Inclusion of therapy in an interdisciplinary care plan under PDGM represents one of the greatest opportunities to impact patient outcomes and patient satisfaction.
What’s to Come?
When PDGM takes effect January 1, 2020, home health providers will begin navigating in earnest the vast changes the Centers for Medicare & Medicaid Services (CMS) is bringing to reimbursement. Among those changes are payment for therapy services.
- Under the current PPS reimbursement model, therapy utilization is a service add-on.
- Under PDGM, Medicare will no longer reimburse for therapy utilization alone as a payment rate determinant.
Instead, providers will receive a bundled payment for all services which can then be allocated, as they see fit, based on patient needs. The new model takes an interdisciplinary, patient-need driven payment approach to the home health benefit.
Under PDGM, CMS has identified 432 different clinical groupings to categorize patients for reimbursement. What home health agencies need is a framework that reverse engineers these groupings by providing an analytical approach to care delivery that meets the patient’s needs.
HealthPRO Heritage has created such a framework: Our Care Pathways to Success is a proprietary calculator and clinical best practice tool for determining therapy utilization. As a care planning solution that delivers on both care and cost management, the Care Pathways to Success results in a triple-win:
- Patient receives appropriate care
- Home health provider achieves positive outcomes
- Health system at large benefits from utilization that is in line with patient needs
Gross margins under Care Pathways to Success have been in line with best-in-class industry benchmarks. Those are significant margins: A survey conducted by BKD CPAs & Advisors and Strategic Healthcare Programs* showed that gross margins for the best 25% of home health providers were 54%.
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The above blog post is an excerpt from the December 18, 2019 article “Embrace Therapy Under PDGM for Outcomes Excellence” written by Home Health Care News in partnership with HealthPRO Heritage.
* BKD/SHP presented results of its Benchmark Leader Survey at the National Association for Home Care & Hospice (NAHC) Conference and Expo in October 2019.