| Full Episodes Worth 11 Times More Than LUPA | | | | number of LUPA cases. Several of Healthcare Market |
| Episodes | | | | Resources' Market Profile Reports can help your |
| Among the most costly groups of Medicare patients | | | | agency determine if it's bearing the burden of LUPA |
| are those subject to LUPA. Using the most recently | | | | diagnoses for your community. |
| available national claims database, Healthcare Market | | | | Certain referral sources, such as ambulatory surgery |
| Resources' research shows that a full episode patient | | | | centers, may also generate a disproportionate number |
| is worth 11 times more than a LUPA episode patient. | | | | of LUPAs because of the limited needs of their |
| Furthermore, the indirect costs in servicing a patient - | | | | patients. Only an agency that is built around a per-visit |
| including intake, medical records, billing and quality | | | | model rather than an episode model may have the |
| review - are practically the same regardless of | | | | cost structure to serve these patients. As the impact |
| whether it is a LUPA or full episode. The average labor | | | | of the reimbursement cuts begin to affect the |
| cost per visit is also higher for a LUPA episode, since | | | | survivability of home care agencies - especially local |
| the added effort of the initial and discharge visits are | | | | visiting nurse associations (VNAs) - tough decisions |
| balanced by fewer "regular" visits. LUPA episodes are | | | | may have to be made as to whether an agency can |
| financially unattractive and, therefore, every effort | | | | afford to continue to serve these patient populations, |
| should be made to minimize their frequency. | | | | particularly if the long-term survivability of the agency is |
| Understanding Why LUPAs Occur Can Help Minimize | | | | at stake. |
| Them in the Future | | | | 3. Operational LUPA Episodes |
| There are three types of LUPA episode patients | | | | Frequently caused by patients missing visits, this type |
| based on the reason for the adjustment: Inevitable | | | | of LUPA is the most preventable. Monitoring these |
| episodes, intake episodes and operational episodes. By | | | | "absences" on a real-time basis and holding staff |
| understanding why an adjustment is made, an agency | | | | accountable for rescheduling the visit is essential. Also, |
| can take steps to minimize the occurrence of LUPA | | | | your agency can contact projected LUPA patients |
| episodes in the future: | | | | between visits to see if their condition has changed. If |
| 1. Inevitable LUPA Episodes | | | | a patient's condition has changed, your agency can |
| These types of LUPA episodes are very difficult to | | | | respond by contacting the physician to get an |
| prevent. They can happen if a patient is readmitted to | | | | assessment visit authorized. In any case, this practice |
| the hospital or transferred to hospice before a | | | | is good customer relations. Additionally, agencies should |
| treatment plan is completed. Another example of an | | | | conduct periodic chart reviews to determine how |
| inevitable LUPA episode is a patient service who | | | | many LUPAs were preventable. |
| requires a re-certification period, but achieves the | | | | LUPA Rates Vary Among Different Markets |
| treatment plan goals before completion of the full | | | | LUPA rates also vary significantly from market to |
| episode visit level. Other than making sure that the | | | | market. Healthcare Market Resources demonstrated |
| transfer to hospice occurs after the fifth visit, there is | | | | LUPA levels vary dramatically by state, for example, in |
| little that your agency can do to prevent these | | | | a previous newsletter article, "Metrics Matters: What |
| inevitable LUPAs. | | | | Percentage of Your Home Care Patient Episodes Are |
| 2. Intake LUPA Episodes | | | | Subject to LUPA?" In fact, we found a negative.65 |
| As you can see in the Metrics Matters section of this | | | | correlation, which is statistically significant, between |
| newsletter, patients with certain primary diagnoses are | | | | recert rates and LUPA levels. That means the higher |
| more likely to generate LUPAs than others. The prime | | | | the recert rate, the lower the LUPA levels. This strong |
| offenders - diagnoses that generate the most "intake" | | | | correlation indicates that LUPAs are less likely to occur |
| LUPA episodes - include: | | | | if agencies serve a highly chronic population. |
| Mental health | | | | Each market has its own LUPA level, caused by: |
| B12 shots (Blood) | | | | The types of patients referred to home health |
| Catheter changes. | | | | At what point in the disease process patients are |
| Once your agency has decided to admit a patient with | | | | referred |
| one of these diagnoses, there is little that you can do | | | | How long agencies are "allowed" to keep patients. |
| to avoid the LUPA. If your agency has programs that | | | | Managing your agency's percentage of LUPA patients |
| serve these patient populations while your competitors | | | | can have a significant impact on your financial results. |
| do not, you'll likely end up with a disproportionate | | | | |