Anyone seeing decreased visits per episode?

caliotter3 · Dec 10, 2007

My company had just added the intermittent visit component and I was not involved with this so I have no idea what the nurses were told. I am not surprised that costs are being lowered at the expense of quality care. It happens all the way around. I work shift work cases and some of my clients have to battle God himself just to get a minimal amount of hours authorized. How do they expect someone to hold a job when 8 hours a day are authorized and it takes a minimum of one hour of travel each way to a job anywhere? No sense. And how about 32 hours of respite care a month, divided up into 4 hour increments. Almost not worth it.

wonderbee, BSN, RN · Dec 11, 2007

There is a magic number of visits that Medicare reimburses at a considerably higher rate in the form of a lump sum. Nursing visits aren't really considered in that formula. It's the high case mix formula. I believe it's 12 visits. Then there is another rung on the reimbursement ladder which is something like 18 visits I believe. So when nursing is in, after the required 5 visits, it becomes less profitable since there will be no additional reimbursement. The goal with the medicares is to get to that high case mix number. We usually accomplish this in a 4 week plan of care which seems to be sufficient in most cases.

We rarely do 3W1 for nursing. Usually 2W1 and often 1W1 and rarely more than 4 weeks. Ours is a small HH company so maybe this is why we only do 4W POCs.

Unless the medicare regs for reimbursement are changing, I can't imagine why there is an urging to decrease visits unless you are falling in between the first and second levels of medicare reimbursement.

ragtopnurse · Dec 14, 2007

There is a magic number of visits that Medicare reimburses at a considerably higher rate in the form of a lump sum. Nursing visits aren't really considered in that formula. It's the high case mix formula. I believe it's 12 visits. Then there is another rung on the reimbursement ladder which is something like 18 visits I believe. So when nursing is in, after the required 5 visits, it becomes less profitable since there will be no additional reimbursement. The goal with the medicares is to get to that high case mix number. We usually accomplish this in a 4 week plan of care which seems to be sufficient in most cases.
We rarely do 3W1 for nursing. Usually 2W1 and often 1W1 and rarely more than 4 weeks. Ours is a small HH company so maybe this is why we only do 4W POCs.
Unless the medicare regs for reimbursement are changing, I can't imagine why there is an urging to decrease visits unless you are falling in between the first and second levels of medicare reimbursement.

From what I have learned Medicare pays a lump sum per episode based on the case mix diagnosis and the clinical, functional and service scores compiled from the Oasis MOO questions. If you don't get at least 5 total visits it falls into what they call LUPA and you only get paid by the visit. If you get 5 or more visits total(it can be a mixture of disclipines even) you get the full amt regardless of how few or how many visits you make. I understand that the fewer visits made, the more the profit but I still don't think it is good quality care to see a patient only 1 time a week, honestly with most of the patients if they only need once a week they probably don't even need homecare (there are exceptions of course). I just wondered if all companies were starting this or if maybe they were already doing it and we are just behind. We don't do 4 wk POC but I think it would be better that way than stretching it out to the end of the cert and only seeing them one time a week. Thanks for your reply. Helps to know we aren't the only ones decreasing visits.

wonderbee, BSN, RN · Dec 14, 2007

I agree with the frequency issue concerning 1x week visits. Those 1 visit per week nursing patients we are borderline cases which could probably do without nursing. We are nevertheless encouraged to admit everyone we can.