Changing From the “Visit Mindset”

In home health we have a visit problem. Not the one that just popped into your mind but the one that has us measuring using the wrong metric.

We still believe we can solve our profitability issues in Home Health by simply limiting the number of visits we provide patients.

We still measure clinician productivity using a visit metric while simultaneously limiting that very thing – VISITS. As I type that I am once again reminded how insane that sounds.

CMS did this to us. They are the ones that decided to incentivize visit counting and thresholds to maximize reimbursement. We simply went along (insert sarcasm).

Well, it is now 2024 and there are no more visit threshold incentives. I know many of you reading this will immediately think “what about LUPA’s.”  The LUPA discussion is for another day, and I would strongly advise you to not use the LUPA threshold as your goal for HH. That is a recipe for an audit and money recoupment, in other words, a recipe for disaster.

In 2020 we began our PDGM era in Home Health. Gone are the therapy thresholds and enter the LUPA calculation.  Many of us cut our teeth on the 4 visit LUPA for every case and we did everything we could to get to visit 5 in a 60-day episode. Now you are not aware of the LUPA threshold until clinical grouping and episode timing have been determined and can range from 2-6 visits.

Many agencies said “cool, cool, cool we just need to strip our therapy visits to bare bones and we will be rolling in cash.”  CMS countered with “ummm we will be paying you based on outcomes, etc.”

Let me be clear, CMS calculated the new payments including therapy monies, and if you use less care than the patient needs, they will continue to cut reimbursement every year. This is called the “behavioral adjustment.” Also, why do we not consider nursing visits an issue as much as therapy??

That brings me to my rant. Get out of the visit mindset. Many of you, upon examination, will see that much great clinical care can occur without an actual physical in-person visit.

I recommend we start basing our thoughts and practice in an “encounter” mindset. Calculate the time that a clinician spends caring for their patients. Be it in-person, telehealth and/or remote patient monitoring, it should count the same.

Obviously, we will not want to encounter a LUPA unnecessarily so maybe consider a “minimum in-person encounter” number vs. a maximum visit when laying out an episode of care.

It will require a change in thinking, but I know you are up for it.