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Medicare Home Health Agency (HHA) Transparency Data (CY2013)

Date
2015-12-18
Title
Medicare Home Health Agency (HHA) Transparency Data (CY2013)
Contact
go.cms.gov/media

Medicare Home Health Agency (HHA) Transparency Data (CY2013)

The Centers for Medicare & Medicaid Services (CMS) released a new dataset, the Home Health Agency Utilization and Payment Public Use File (Home Health Agency PUF).  This data set, which is part of CMS’s Medicare Provider Utilization and Payment Data set, details information on services provided to Medicare beneficiaries by home health agencies.  These new data include information on 11,062 home health agencies, over 6 million claims, and over $18 billion in Medicare payments for 2013.  The data is posted on the CMS website at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/HHA.html.

The data set identifies individual home health agencies (HHAs) using their 6-digit identification number.  Services furnished by these HHAs are grouped according to case-mix groupings, or home health resource groups (HHRGs).  For each HHA and HHRG, the data set has the total number of episodes that were provided, distinct number of beneficiaries served, the HHAs total and average charges, the total and average Medicare payments, and the total and average Medicare standardized payments .  The HHA provider dataset also has additional information on low-utilization payment amount (LUPA) episodes and outlier payments.  The data set does not contain any individually identifiable information about Medicare beneficiaries. To further protect the privacy of Medicare beneficiaries, any aggregated records which are derived from 10 or fewer claims are excluded from the Home Health Agency PUF.

The Home Health Agency PUF data allow for many types of analyses to be performed, including, for example, summary analyses by HHRG and state.  Table 1 below displays the patterns of utilization and total Medicare payment amounts for the top ten HHRGs by total payment.  The HHRG with the highest total Medicare payment at $1.19 billion was 1CGK (Early Episode, 0-13 therapies, Clinical Severity Level 3, Functional Severity Level 2, Service Severity Level 1).  Most of the HHRGs listed below include lower levels of therapy.

Table 1. Top Ten HHRGs by Total Payment, 2013.

HHRG HHRG Description Total Episodes Unique Beneficiaries Served Total Medicare Payment Amount
1CGK Early Episode, 0-13 therapies, Clinical Severity Level 3, Functional Severity Level 2, Service Severity Level 1 490,124 430,045 $1,196,965,363
3CGK Late Episode, 0-13 therapies, Clinical Severity Level 3,  Functional Severity Level 2, Service Severity Level 1 288,978 152,448 $785,041,728
3CHK Late Episode, 0-13 therapies, Clinical Severity Level 3,  Functional Severity Level 3, Service Severity Level 1 254,721 114,943 $735,645,633
1BGK Early Episode, 0-13 therapies, Clinical Severity Level 2,  Functional Severity Level 2, Service Severity Level 1 328,128 305,101 $717,847,604
3BGK Late Episode, 0-13 therapies, Clinical Severity Level 2,  Functional Severity Level 2, Service Severity Level 1 326,933 176,063 $686,782,491
5CHK Early or Late Episode, 20+ therapies, Clinical Severity Level 3, Functional Severity Level 3, Service Severity Level 1 100,692 85,890 $626,596,891
1CHK Early Episode, 0-13 therapies, Clinical Severity Level 3,  Functional Severity Level 3, Service Severity Level 1 178,045 154,337 $474,084,242
1BGM Early Episode, 0-13 therapies, Clinical Severity Level 2,  Functional Severity Level 2, Service Severity Level 3 147,596 145,233 $432,740,375
3AGK Late Episode, 0-13 therapies, Clinical Severity Level 1, Functional Severity Level 2, Service Severity Level 1 252,214 139,779 $429,279,180
1CGM Early Episode, 0-13 therapies, Clinical Severity Level 3, Functional Severity Level 2, Service Severity Level 3 125,849 122,938 $412,886,178

Table 2 below displays the patterns of utilization and average Medicare payment amounts for the top ten HHRGs by highest number of episodes.  The HHRG billed the most frequently was 1CGK (Early Episode, 0-13 therapies, Clinical Severity Level 3, Functional Severity Level 2, Service Severity Level 1) with 490,124 total episodes in 2013 and an average Medicare payment amount of $2,442 per episode.

Table 2. Top Ten HHRGs by Number of Episodes, 2013.

HHRG HHRG Description Total Number
of Episodes
Unique Beneficiaries Served Average Medicare Payment Amount
1CGK Early Episode, 0-13 therapies, Clinical Severity Level 3, Functional Severity Level 2, Service Severity Level 1 490,124 430,045 $2,442
1BGK Early Episode, 0-13 therapies, Clinical Severity Level 2,  Functional Severity Level 2, Service Severity Level 1 328,128 305,101 $2,188
3BGK Late Episode, 0-13 therapies, Clinical Severity Level 2,  Functional Severity Level 2, Service Severity Level 1 326,933 176,063 $2,101
3CGK Late Episode, 0-13 therapies, Clinical Severity Level 3,  Functional Severity Level 2, Service Severity Level 1 288,978 152,448 $2,717
3CHK Late Episode, 0-13 therapies, Clinical Severity Level 3,  Functional Severity Level 3, Service Severity Level 1 254,721 114,943 $2,888
3AGK Late Episode, 0-13 therapies, Clinical Severity Level 1, Functional Severity Level 2, Service Severity Level 1 252,214 139,779 $1,702
1AGK Early Episode, 0-13 therapies, Clinical Severity Level 1, Functional Severity Level 2, Service Severity Level 1 191,559 182,363 $2,151
1CHK Early Episode, 0-13 therapies, Clinical Severity Level 3,  Functional Severity Level 3, Service Severity Level 1 178,045 154,337 $2,663
1CFK Early Episode, 0-13 therapies, Clinical Severity Level 3,  Functional Severity Level 1, Service Severity Level 1 158,058 141,987 $2,073
1BGM Early Episode, 0-13 therapies, Clinical Severity Level 2,  Functional Severity Level 2, Service Severity Level 3 147,596 145,233 $2,932

The Home Health Agency data can be also used for geographic comparisons of costs and utilization of home health services and, when combined with data on the number of beneficiaries who receive home health care, per episode costs can be calculated.  

Map 1 below displays the average Medicare standardized payments per episode by state for 2013.  Nationally, the per episode average standardized payment for all HHAs was $3,037.  As the map demonstrates, the highest average per episode rates were in the Southeast and Mountain states, while the states with the lowest per episode rates were scattered across the Southwest, Midwest and West coast.

Map 1.  Home Health Average Standardized Payment per Episode, by State, 2013.

Map 2 shows average standardized payments per Medicare beneficiary (all Medicare beneficiaries including both home health users and non-users).  The Southwest and Florida tended to have much higher payments than the rest of the country.

Map 2.  Home Health Average Standardized Payment Per Beneficiary, by State, 2013.

Map 3 shows outlier payments as a percent of total Medicare payments.  Utah, New York and Florida had particularly high levels of outlier payments as a percent of total payments, as many of the HHAs in those states had the maximum 10% allowed by law.  Much of the Southeast and Midwest tended to have lower percentages.

Map 3.  Outlier Payments as a Percent of Total Medicare Payment, by State, 2013.


*Standardized payment amounts are Medicare payment amounts adjusted for geographic differences in payment rates.

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