Home Health Best Practices for LUPA Management

Home Health agencies have been carefully tracking their LUPAs (low utilization payment adjustments) for years, but the combination of PDGM and factors relating to COVID-19 caused a surge for many agencies from 2020-21. In this article, we will share some helpful tips for updating your home health best practices and managing your LUPAs. We’ll start by reviewing some of the reasons we saw an increase in LUPAs over the past couple of years.

Why LUPAs increased

Environmental factors in the industry created a perfect storm in 2020 that led to a rise in LUPAs for many home health care agencies. Fear of catching and spreading COVID-19 and the susceptibility of older citizens to the illness caused many patients to refuse visits from caregivers. This in turn, drove up LUPAs, especially during the early days of the pandemic.

At the same time, home health providers were adjusting to the nationwide rollout of PDGM. While increased LUPAs were not necessarily expected to come from the PDGM update, adjusting to the new rules at the same time as the pandemic made the effects of the new regulations murkier and harder to address. PDGM updates included a new case-mix adjustment methodology which changed LUPA thresholds based on patient condition. Under the previous version of the HH PPS, agencies had a single threshold (5 visits in 60 days). Now there are hundreds of potential thresholds to manage based on the patients’ diagnosis and condition.

These factors made it vital for agencies to look carefully at their data to understand why LUPAs are occurring and create strategies to avoid missed visits as much as possible. Regulation updates and legislative support for telehealth visits may help bring down LUPAs in the long run, but there are things agencies can do now to improve their home health best practices and achieve more sustainable LUPAs.

7 Tips for managed LUPAs

Common factors that lead to LUPAs include multiple missed visits, staffing issues, patient refusals and scheduling issues. Here are a few tips for managing your LUPAs.

Create a LUPA monitoring process - Set up tracking procedures to keep LUPA management top of mind with your staff members. Designate one person to regularly review your LUPA trends. The Homecare Homebase PDGM LUPA and Outlier Analysis Report is a great resource to help your team stay on track. Customers with HCHB Analytics can also set up alerts to notify key team members when LUPA percentages reach a specific threshold.

Take a deeper dive into your LUPA analysis – Consider looking beyond individual patient data. Take a look at how LUPAs are trending within your organization. Review how your LUPAs are distributed by service and timing or clinical groups. You can check your LUPA percentage and threshold behavior in HCHB Analytics’ Home Health Medicare Key Metrics and Impact Model Dashboards.

Educate your staff – Make sure your staff understands what LUPAs are and how they affect your bottom line. Share your current status and goals. Work with your team to understand why LUPAs are occurring and look for opportunities to adjust your processes. Analyzing the Homecare Homebase PDGM reports and workflow are great places to start.

Identify high risk patients – LUPA prevention starts at admission. Identify patients who are at a high risk for hospitalization and carefully review utilization guidance and visit thresholds for these patients. Try to schedule the appropriate amount of visits as early in the process as possible and keep a careful eye on any missed visits for these patients to make sure you are maintaining the appropriate visit threshold for their diagnosis and condition.

Timely therapy evaluation addons – Try to schedule your therapy evaluations on the admission date or at least in the same week to ensure the visit takes place and the patient is properly evaluated in case of an early or unplanned discharge from service.

Review LUPA alerts and warnings – Homecare Homebase provides LUPA alerts and warnings for clinicians using PointCare to schedule, reschedule and mark missed visits. These warnings and alerts help make sure your staff is aware that the intended threshold may not be met and your team might end up with a LUPA. Let your team know how you would like them to respond when they see one of these warnings. In some cases, LUPAs are necessary, but this may be a good opportunity to check with the patient on options for rescheduling rather than canceling a visit. Homecare Homebase also provides warnings for schedulers working in HCHB’s back-office solution, so they know if a missed visit will result in a LUPA.

Consider integrating additional tools – Homecare Homebase integrates with Medalogix to provide additional utilization guidance based on the unique needs of each patient.

LUPA management has been an important concern for the bottom line of home health agencies and will continue to be a key metric to track in the years to come. Homecare Homebase is here to help make LUPA management easier. Want to learn more? If you are already an HCHB customer, check out the LUPA best practices webinar available for free on our Customer Experience Portal or reach out to your Account Executive. If you are interested in discussing whether Homecare Homebase is the right software solution for your agency, give us a call at 1−866−535−4242 or contact us online.