent repeat hospitalizations. The important thing for administrators and staff to know is that by tapering a visit in the second 30 days, the organization could be setting itself up for a LUPA under PDGM. It’s imperative to begin thinking about the management of PDGM 30-day periods of care. For example, for LUPA visits of two or less in the second 30-day period, determine if this low-visit count is impacting clinical outcomes. Then consider how moving those one or two visits into the first 30-day period would impact patient outcomes. Under PDGM, LUPA thresholds will be based on clinical grouping and episode timing.
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