Home Health LUPA Challenges Continue as Pandemic Subsides


The frequency of low-utilization cost changes (LUPAs) elevated for a lot of dwelling well being suppliers within the first yr of the Affected person-Pushed Groupings Mannequin (PDGM), which coincided with the COVID-19 disaster.

Partially, that’s as a result of there are way more LUPA variables to maintain monitor of beneath the brand new cost mannequin. At occasions, will increase had been additionally linked to dwelling well being sufferers unexpectedly declining scheduled visits due to COVID-19 fears.

To some, avoiding LUPAs by hitting a sure go to threshold might look like a comparatively easy course of. However dwelling well being suppliers within the weeds are telling a unique story.

“It’s in all probability one of many larger challenges beneath PDGM,” Nick Seabrook, the managing director of BlackTree Healthcare Consulting, instructed House Well being Care Information. “Beneath the Potential Fee System (PPS), we had a single threshold. We needed to handle 5 visits, and it was over 60 days. Now, you have got 432 thresholds to attempt to handle, and it’s over 30 days. I feel these two elements are what’s actually driving LUPAs up.”

King of Prussia, Pennsylvania-based BlackTree Healthcare Consulting offers billing, OASIS and different providers to dwelling well being businesses, amongst different post-acute care suppliers.

House well being corporations had been involved about LUPAs previous to the onset of PDGM, whereas the Facilities for Medicare & Medicaid Companies (CMS) truly thought they’d be much less of a difficulty.

“One of many elements of that behavioral adjustment was the idea that we had been going to get higher at LUPA administration,” Seabrook mentioned. “However I feel that was a short-sighted view on their finish, simply realizing that it’s extra subtle now than it was earlier than.”

EvergreenHealth House Care, a hospital-based dwelling well being and hospice supplier in Washington state, was hit laborious by LUPA struggles in 2020. It was one of many first suppliers within the nation to deal with COVID-19 sufferers, with the pandemic exacerbating PDGM’s ache factors.

Brent Korte, the chief dwelling care officer for EvergreenHealth, expects the problem to repeatedly enhance as time passes. However the struggles have taught each him and his group about what’s wanted to stop LUPAs.

“You want an up-to-the-minute understanding of the place every affected person traces up with LUPAs,” Korte instructed HHCN. “And we didn’t have that, and that was actually disarming. It triggered loads of additional work on our half, usually as a corporation. I feel we’ve discovered a ton from it. Hopefully, we’re going to bounce into the remainder of 2021 with much more give attention to truly tackling PDGM versus being distracted solely by the pandemic.”

Not only a distraction

The pandemic hasn’t simply been a distraction from common dwelling well being challenges. It has had tangible results on LUPAs.

Sudden hospitalizations because of unplanned issues, staffing shortages tied to quarantine protocols and canceled visits due to sufferers’ anxieties can all throw a corporation’s LUPA-mitigation efforts out of whack.

If a missed go to is on a Tuesday, as an example, even making up for it instantly the subsequent day might result in a LUPA within the new 30-day intervals. Moreover, entry to sufferers in amenities was additionally a problem in 2020, which made the scheduling course of tougher.

“If we will’t see a affected person on at some point, and we now have to go in on the subsequent, it might set off a LUPA, and that’s been enormously [challenging],” Korte mentioned. “Our case hundreds have additionally grown, which implies our nurses and bodily therapists, particularly, have needed to [do more]. Within the meantime, the pandemic has triggered a deluge of considerably extra acute sufferers, sufferers who would in any other case have been admitted to expert nursing amenities.”

To Seabrook’s level, the behavioral adjustment from CMS didn’t mirror the fact that set in for EvergreenHealth, in addition to different suppliers throughout the nation. The adjustment was a proactive transfer on the company’s half — not reactive.

“We’d have most well-liked that CMS, in a single regard, be reactive versus proactive in attempting to change our compensation,” Korte mentioned. “I feel for some suppliers, that behavioral adjustment in and of itself triggered a behavioral adjustment.”

Given the present acuity of its dwelling well being sufferers, EvergreenHealth hopes to decrease its LUPA fee into the only digits by the tip of this yr.

“If we will meet our sufferers’ wants, realizing how sick they’re by way of the pandemic and the way we’ve had such a rise in acuity within the final 14 months, being within the single digits for LUPAs could be an incredible purpose to succeed in,” Korte mentioned.

Discovering what works

So far as what’s labored, educating every clinician on LUPAs has stored EvergreenHealth’s head above water.

It’s one factor for an company’s leaders to grasp what triggers LUPAs and repair them, however with out top-down continuity, issues can fall by way of the cracks operationally.

“What actually works is ensuring that clinicians perceive their influence and perceive the coordination that it takes,” Molly McDonald, the scientific high quality coordinator for EvergreenHealth’s dwelling well being and hospice enterprise, instructed HHCN. “It’s greater than the one time when the affected person comes on service, attempting to plan that out. It takes fixed re-coordinating.”

In sure cases, a supplier received’t know what a affected person’s HIPPS code is till 10 days in, which is now a 3rd of the best way into the interval, Seabrook mentioned.

“After a supplier goes by way of their common QA course of and OASIS is accomplished, then the standard workers is reviewing the OASIS,” Seabrook mentioned. “They’re offering their suggestions to the clinician, the clinician makes their change, and now they lock the OASIS in and you’ve got that HIPPS code. You’re taking a look at that doubtlessly 10 days into the interval, and that HIPPS code goes to find out what that LUPA threshold is. You’re a 3rd of the best way right into a interval earlier than you lastly discover out that threshold.”

COVID-19 continues to be affecting the LUPA downside all through the house well being sector. Because the disaster subsides, so will a few of the ache that comes with PDGM woes.

Nonetheless, LUPA administration will proceed to require diligence for suppliers to bolster their backside traces.

“The issue will get higher,” McDonald mentioned. “However we’re nonetheless emphasizing the whole lot that we did on the subject of the COVID overlay of this and the significance of continued PPE, an infection management and vaccination pushes. This permits us to proceed to see sufferers of their dwelling and in amenities. If we don’t, that also is an actual downside on the subject of the LUPAs.”


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