Top Anxieties Around PDGM, and How PointClickCare Can Help

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Over the past few months, PointClickCare has been connecting with providers large and small to find out how they feel about PDGM. Through various educational webinars, workshops, and poll questions, we have found the following topics to be top of mind for many home health and home care agencies. In this post, we provide our readers with our responses to each of these hot topics.

1. Comprehension

In one of our recent webinars entitled, How will PDGM Affect You? attendees were asked: How well do you understand the new PDGM rule?

  2.3%    Very well. We already have a plan in place.  
  74.4%    I am somewhat familiar with the rule but could use some help.  
  18.6%    I’m freaking out! I don’t know where to start.  
  4.7%    What’s PDGM?  

Our response: In response to the need for added PDGM education and support, we have launched our PDGM Resource Center. Providers can visit this page to view all our PDGM materials as they roll out throughout the year including: monthly webinars, checklists, eBooks, and more.

2. Wants and Needs

During one of our Market Advisory Committee (MAC) workshops, participants were asked to outline their most acute wants and needs. Top responses include:

  1. Education: webinars, reading materials and guides
  2. Product roadmap with timelines from their EHR vendor
  3. Tools that outline risks
  4. Tool to predict current payment vs. payment under PDGM

Our response: As mentioned, our PDGM Resource Center houses all our education materials. One interesting thing you might find is a Product Roadmap with timelines. We are also planning on providing agencies with tools that outline risks, such as a system that will alert the inputter if the Principle Diagnosis is outside of one of the 12 Clinical Groupings and a Missed Visits Alert, so agencies can do what they can to avoid LUPAs when a visit gets missed. Later in 2019, we are also planning to release a dashboard to show a side-by-side comparison to predict current payment vs. payment under PDGM.

3. Major Concerns

When asked to describe their top concerns with respect to PDGM, providers answered:

  1. Changes to LUPAs
  2. Referrals: sources, community vs. institutional
  3. Staff Needs: training, change management, restructuring of teams
  4. PDGM and PDPM overlap (for organizations who are affected by both)

Our response:

Changes to LUPAs: With the changes to LUPAs in the PDGM, one of the major items that agencies need to be aware of is each of the 432 HHRGs has its own threshold, ranging between 2- 6 visits. On top of that, the LUPA threshold count resets after each 30-day payment period vs. the 60 days in PPS.

Agencies are going to have to be cognizant of this change when it comes to initial care planning and setting service frequencies across the episode. Many agencies front-load visits for acute patients as that often returns the best outcomes. However, doing so may result in the second 30-day payment period resulting in a LUPA episode. While we want to continue to keep the patient’s outcome our first priority, we want to make sure we understand any impact to the agency. Agencies will also want to be able to initiate secondary disciplines as soon as possible in the process.

During the episode, it may be harder for agencies to identify potential LUPAs. Agencies are really going to have to keep their eyes on missed visits as there could be a greater chance of having a LUPA with a variance to the care plan.

A missed visit dashboard will be front and center for the PointClickCare Home Care solution to help prompt agencies to get missed visits rescheduled.

Referrals: Since an Institutional referral can represent upwards of $551 more than a Community referral, many agencies are looking to strengthen their referral sources with Hospitals and SNFs. Using evidence-based clinical care plans, like the Eventium content that is embedded in the PointClickCare product, agencies can demonstrate how they are getting better and more consistent outcomes for their patients to potential referral partners.

Tools like insurance eligibility can identify active home health benefits and display recent home health episodes, if they exist.

If a patient is being discharged from an Institutional setting, the intake staff should scan the paperwork into the chart and communicate to the Revenue Cycle Manager and Case Manager that the patient came from an institutional setting. The billing team can use occurrence codes 61 or 62 on the Final Claim to indicate that the patient came from an Institutional setting. This can potentially can speed up cashflow if the hospital or SNF is slow to submit their claim to CMS or if the patient came from a VA Hospital.

Staff Needs: Training, change management, and restructuring of teams are all top of mind. We are dedicating the months from April to June 2019 to help providers understand how they can best transition their staff to the model and ensure competency.   

PDGM and PDPM overlap: There will be overlap between PDGM and PDPM. Not to worry though, PointClickCare services the entire LTC continuum. We have a robust PDPM program for those providers who provide skilled nursing. You can learn more here.

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