M items tied to payment under PDGM

Functional status will impact expected resource use and reimbursement under new PDGM model

When calculating reimbursement under the current Medicare payment model, home care providers are not used to factoring in the risk of re-hospitalization or how well a homebound patient can groom himself or herself as well as dress, bathe or transfer to the toilet.

But functional items will matter much more under the Patient-Driven Groupings Model (PDGM) taking effect in January 2020, which uses a complex new payment methodology driven by variables which include the patient's impairment level.

As home care providers take a harder look at expected resource use due to functional deficits, they may want to include staff training in the OASIS-D assessment in their PDGM preparation, according to J’non Griffin, owner and president of Home Health Solutions.

“Certain M items are taking on increasing importance in determining payment under PDGM,” she said. “Some of them, including the patient’s risk for re-hospitalization as well as certain functional deficits, will be of greater significance in calculating payment. That makes it crucial for clinicians to understand how to accurately answer these OASIS questions.”

Traditionally, it has been clinicians who have prioritized OASIS training, with agency decision-makers tending to prioritize other expenditures.

“But the new payment model calls for new thinking about the importance of training to an agency’s overall success,” J’non said. “The OASIS has always been significant in outcomes, reimbursement, star ratings and more. Under PDGM, it becomes even more so. Agencies looking to be successful under the new model are going to need to get serious about staff training."

Under PDGM, each 30-day period of a patient’s home care will be placed into one of three functional impairment levels – low, medium or high -- based on certain OASIS questions. The impairment level determines the expected use of resources during the 30-day period and will be factored into a complex methodology used to calculate payment for the episode of care. Certain other variables will also be factored into the calculation, including a clinical grouping classified by primary diagnosis, co-morbidities, admission source and whether the current 30-day period is the first or a subsequent episode of home care.

Need group training for OASIS-D?

To help make group training more affordable to agencies preparing for PDGM, Home Health Solutions is currently offering a substantial discount on OASIS-D training for 5. The Class Act package covers 5 attendees for a two-part, 7-hour webinar covering all OASIS-D items, old and new.

During the webinar, J’non provides detailed explanation for how to accurately code all M items – including those functional ability items increasing in significance under PDGM – as well as all the confusing new GG items on OASIS-D.

Can’t get everyone at your agency together for training? No problem. The Class Act package makes the webinar available for viewing at the convenience of each individual attendee!

The Class Act package for 5 is just $699 during this limited-time sale. Visit The Solutions Shop now to check it out! Looking for PDGM training? Home Health Solutions can help your agency prepare for PDGM with an operational analysis and staff training. Contact us today to ask for more information!