Navigating CY 2025 Home Health Reimbursement Cuts: Medalogix Offers Innovative Solutions to Enhance Efficiency and Outcomes 

As the Home Health industry grapples with the CY 2025 proposed rule, we are already preparing for inevitable reimbursement cuts quickly approaching in January. The question is no longer whether we will face cuts, but rather how extensive they will be. At Medalogix, we engage in daily conversations with providers across the industry who continue to navigate this challenging reimbursement landscape. They are committed to doing more with less and striving to deliver higher quality care despite having fewer resources.

The proposed 4.067% permanent reduction is not surprising, as it continues a trend that has been established for several years. With PDGM intended to be net neutral, CMS has a path to achieving this with continued cuts. But what is missing from this narrative for providers? A definitive Playbook on how to respond. There is no new Guide on just how home health leaders implement even more change to operate under continued reimbursement cuts and higher expectations. In this new climate Efficiency Matters, Thoughtfulness Matters, Data Matters, and Every Clinical Decision Matters. 

Fortunately, this is happening during a particularly historic time in healthcare, where technology is driving unprecedented efficiencies. Leveraging machine learning AI, Medalogix has identified strategies to sustain and enhance efficiencies in this challenging reimbursement climate.

The Challenge

• Year after year reimbursement reductions 

• Caring for sicker patients in the home setting 

• Juggling ongoing clinical staffing shortages 

• Maintaining positive margins despite the changing Medicare Advantage landscape 

• Complying with increasingly burdensome regulations and documentation requirements 

Despite the challenges, the expectation remains that patients are satisfied, outcomes are exceptional, and providers face no limitations in their capacity to provide care. This trend is unsustainable without innovative solutions to guide the way.

The Solution

Create Efficiencies. Enhance Outcomes. 

Leveraging innovative technologies can significantly enhance operational efficiencies, allowing providers to focus their time and resources on the right patients and tasks. Medalogix has strategically designed solutions to streamline operations while promoting patient-centered care planning aimed at maximizing quality outcomes. From the moment a referral is received to the time a patient is discharged, the suite of Medalogix solutions is positioned to guide and support your teams throughout the patient journey.

Pulse Referrals & Admissions

This innovative solution has already enabled providers to enhance their intake and OASIS coding and scrubbing processes, maximizing efficiency, quality, and financial outcomes. By generating a referral summary prior to home health admission, clinicians can spend less time reading lengthy documentation before completing a Start of Care (SoC) visit, allowing them to dedicate more time to bedside care. After the SoC visit, AI technology analyzes available documentation and provides OASIS coding and scrubbing guidance, ensuring the accuracy needed for optimal financial and quality outcomes while reducing the administrative burden of post-admission tasks. Incorporating the Referrals and Admissions solution to streamline the admissions process offers a new and innovative way to create additional efficiencies, potentially mitigating the impact of looming reimbursement cuts. 

A multi-client Medalogix study of completed episodes found recurring deficiencies in coding, with 57% of episodes requiring correction for either documented clinical needs that were overlooked or for compliance issues. By following intelligent insights to correct these deficiencies in coding, agencies can in turn drive greater accuracy in reimbursements for more stable footing in a shifting financial landscape.

Pulse Episodes

The Pulse Episodes solution provides a bird’s eye view of your patient population with patient insights and data-science backed guidance to inform care planning across the patient journey. Immediately after the Start of Care, Pulse utilizes predictive analytics to provide utilization guidance to promote care coordination and ensure that the visit frequency matches patient acuity and supports medical necessity. A second data science model dynamically categorizes hospitalization risk for each patient which updates during the episode based on clinical documentation and patient presentation during each home care visit. This model then risk stratifies the entire home health patient population to support population and utilization management decisions.

These features leveraged together can promote value-based outcomes where care is tailored and adjusted to each patient removing subjectivity and guesswork. As the patient approaches the end of the episode, Pulse provides risk-based guidance to inform recertification or discharge based on patient-specific characteristics. In addition to delivering comprehensive data science insights, Pulse Episodes offers valuable information on operational and quality components. This includes alerting users to LUPA risk and providing visibility into HHQRP and Home Health Value-Based Purchasing elements.

Valuable features in Pulse Episodes include:

• Risk-based guidance to inform utilization and discharge vs. recertification decision making 

• LUPA alerts  

• Individual patient visit-by visit hospitalization risk level and history of risk throughout episode(s) 

• Visit details/snapshot of each home health nursing and therapy visit 

• Multidisciplinary calendar view tailored to each individual patient 

• Visibility into Home Health Value-Based Purchasing elements 

• Detailed home health history, including prior episodes and TIFs 

Agencies across the country have improved patient care with Pulse Episodes. They leverage Episodes to reduce the number of patients receiving too few visits, improve continuity of care, reduce unwanted hospitalizations, and improve post-discharge outcomes. 

Pulse Transitions

When a patient is admitted to home health services, both the referral source and the agency team have determined that the patient would benefit from and is eligible for home health care. While the ideal goal is for each patient to discharge independently to the community, changes in risk level and declines in condition occur frequently. Pulse Transitions analyzes visit-by-visit patient data to equip home health teams with the information needed to identify and provide better care to patients approaching end-of-life. By comparing each patient against broader Medalogix client data, Transitions categorizes mortality risk level and highlights key data to objectively identify patients on the home health census who are likely to pass away. By identifying appropriate patients and providing a step-by-step workflow, Transitions facilitates timely, compassionate end-of-life conversations and supports patients and caregivers as they navigate the difficult decisions regarding hospice care. This in turn helps more patients spend more time in the right care setting. 

A Holistic Platform for Home Health Success

While each of these modules offers value, the benefits they can collectively bring home health agencies are second to none. From the moment a referral is made to when a patient discharges, Pulse acts as a clinician companion to inform decision making. Each patient has a unique journey, and Pulse can guide the path while creating efficiencies along the way. Leveraging Medalogix technology at each step during the patient’s journey will increase an agency’s capacity to provide care while ensuring that optimal quality and financial outcomes are achieved. This holistic approach to care is what is needed under value-based payment models for agencies to recognize success despite diminishing reimbursement.

To conclude, Medalogix has been prepared for these changes in home health reimbursement models for years. While the mainstream buzz about predictive analytics has surfaced attention to the need for technology and innovation in healthcare, our Pulse platform has been supporting this shift for years. It’s clear that the shift toward value-based care in the home health space will continue its multi-year trajectory, which clarifies more than ever the necessity for innovative solutions that drive both efficiency in care provision and improved patient outcomes. To that end, Medalogix is the most reliable solution for the home health industry.