The right PDGM strategy

Strategic moves could help agencies stay in the game during unprecedented challenges ...

COVID-19 has been a game-changer for most home health agencies, impacting not only how we see our patients and develop effective plans of care for them, but how we prepare for surveys, meet supervisory requirements and implement our QAPI (Quality Assessment and Performance Improvement) plans.

The timing of the coronavirus pandemic could scarcely have been worse, coinciding with the first months of a major overhaul of Medicare’s payment model, the Patient-Driven Groupings Model (PDGM.)

For six months, agencies have navigated their way through Medicare’s new patient-specific reimbursement variables. Up against shorter billing cycles and stricter diagnosis requirements, agencies have had to outrun the calendar, educate referring physicians and make certain their own staff follow stricter rules and new deadlines.

They’ve also had to re-engineer care pathways to effectively use resources without the comfort of familiar threshholds, and determine how and whether new provider flexibilities from the Centers for Medicare and Medicaid Services (CMS) might best be used.

And they’ve done it all while scrambling to outfit staff with basic PPE, the personal protective equipment needed for infection control.

“If we’re looking to describe 2020 in one word, how about ‘Whew!’,” said J’non Griffin, owner and president of Home Health Solutions, a nationwide consulting and outsourcing firm for home health, hospice and long-term care.

“We were expecting home health to be shaken by the implementation of PDGM in 2020, but the pandemic has created an environment of unprecedented challenges,” she said.

Five essential steps

J'non recently partnered with Annette Lee, founder of the Iowa-based consulting firm Provider Insights, to take stock of the challenges impacting home health providers over the past six months.

They sifted through all available data from the first quarter and most of the second quarter of the year to identify certain key elements for financial and operational change going forward.

“Five essential steps became clear as we analyzed the data to determine what has worked and what hasn’t worked during the first half of PDGM’s inaugural year,” Annette said.

Annette outlines those five steps in a new educational webinar she has recorded for Home Health Solutions. The webinar reviews and dissects current PDGM information, explaining which data was used, how it was investigated, how it compares to expectations – and outlines how home care providers should act on the information.

“These steps will ensure that even during a pandemic, your agency will prevail with PDGM,” Annette said.

The recorded session also includes information on the impact of COVID-19.

“Providers need direction in using the flexibilities provided by CMS and addressing the barriers to patient care that have never been witnessed before,” Annette said. "These issues are also addressed during the webinar."

he webinar will be available for purchase in the Home Health Solutions online store, The Solutions Shop, on Friday, June 26.

A sixth step, too

The teamwork between J’non and Annette to produce the new webinar highlights an additional, sixth step home care providers may want to consider in developing a new strategy for success in 2020.

“Strategic partnerships are essential for success in today’s marketplace,” J’non said. “This is the time to get creative and consider new ways to bring about the costs savings and time savings that your agency needs for maximum productivity.”

Collaborative efforts can yield substantive rewards for providers, she said. “If you haven’t considered outsourcing some of your agency’s services to shore up the bottom line, 2020 is definitely the year.”

Partnering with Annette to produce a series of webinars has enabled Home Health Solutions to meet the increased demand for guidance from home care providers during the pandemic.

Annette has previously recorded “Hospice Care During a Pandemic” and “The Who, What & When of Medicare Notices” for Home Health Solutions. Both webinars are available for purchase in The Solutions Shop.

“We’re excited to be able to work with Annette to expand our offerings and make more educational products available to our