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Does In-House Therapy Make Sense Under PDGM?

The Patient-Driven Groupings Model (PDGM) is a game changer, requiring home health providers to explore new business models based on the introduction of new risks and potentially significant financial impacts.

Therapy structure is a prime example of an area that is ripe for change! In fact, home health is one of very few post-acute care settings with a high percentage of in-house therapy operations. As a result, a natural question for those out of the box thinkers is whether carrying the full risk of in-house therapy is sustainable under PDGM?

PDGM will pressure test home health agencies in several ways, most notably as outlined below:

  • Census volatility/changes in patient mix;
  • Revenue cycle/cash flow shortfalls;
  • LUPA threshold management;
  • Nursing skill/documentation;
  • OASIS coding & scoring;
  • Demonstrable patient outcomes & quality measures; and
  • Diagnostic coding.

Questions Worth Asking: While in-house therapy has historically carried many benefits, are agencies better served focusing their energies on managing these critical competencies while engaging an expert to manage therapy? Does staffing therapy, recruiting, credentialing, training, scheduling and managing personnel along with assuming the benefit load and, ultimately, the full cost risk of this workforce still make sense? 

In the alternative, consider an opportunity to de-risk, shed related ancillary back office costs, and engage the expertise of a therapy organization that can add value to your agency’s approach while bearing the risks of therapy specific expertise and related PDGM performance. 

The key areas supported by an effective outsourced contracting approach (based on HealthPRO® Heritage at Home’s contracting model) include:

  1. Recruiting & Hiring: The therapy company incurs all recruitment costs and supports a dedicated team of recruiters with a sole focus of reaching the right candidates, screening, conducting full qualification reviews, hiring, and on-boarding therapists. This includes 35+ hiring functions that your agency no longer has to perform. 
  1. Training: The therapy company creates, delivers, and assesses adoption rate for all training at no additional cost to your agency. Training includes up-to-date regulatory/best practice approaches, home health specific documentation, OASIS and Functional Scoring competency, plus quality assurance and compliance education for new and existing therapy staff. 
  1. Scheduling: All you need to do is send the referral! The therapy company employs and maintains a trained workforce to coordinate and schedule prompt therapist coverage. This team collaborates with your agency staff on patient scheduling specifics and visit frequency, handles all patient calls and concerns, communicates changes, and schedules all 30-day reassessments and discharges.
  1. Supervision: The therapy company bears the responsibility for supervising therapy staff. Our OASIS-certified, locally-based clinical supervisors ensure that all staff have the resources and support they need to be successful, including the assurance that agency and regulatory policies and procedures are observed at all times. 
  1. Case Conferences & Patient Updates: The therapy company is responsible for patient care collaboration, including provision of regular patient updates to assure successful implementation of patients’ individualized care plans and support outcomes attainment. 
  1. Managing Costs/Effectuating Savings: Contracting therapy enables you to employ a variable cost model vs. maintaining the fixed costs associated with in-house therapy. Finding the right partner who knows your market, has proven ability to bring qualified, trained therapy staff and a collaborative care approach, and offers a level of PDGM expertise will help position your agency favorably at a critical time in our profession.

For more information about how we can help you navigate PDGM or our innovative contracting models, contact us at:  homehealth@healthpro-heritage.com

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Tags: PDGM, CMS Update 2019, Patient-Driven Grouping Model