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The National Association of Home Care and Hospice (NAHC) has released preliminary data specific to the early PDGM claims and trends. This is our first opportunity to be able to begin benchmarking performance compared to the trends that are occurring across the industry. Below you will find various different metrics that can be used to compare your agency performance under PDGM to the national averages of claims data submitted thus far. 

The Patient Driven Grouping Model (PDGM) was implemented January 1, 2020 and changed reimbursement models of Medicare home health services from therapy utilization driven to patient characteristics. While this has allowed for a focus from quantity to quality, some home health agencies are restricting therapy visits and placing their quality measures, Star Rating, and most importantly patient outcomes at risk. CMS calculates Star Ratings through several areas therapy may influence including, ambulation, bed transfers, bathing, discharge location, and rehospitalizations.

CMS issues warning to home health agencies – don’t aggressively change your therapy utilization! 

“There is no need to drastically change behavior,” says Senior Vice President of Home Health Operations David Jones. “In fact, agencies that do are at risk under the watchful eye of CMS.”

In the past years, overutilization of therapy had been a concern for CMS as most agencies were using therapy as a driving force for reimbursement under the previous prospective payment system and had identified significant overutilization of therapy visits by as much as 30-40%. However, audits revealed that nursing visits were also over utilized along with therapy. One would assume that nursing should be equally held accountable under PDGM for patient improvements as well and not assume that they get a free pass. However, there has been no reduction in the nursing salaries, workforce, or in their allowed patients visits thus far under PDGM by most agencies. Nursing visits were never a factor contributing to reimbursement, yet are still valued as an integral contribution to a home health episode. Therapy should not be different. PDGM does eliminate therapy-visit volumes as a determining factor in calculating reimbursements, but that does not mean that the need for therapy has changed. Therapists are strategically positioned to promote, enhance, and improve a patient’s functional abilities in the realm of home health; however, there are barriers to their services because of some agency practices. This may include reduction in therapy visit utilization, frequency or restricting disciplines.

With one month since the PDGM transition, the industry asks, “How can we assure and measure whether our teams are successfully navigating the transition to PDGM?” Jason Sasser, PTA/CWT/CSST/ COQS, Vice President of Clinical Strategies, HealthPRO® Heritage at Home, reflects on the industry’s most pertinent questions related to PDGM best practices and how to measure success. 

Review Choice Demonstration came to Ohio September 30^th, 2019 and hot on its heels is PDGM. The more prepared you are for all of the changes that come, the better poised your agency will be in the coming months and years.

The Patient-Driven Grouping Model (PDGM) is almost one week underway! In order to assist with the transition to PDGM, CMS has updated OASIS data collection. These revisions include the addition of two new items and change twenty-three existing items as optional at some OASIS time points. Let’s breakdown the changes. 

PDGM Implementation is Tomorrow! 
In 2019, we've published extensive break-downs of the things you may need to know about therapy in Home Health Agencies and Senior Living facilities. 

Inclusion of therapy in an interdisciplinary care plan under PDGM represents one of the greatest opportunities to impact patient outcomes and patient satisfaction.

HealthPRO® Heritage at Home is fully prepared to bring its expertise and resources to home health agencies looking to strategize and succeed under PDGM. Among the many offerings to agencies are [+ downloadable checklist*]: