Performance Improvement 2009. What Changes to the Home Health Prospective Payment System of Case Mix Groups Would Improve Its Predictive Power and Financial Incentives?


The study addressed Medicare's information needs for refining the home health case mix model and monitoring the home health prospective payment system. Topics covered included: trends in patient and payment-related data over time; refinements to diagnosis groups within the original case mix model; reducing reliance on the therapy threshold in the case mix model; and how the system can account for costs of caring for long-stay patients and highly variable costs of bundled nonroutine medical supplies.

Main results were that redefining the system's therapy threshold, adding more thresholds, and accounting for the timing of the 60-day claim in relation to the care episode's entire sequence of claims, could improve the predictive power of the case mix model.

Report Title: Refinement of Medicare's Home Health Prospective Payment System: Final Report;

Agency Sponsor: CMS-ORDI, Office of Research, Development, and Information
Federal Contact: Ann Meadow, 410-786-6602
Performer: Abt Associates, Inc.
PIC ID: 8953

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"PerformanceImprovement2009.pdf" (pdf, 1.26Mb)

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