Welcome to the HealthPRO Heritage Blog

Achieving Agency Growth Under PDGM

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.

In order to be successful in the new world of PDGM, health care providers, regardless of service line, can no longer operate in a silo.  The importance of establishing cross-continuum, upstream and downstream partnerships is more necessary than ever.  During the multiple NAHC PDGM Summits that took place earlier in the year, the constant theme was diversification of both your referral sources and your case mix to support other internal efforts to stabilize your agency in 2020 and beyond.

Over the course of the past several months, HealthPRO Heritage has talked with our agency partners regarding their analysis of current referral sources to observe trends, identify service failures and/or reaching out to re-initiate contact, if needed. Solidifying current partnerships is an obvious focus, but what about securing relationships with non-traditional referral sources such as group homes, physician practices, hospice agencies or even other home care providers who do not have specialized programs or contracts with insurance carriers?

During the first months of PDGM education regarding the new “Admission Source” factor, agencies had formed a reactive plan would strive for more institutionalized referrals and in turn, be pushing away from community-based referrals.  However, ignoring community referral sources can result in missed opportunities as they support fluctuations in institutional referrals and may even reimburse at a higher rate than originally assumed. Physician practices as well as freestanding AL/IL communities can help keep agencies afloat with consistent referrals.  Community referrals will also aide in stabilizing overall census because you have the opportunity to establish a preferred partnership through consistent communication and quality care.

Additionally, a key factor in achieving agency growth despite PDGM changes is knowing the strengths of your team.  Who on your clinical team excels in wound care, lymphedema, IV training, or has specialized certifications?  Along those same lines, having knowledge of other agencies specialties, the demographic area you serve, as well as your community and local care facility needs helps your agency to identify niche growth opportunities. If you are seeing a trend in increased lymphedema patient referrals and the closest lymphedema clinic is 100 miles away – perhaps you should start recruiting clinicians with lymphedema experience and market to the referring sources. HealthPRO Heritage can assist your agency in identifying market niches by utilizing market data to drive the development of specialized programs.  

With HealthPRO Heritage’s vast infrastructure, we are prepared to help you execute and succeed in building relationships throughout the continuum. In addition to our stellar operations team, we have a business development team who can assist in developing collaborative care management processes as well as provide an innovative perspective on niche markets and specialty programs.

Click here for the full printable article. 


Tags: Home Health, PDGM