OASIS Alert

Published on Wed Jul 28, 2004 PDF

Be ready to justify deviations.

Even though the government's utilization data is five months old when it is released, agencies should take a look at it -- you can bet intermediaries will.

It's important to know that fiscal intermediaries have lots of information, including visits per episode, average number of visits per diagnosis, therapy visits per beneficiary and therapy visits per diagnosis, counsels consultant Pat Sevast with American Express Tax & Business Services in Timonium, MD. The FI will look for places where providers'numbers are significantly higher than the average, she adds.

Government data (see "Utilization") are provided free. They are an important source of information if you can't afford pricey benchmarking contracts, experts say. Even with private benchmarking data, it's important to compare your results with those of agencies served by your FI, says Chapel Hill, NC-based senior consultant Judy Adams with the LarsonAllen Health Care Group.

Depending on the government for your information has its downsides. Breaking visits down by date -- as the FI does -- rather than by episode may make it harder to accurately compare your agency's data with the feds', experts say. And data from the last half of last year may not reflect the realities of home care providers today.

The trend toward fewer episodes and fewer visits per episode continues, Adams reports. Be aware when making comparisons that there are many reasons for the wide variation among providers, Adams says. Lack of family caregiver availability -- especially with wound care patients -- can lead to more outliers, as well as more nursing visits. Larger numbers of chronic patients, such as those needing B-12 injections or catheter care, will result in more low utilization payment adjustments (LUPAs), Adams notes.

Whether the patient lives in an urban or rural area, physician practice patterns, education level of patients, agency preferences and availability of therapists all are factors that could explain variations, experts say.

If you find your numbers looking like outliers, search for factors that set your agency apart and that might cause the significant differences. Then document those reasons. It's worth taking the time to figure this out before a surveyor or intermediary asks, says John Gaynor with Chicago-based Gaynor& Associates.