There’s no turning back. PDGM will soon move Medicare towards a more value-based, outcome-driven payment system that puts the unique care needs of each patient first. The upcoming changes under PDGM have dominated the dialogue (and planning) in your industry since the new model was announced. Yet, you still have uncertainties about how you and your staff can balance patient care and business success when PDGM arrives.
PointClickCare and HomeCare Magazine recently presented a webinar on how providers can best prepare their staff for PDGM. Our panelists were Susan Jirsa, BA, BSN, RN, COS-C, HCS-D, Director of Medicare Education for Recover Health; Bryan Casey, Regional Director of Operations for Continuing Healthcare Solutions; and Erin Sprando, Director of Operations for Marquis Companies.
Tracking and Training are Fundamental to Staff Preparation
Our panel agreed that tracking and training are most important in any agency’s preparation for PDGM. With the advent of new workflows, you and your staff need a clear picture of where you stand statistically today – and how that may or may not change next year. Here are some key patient metrics you should be tracking now:
- Current census by case mix
- Outcome and Assessment Information Set (OASIS) reviews
- Profit by payer
- LUPA episodes
- Rehospitalizations and emergency department (ED) visits
- Lengths of stay
- Community vs. institutional admissions
- Accuracy of diagnosis codes and clinical documentation
- Therapy utilization
It’s also essential to educate everyone – administrators, billing managers, order management trackers, intake staff, case managers, admission nurses, sales and marketing, therapists, home health aides and physicians and other providers – on the basic tenants of PDGM and how it will affect their jobs. If you haven’t done so already, create a steering committee with representation from all roles, to ensure that everyone understands the new model and what changes must be implemented.
Eliminate Clinical Staff Concerns
PDGM has caused your HHA clinicians to worry, with rumors of doubled workloads or layoffs running rampant. If you’re not already working with your clinical staff to evaluate your current situation, begin now. By involving them in the upcoming changes, you will empower them to manage transitions appropriately. Our panel suggested other ways you can help the clinical staff prepare for PDGM:
- Improve documentation to support coding choices
- Promote care plans focused on patient outcomes
- Meet regularly to discuss visit projections
- Consider alternative approaches, like telehealth
PDGM will require greater collaboration between the nursing staff and therapists, so teach them how to work as multi-disciplinary teams. You might also consider the potential use of rehab aides – highly trained home health aides who would be billed accordingly for therapy patients.
Train Your Intake Staff on the Basics
With the new diagnosis codes, LUPA modifications, less data from the OASIS, and other PDGM requirements, your intake personnel also will have more on their plates. Prepare them to collect more information up front than they did under PPS, by training them on the fundamentals of ICD-10 coding, and teaching themto be more vigilant about verifying insurance information and admission details.
Technology Solutions Can Ease the Transition
As our panelists have found, the right technology can help your staff – from back office to clinicians – make the transition to PDGM as smooth as possible. Check out our PDGM Calculator to find out how your business will perform under the new model. As you consider necessary changes to accommodate PDGM, look at how our home health cross-continuum technology solution can make you more compliant, reduce adverse health events, improve communication, and enable you to get paid faster.
Listen to the full webinar, to hear more advice from Susan, Brian and Erin on preparing your staff for the new model. By acting now, you’ll be able to confidently face the new quality-driven home health world in 2020 and beyond.