Full Episodes Worth 11 Times More Than LUPA Episodes
Among 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 Future
There 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 Episodes
These 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 Episodes
As 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:
B12 shots (Blood)
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 Episodes
Frequently 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 Markets
LUPA 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.…
Full Episodes Worth 11 Times More Than LUPA Episodes
There’s a lot of to-do going on about natural vitamins having an edge on the synthetics. And, truth to tell, going natural sure sounds good. The way God intended and all.
But like with so many things, the devil’s in the details.
The major sources of natural vitamin B vitamins are wheat and yeast. Well, if you have candida-a constant concern with thyroid and adrenal problems-you don’t want to throw yeast down the old hatch. Same thing if you have a mold allergy.
And wheat? Anybody with a digestive system dancing the fandango should consider the possibility of an allergy. Medicine’s finally realizing the disaster of one such, a sensitivity to gluten. And no wonder since they’ve pumped the gluten content in today’s wheat way, way up-because it makes bread “fluffier.” So much for natural.
Natural vitamin C, meanwhile, often comes from corn-to which untold numbers of people are allergic. And who knows if the corn is genetically modified, as most of it is?
A lot of vitamin pills contain corn starch as a binder, which is why I talk about capsules so much-not so many fillers.
And natural vitamin E tocopherols can come chock-a-block full of evil soy. And some E comes to us from wheat germ, which, of course, takes us back to the whole gluten story.
On the other hand, some vitamins, like vitamin A, are better in their natural, animal-based form. Which means, of course, that most vitamins offer us synthetic, plant-based forms of vitamin A.
And natural, plant-based vitamin/mineral products come up way short in minerals, too. Since almost all of us are mineral deficient, this is a very bad thing.
So, what about synthetics then? Well, it depends. Our bodies are happy to join forces with synthetics that look like the real thing, bio-identical as it’s called, but sometimes the supplement people decide they have a better idea.
And maybe their idea looks good on paper. A lot of things look good on paper. I used to write software, and I guarantee you everything I wrote looked swell on paper. But sometimes when a computer got its innards on my fabulous code, things fell apart. In fact, I’ve been known to yell at computers for their intransigence, for all the good it did me.
Our bodies are like that, too. If something unrecognizable comes down the hatch, things fall apart. Not as quickly as with a computer, though, and that’s a pity. The sooner we know, the better off we are.
So, it’s not just any natural, and it’s not just any synthetic.
Let’s talk, then, about a natural turned into a synthetic. It’s called an isolate, wherein they strip away all the so-called extra parts of something natural to get down to the “active ingredient.” They isolate it.
Our bodies don’t think much of isolates. Fact is, they don’t recognize them without their missing parts and start defending themselves against the foreign attacker.
This is how a lot of prescription drugs do us in. It’s a big reason why “properly prescribed, properly taken” prescription drugs kill more than 100,000 people a year in the U.S. alone.
To get a patent, pharmaceutical companies have to come up with something that doesn’t naturally occur in nature. (Well, that’s the law, which is sometimes observed, sometimes not.) Patents generate the big bucks. Big, big, big bucks. Really big bucks. Really big.
And so we get isolates, which never occur in nature, alien life forms that they claim will make life better. Riiight.
And it’s not just prescription meds. Big Pharma’s muscling into the vitamin/mineral world, too.
When vitamin D hit the news, pharmaceutical companies jumped all over it, racing to get a patentable version by isolating one part of the whole. Last I heard their “new, improved Vitamin D” was bumping people off instead of doing them any good.
Just say no to isolates.
And stay alert. As you see, just any old vitamin or mineral won’t do.…
Arthritis can reference more than 500 different conditions, which affect a similar number of joints. Rheumatoid arthritis is the most common kind. This type of arthritis typically manifests itself during the later years, and if not treated properly, it can force unpleasant and far-reaching changes on one’s lifestyle. This below article discusses valuable information about arthritis.
Reduce the stress in your daily life. Stress causes your body to release the neurochemical cortisol, while causes inflammation. People with arthritis should know that inflammation is the main cause of the pain and stiffness of arthritis. Reducing stress reduces your body’s production of these chemicals, which relieves your symptoms.
If you are a smoker, consider quitting, and if you don’t smoke, avoid cigarettes. Nicotine reduces the blood flow to the extremities which can reduce inflammation short term. You should understand though, that this lessened blood flow can cause significant damage to your joints, which will result in greater arthritis symptoms.
Be sure to move throughout the day. Remaining in the same position for a long time puts more stress on your joints than if you shift positions. Be sure to take regular breaks to stand and stretch and make sure that your work environment is set up to allow you to protect your joints.
Discuss your arthritis with the younger members of your family. Small children may be concerned that you are injured if you are using wrist splints or walking aids. Discuss the condition with them at their level, so they can understand without fear and perhaps even assist you during a flare-up.
If health is an issue, consider implementing a weight loss and fitness routine. Weight is often a factor causing pain for people who suffer from arthritis. By just losing a few pounds, you can reduce the amount of pain you suffer. You’ll surprise yourself at how good you’ll feel just by losing a few pounds.
You may want to consider using celery seeds if you suffer from chronic arthritis. Not only are these seeds natural and healthy, but they help to reduce some of the swelling that is associated with arthritis pain and other chronic conditions. You can purchase these seeds from many health food stores.
Make sure you are getting enough sleep. The stiffness and pain that is common in arthritis can lead to debilitating fatigue, and many of the treatments for the condition can also cause fatigue. Do what you can to ensure a good night’s sleep every night, and you’ll feel better and be healthier.
Research the various forms and symptoms of arthritis. Research the many available resources available to find information regarding diet, exercise and pain control. If you take the time and do the research, you will discover new treatments and techniques to help you cope with and prevent the pain of arthritis.
One of the most effective ways to fight rheumatoid arthritis is to take care of your body. Reducing your risk factors can go a long way in helping you to live a healthy life without arthritis pain. Hopefully, the information that has been provided in the above article has offered you some practical information to apply to your situation.…