How to Prepare for Successful PDGM

How to Prepare for Successful PDGM

The Patient-Driven Groupings Model (PDGM) is the new payment model for Medicare Part A for home health services that takes effect January 1, 2020. While the Centers for Medicare & Medicaid Services finalized this new case-mix classification model in 2018, many months later, a lot of preparation is still needed to make sure both the executives and clinicians are ready for when everything goes live.

Following is a list of five areas that need to be considered before PDGM becomes effective:

  1. Develop a Plan

January 1, 2020 will be here before you know it. So it’s important to have all the pieces in place before that to ensure you’re ready and you understand your data, staff, contracts, referral source data, and systems and processes. While this may seem daunting, Casamba has developed a milestones checklist to help you develop and understand the key elements of planning for PDGM. Click here to download the checklist.

  1. Calculate Expected Payments

CMS’s interactive grouper tool, is a great way to get a head start on understanding potential payments with PDGM.  While some critics suggest this tool may not provide exact information, it is useful in helping agencies get some perspective on how things will evolve. As it relates to the grouper tool, Kenneth Miller, chair of the practice committee for the home health section of the American Physical Therapy Association, told Home Health Care News, “My recommendation is don’t change utilization patterns…Continue to provide the care that’s necessary. If you notice with the PDGM grouper [tool] you’re losing money, see where you’re losing money, whether it’s an over-utilization of care [or] do you have too many recertifications? LUPAs?”

  1. Communicate with your Staff

According to a recent Casamba survey, a lot still needs to be done for clinicians to be up to speed on the new payment system. In fact, less that 33 percent of healthcare executives surveyed said they either “Agree” or “Strongly Agree” when asked if their staff understands the elements of PDGM. When asked of their own understanding, more than 80 percent these same respondents either agreed (50 percent) or strongly agreed (31 percent), almost 2.5 times that of their staff. Regular communications with staff about key topics will go a long way in improving clinician understanding of PDGM and, ultimately, facilitating the overall transition.

  1. Be Ready for Wound Care

One area that shouldn’t be ignored in this lead up to PDGM is wound care. According to a May 2019 story in HHCN, wound care is “one of the most frequent clinical groupings and the one utilizing the most in terms of home health resources.” The story goes on to note that in preparation for wound care, home health providers should train staff and ensure that they have the right staff – including those with specific certifications.

  1. What about Telehealth?

PDGM is a cause of a lot of concern for therapy services. One possible solution is an increase in telehealth and telemonitoring. Ellen Strunk, president of Rehab Resources and Consulting, told HHCN, “Under PDGM — where visits don’t drive revenue, it’s just the skilled service that matters — [telehealth] is not going to be a strictly plus or minus to the bottom line, but the potential for the positive is there.”

PDGM is a significant payment model change. Like any major change, preparation is critical in ensuring a smooth transition and helping deliver the best potential outcome for all. By following the preceding steps, you’ll be well on your way to making January 1, 2020 a day not to be concerned about, but embraced.


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How Telehealth Can Solve Home Health Agencies’ PDGM Therapy Problems

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