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Some of the key findings that Northhampton, MA-based Fazzi Associates’ "Ground Point Zero Report" determined were essential to PPS preparation:
• The development of agency-focused strategies and performance measures, rather than those that focus on departments and turf-related considerations.
• Identifying and managing outcome measures and performance indicators.
• Developing and implementing a marketing plan to create a desired case mix. In this case Fazzi found it critical to point out that it is not important to avoid certain, more costly patients. What is important is to recognize that an agency can provide services in a more cost-effective manner to certain patients and should target those patients in its marketing plan. Determine the agency strengths and focus on those cases, rather than on which types of cases to avoid.
• Review and refine admission criteria and identify who has authority to admit patients.
• Educate staff to accurately complete the Outcome and Assessment Standardized Information Set (OASIS) assessment. It is critical that care managers in the field know how to do this, as the OASIS assessment will determine the reimbursement amount that the agency will receive for a patient. Mistakes can be costly.
• Develop utilization guidelines for each home health resource group (HHRG) based on the agency’s cost per visit. By establishing guidelines that provide care managers with a clear understanding and targets for visits, the agency will build into its operational structure the ability to monitor clinical performance and cost.
• Create a clinical review function that determines the accuracy of the OASIS assessments. The report recommended that an individual be responsible for reviewing all OASIS assessments, care plan, and admission visit clinical notes to determine whether they are consistent with one another.
• Update and streamline care pathways to incorporate recognition of the utilization guidelines for each HHRG.
• Incorporate alternative services and alternative products as part of the plan of care. It’s important to note that under the PPS, reimbursement is not visit-driven. Instead, agencies must work within the limits of the HHRG reimbursement and ask themselves what other resources might benefit the patient.