PDGM – Clinical-Episode Management

Survival is key, as home health providers brace for PDGM, the largest change to home health reimbursement since the implementation of PPS in 2000. The complexity of the new PDGM payment model is overwhelming, with 432 different case-mix groups, 12 different clinical groupings and LUPA thresholds ranging from 2 to 6 visits. When adding the significance surrounding the model’s shift to 30-day payment periods, providers need to be proactive in seeking support to effectively interpret and navigate this new and extensive regulatory payment environment. Agencies will be expected to significantly change day-to-day operational practices to ensure success under PDGM, which must start with further development of all executive and clinical leaders. A strong clinical episode management program is critical to ensure sustained, efficient, cost-effective and uncompromised quality care delivery under the PDGM program.

PDGM – Data/Preparation

The Patient-Driven Groupings Model (PDGM) will be implemented on January 1, 2020. This is the biggest change to the home care industry since the introduction of the prospective payment system in 2000. The new payment system dramatically impacts agency operations, processes and performance. Agencies must develop and implement plans to successfully transition to PDGM. This session will discuss key areas, strategies and processes in preparing an agency for PDGM.

PDGM – Financial

Thriving under the PDGM payment reform requires a clear understanding of how PDGM will affect financial outcomes in a home health agency. This session explores the fundamental steps necessary for home health agencies to assess the impact of PDGM on their operations and determine specific implications for budget and cash flow.

PDGM – Therapy

Since the inception of PPS in 2000, home health payments have been based on a 60-day, therapy-driven model. Adjustments to the PPS payment model have been made over the years due to CMS identifying therapy utilization as a poor indicator for payment. In fact, although a higher level of therapy professionals has been utilized throughout the industry, higher clinical STAR and Home Health Compare outcome ratings have not followed suit. This session will teach you how to operate in a model where every discipline is valued the same. We will provide valuable examples of best practice agencies with lower therapy utilization who continue to demonstrate high quality outcomes based on Home Health Compare scores and STAR ratings. This session will discuss methods to ensure cost-effective therapy discipline utilization under PDGM without compromising quality patient care. We will discuss how alternative disciplines may be used to support therapy plans of care and reduce the number of high-cost therapy visits needed to meet patient goals. In summary, this session will also equip you with the valuable comparative best practice information necessary to evaluate your existing agency therapy program and implement appropriate discipline utilization and alternative best operational practices to ensure success under PDGM.

Home Health | Hospice | Business Leadership | Patient-Driven Groupings Model (PDGM)