Welcome to the HealthPRO® Heritage Blog

Trick or Treat? CMS Releases Final Rule for Home Health CY2020

Posted on: November 1, 2019

October 31, 2019 – As expected, CMS finalized the significant payment model change for Home Health services starting in 2020. The Patient-Driven Groupings Model (PDGM) will start with any new patient episodes on or after 01/01/2020.

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Tags: Home Health, Final Rule, PDGM, Patient-Driven Grouping Model

Four Pillars of Success for PDGM

Posted on: October 21, 2019

Over the course of the last several months we have pushed out education across multiple platforms on how HealthPRO® Heritage at Home can help you Prepare, Execute, and Succeed in PDGM. We are now into a time for final preparations  with only 11 weeks left until the January 1st 2020 implementation date.  This blog highlights the four pillars of success under PDGM.  

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Tags: Home Health, PDGM, Patient-Driven Grouping Model

LUPA Management: Avoiding the 4 Letter Word

Posted on: September 27, 2019

LUPA (Low Utilization Payment Adjustment), the 4 letter word that we have all been trying to avoid under the current PPS system.  Just when we thought we had it under control, CMS has decided to add a whole other level of complexity with PDGM.  The challenge to managing LUPA’s under PDGM will be two-fold; a “moving LUPA” for each 30-day payment, and the need to meticulously manage visits within each of those 30-day windows to avoid that LUPA. 

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

Achieving Agency Growth Under PDGM

Posted on: September 11, 2019

With PDGM a mere 3 months away, agencies need to focus not only on preparing for the biggest change to Medicare reimbursement in 20 years, but also be diligent in developing their 2020 marketing plan to ensure successful growth. Home care is uniquely positioned as one of the lowest cost options for skilled care and is available to patients who adhere to the home bound status. One aspect that does not change with payment reform is the ongoing need for quality and value based care delivered in the home.

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Tags: Home Health, PDGM, Patient-Driven Grouping Model

Will You Sink or Swim in PDGM? Care Pathways to Success

Posted on: August 28, 2019

Is your current therapy company or in-house therapy team equipped to help you prepare, execute and succeed under PDGM?

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Tags: CMS, Home Health, PDGM, Patient-Driven Grouping Model

Intake Isn't Just Intake Anymore: Important Steps in PDGM Referral Processing

Posted on: August 13, 2019

Five, ten, and fifteen years ago, the intake department was just that: Intake. Taking in the information given to them from a referral source and performing the necessary data entry. As we prepare for the new world of PDGM, the Intake Department will be an integral part of the team.

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Tags: Home Health, PDGM, Patient-Driven Grouping Model

CMS Issues Updated Home Health Proposed Rule - Taking the Good with the Bad

Posted on: July 12, 2019

On July 11, 2019, Centers for Medicare & Medicaid Services (CMS) issued the 2020 Home Health Prospective Payment System (PPS) Proposed Rule (effective January 1, 2020). While many of the provisions in the original Patient-Driven Groupings Model (PDGM) remain unchanged, the home health experts from HealthPRO® Heritage at Home offer the following summary of important updates:

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Tags: PDGM, Patient-Driven Grouping Model

Focus on Functional Assessments

Posted on: June 26, 2019

It can be easy to get lost in the details of PDGM and forget how vital outcomes and ratings are in driving overall agency success.  It’s one of the biggest reasons why appropriately managing therapy in PDGM is a key competency.

In HealthPRO® Heritage at Home's recent survey with the National Association for Home Care and Hospice regarding therapy in PDGM, 48% of respondents anticipate less therapy utilization. Agencies should be cautioned on cutting therapy utilization given the focus on functional assessment and outcomes.  Functional assessments - completed best by a skilled therapist - will contribute significantly to payment in PDGM, while also continuing to drive publicly reported outcome measures and star ratings.

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

Does In-House Therapy Make Sense Under PDGM?

Posted on: June 5, 2019

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.

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

Exclusive Prep for PDGM

Posted on: June 3, 2019

HealthPRO® Heritage at Home is leading the industry in readiness for the January 1, 2020 change to the Patient-Driven Groupings Model (PDGM). Success for both our partner agencies and employees will be driven through knowledge and implementation of process and strategy around PDGM.

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