Checkpoints for PDGM success

 In Podcasts, Reimbursements

At a couple of recent national and state conferences for home health and hospice I’ve attended, many of the education sessions have been devoted, not surprisingly, to PDGM. Knowledgeable people gave sound advice on ways to manage the new rules of PDGM and come out on the other end with excellent patient care as well as enough revenue margin to stay in business.

Three main areas kept coming up from the speakers, which are recapped here:

  1. Precise coding is critical. Of course it is, Captain Obvious. But how you get that precision may not be so obvious. A key component is in better education and communication with your referrers. Face-to-face encounters between highly trained members of your admissions team and the referrer will help yield the best results – especially if you want to capture all appropriate comorbidities for treatment and reimbursements. And if you’re not already using certified coders for your PDGM data entry, you certainly should be.
  2. New thresholds on therapy visits will require new utilization patterns. With changes to what was previously the greatest revenue driver for home health agencies, utilization of services and related staff will shift away from a higher volume of therapy visits to other forms of case management. How will you adjust patients’ care plans for staff members to provide excellent care with fewer therapy visits to the home? How will you manage your patient case load to adjust? Will you change your patient mix? Will telemedicine replace a portion of your previous therapy visits? Your strategy to adjust to this significant change is vital to your future success.
  3. Staffing and scheduling will be crucial for avoiding LUPAs. With the new 30-day payment periods, providers are expressing concerns about a potential increase in LUPAs, especially during the second payment period. Case management often dictates front-loading visits and treatments during the first period, particularly to assure a hospital readmission doesn’t happen. Some providers are saying that even if they can schedule enough of the right kind of encounters to avoid LUPA thresholds in the second payment period, they currently may not have the proper staffing mix to fulfill those appointments on schedule. One wise and experienced speaker said perhaps providers need to consider incentives for their current staff to meet scheduling demands. For instance, would an RN do a home visit on a Saturday for an extra $50 or $100 if that visit avoided a LUPA and the $1,100 “adjustment” on reimbursement? The math would certainly come out in the provider’s favor. Food for thought.

Would you like more insights on checkpoints and opportunities for succeeding in the PDGM era? Listen to our interview featuring Mark Hunt, vice president of the home health division of Covenant Care embedded at the beginning of this post or on Apple Podcasts.

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