This article is sponsored by Maxwell Healthcare Associates. In this Voices interview, Hospice News sits down with Jennifer Maxwell, CEO and co-founder, Maxwell Healthcare Associates, to learn how hospice providers are preparing for the year ahead in light of changes set forth by the new rule. She also lays out the steps providers should take in anticipation of OASIS-E and discusses key strategies for addressing recruitment and retention in the new hospice environment.
Hospice News: What career experiences do you most draw from in your role today?
Jennifer Maxwell: It starts with my experience as a counselor. In that role, I learned the importance of putting people first and actively listening to what they are saying, which could not be more foundational to my work today. When I think about patient care and clinicians in the field, quality training, processes and technology are my top priorities. I’ve spent my career understanding clinicians’ needs in order to support those initiatives by building software that gives them an extra set of eyes. And it has enabled me to help make a difference for clinicians at the bedside.
People, processes and technology are the future of hospice care and health care in general. We need to listen to what patients and staff have to say, then create tools, training programs and technologies that will execute on those needs. This is key to achieving the best level of care and patient outcomes while increasing staff retention and satisfaction.
What are the key takeaways from the final rule put out by CMS on November 1st, 2022?
The proposed rate cut in July was set at -7.85%, but that changed to -3.925% or budget neutrality on November 1st. The final rule emphasized routine updates to the Home Health Value-based Purchasing (HHVBP) model, as well as quality reporting. It also provided a payment update of 4.1% based on the market basket adjustment, a 0.1% productivity adjustment, and a 3.5% behavioral adjustment, which comes out to about a 0.7% increase for 2023 when you put all of the data together.
Additionally, the final rule delayed the OASIS for all patients, regardless of payer, and it changed the VBP modeling years from 2019 to 2022. High-level, that challenges providers to see where they stack up to their peer organizations using all of that data. G codes for virtual and telehealth visits, as well as remote patient monitoring, were also introduced.
What behavioral changes do agencies need to make to prepare for 2023 in light of the final rule?
As I mentioned, OASIS-E is being held regardless of payer, but all agencies still need to get ready for OASIS-E by January 1st. Agencies should look to automation and centralization, and take a deep dive into quality of documentation. Along with an emphasis on patient care, additional behavior needs should be addressed. There is also a need to emphasize nurse care at the branch level, and focus on missed visits elimination and optimized care utilization.
Claims workflow, timeliness of care and payer profitability analysis for non-Medicare businesses will be very important. We’ve seen a lot of agencies focusing on patient volume from payors instead of looking at profitability. Agencies need to be cognizant of what that looks like for their revenue generation in 2023. Finally, it will be critical to focus on recruitment and retention with the goals of quality, onboarding and training, along with decreasing caregiver burden for clinicians as quickly as possible.
With staffing being such a massive issue across the industry, what can agencies do to retain staff members as they prepare for 2023?
We don’t see that trend decreasing at all, so it is imperative to focus on each role in and of itself, helping every staff member become an expert in their respective areas rather than being a jack of all trades. Taking a Lean Six Sigma approach to workflow throughput will help facilitate the right care, at the right time, with the right care plan.
Then when it comes to training, we need to help clinicians do more with less. Streamlining and automating those processes is a big piece of that, and when the clinicians you hire are laser-focused in their roles, it will lead to higher output and better health outcomes for patients.
Agencies will need to prepare for OASIS-E before January 1st, 2023. What are some high-level steps that they can take to prepare?
First and foremost, agencies need to review the documentation within their EMRs, eliminate those redundant questions, then train the clinical staff to review that as well. Next, they should update the reporting requirements and prepare for those crossover episodes — the ones that start in December and end in February where agencies will be on two different versions of OASIS.
Additionally, it will be critical for agencies to make sure they’ve tested the vendors they’re using prior to New Year’s Eve. This includes things such as HHCAPS, HSP, EMR, reporting tools and analytics tools, which will all be important to OASIS-E preparations. I can’t emphasize enough the importance of training those clinicians so they understand what needs to happen during those crossover episodes.
What technology solutions do agencies need to consider in 2023 and why?
They need solutions to help manage utilization, decrease hospitalization and manage those missed visits, because those are essentially the heart of patient care. I think of tools like Medalogix Pulse, which simplifies the process and makes it easier for everyone to focus on direct patient care.
Medalogix Pulse is a vist-by-visit resource management solution that ensures patients receive the right care at the right time. This kind of technology will help providers streamline the care process and identify those risks up front to make the greatest impact on all stakeholders moving into 2023 and beyond.
Finish this sentence: “The top strategy that care providers should employ in 2022 to best prepare for 2023 is…?”
Centralization, centralization, centralization.
Editor’s note: This interview has been edited for length and clarity.
Maxwell Healthcare Associates is a team of post-acute industry veterans passionate about helping home health and hospice providers thrive amid healthcare’s disruptive environment. Learn how MHA can assist your agency prepare for 2023 with solutions focused on people, processes, and technology.
The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact [email protected].