Flourishing Under Healthcare Reform – Maximize Your Profits By Minimizing The Impact Of LUPAs – Healthcare

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