Home Health LUPA Trends at a Glance

Key takeaways from McBee Market Reporting analysis of CMS Q1 2020 PDGM claims data.


Want to know where your agency stands in comparison to national data? Get started with our Episode Management Analysis. 

Discover opportunities to mitigate avoidable LUPAs, optimize reimbursement and establish new care patterns into culture. Our Episode Management Analysis gives insight into your agency’s LUPA rates by period, clinical group, and early/subsequent payment periods. Learn more about our services and how McBee can equip you with the right resources and sustainable strategies to adapt, innovate, and thrive as you help to lead the future of community-based care.

McBee Market Reporting

With McBee PDGM Market Data & Analytics Reporting, our data experts dive deep into your agency’s claims data to highlight some of the most important areas to leverage for success under the payment model.

  • Over/Under Utilization STAR Ratings Dashboard – Compares your visit patterns for the selected clinical grouping, primary diagnosis, and HHRG against the national average of four- and five-STAR agencies. This dashboard summarizes the visit patterns of top STAR rating agencies against your visit patterns to understand where over or under utilization may be taking place within your agency.
  • Visit Pattern Dashboard – Highlights the average number of visits by discipline, by week for the selected clinical grouping, primary diagnosis, and HHRG based on the visit data reported on the claim. This dashboard helps you understand your average care plan utilization with comparison against the HHRG’s LUPA visit threshold to identify deviations from care plans that could potentially result in a LUPA.
  • LUPA Risk Dashboard – Defines the top clinical grouping, primary diagnosis and HHRG that results in a first or second 30-day LUPA based on your 2019 and Q1 2020 claims data. Under PDGM, the LUPA threshold ranges from 2-6 visits. This dashboard allows you take a closer look into your biggest LUPA risk areas to assess the reasons for LUPA, care plan enhancements, and opportunities to maximize clinical outcomes.