Home health claim amounts vary widely across the country

A new data set containing information about home health agency use reveals how the $18 billion paid out by the Medicare program for home health claims broke down among home health resource groups (HHRGs) and across the states for calendar year (CY) 2013. The most popular HHRG by both total Medicare payment amount ($1.19 billion) and total number of episodes (490,127) is HHRG 1CGK (Early Episode, 0-13 therapies, Clinical Severity Level 3, Functional Severity Level 2, Service Severity Level 1). Although some patterns appear when mapping per episode and per beneficiary amounts paid out by state, the amounts are not consistent within a region.

Numbers

CMS compiled the home health agency utilization and payment public use file (Home Health Agency PUF) from fee-for-service administrative claims data in an effort to increase transparency. The data includes claims from over 11,000 home health agencies. CMS notes that this information contains certain limitations, as the data does not reflect quality of care and is not risk-adjusted for severity of disease in patient populations. Out of the top 10 HHRGs by total payment, eight involve service severity level one and six involve clinical severity level three. The number of unique beneficiaries served for each of the top 10 HHRGs ranges from 430,045 to 122,938.

The numbers also revealed how payment amounts varied by state. Nationally, the per episode standardized payment averaged $3,037, but the actual amounts varied widely across the country. In general, the southeast and mountain state regions had the highest payment amounts while Texas and some of the surrounding states were in the lowest bracket. However, when the home health average standardized payment per beneficiary was calculated, the map changed drastically, revealing that Florida and the southwest have much higher payments per beneficiary (including Texas and the surrounding states that ranked low when calculating per episode).