The Patient-Driven Groupings Model (PDGM) is fast approaching, and the new mandate will force all home health providers to make significant changes to their business operations. Providers that do not make the necessary PDGM updates risk being overtaken by better-prepared, compliant competitors. This drastic overhaul to the current payment landscape is jarring, but organizations that are actively taking steps to update their current operations now will be ahead of the game once PDGM officially takes effect on January 1, 2020.
But even amidst these challenges, there’s good news: agencies still time to make huge strides in preparing for PDGM, while also ensuring employees get acclimated to this new way of doing business.
Here are 4 steps your agency can take immediately to thrive under PDGM in 2020:
Step 1: Start using PDGM today
The time for forecasting the ways your current business model will be affected by PDGM is over.
Home health providers should now be using the more complex and targeted patient classification system required by PDGM to get a clear picture of how much care various patient types will need. The new system of patient classification includes the consideration of admission source, clinical grouping, timing, functional impairment level, and co-morbidity adjustment, which results in a very detailed patient profile that can help inform care planning and achieving better outcomes. This bonus effect of PDGM is one that many home health providers have yet to incorporate into their plans. But your agency has the opportunity to get ahead.
Once your agency has a firm handle on its current patient profile using PDGM, you can clearly see how well your current patient mix will fare under the rules and whether shared patient factors — such as referral source (hospital vs. community) and comorbidities — need to be retargeted for accurate reimbursement.
Step 2: Rethink your current therapy strategies
Therapy will always be an essential component of care for home health patients. Under PDGM, however, therapy thresholds are no longer a major factor in reimbursement. Organizations that rely largely on therapy patients to sustain funding will experience a significant drop in the amount they will be reimbursed beginning in 2020 if they don’t adjust their patient targeting and provision of care.
Rather than drastically cutting back on therapy services, agencies can transition to a new system of care that features improved coordination with therapists and utilizing telehealth and telemonitoring to supplement therapy services.
Start by talking with therapists about their needs and explore ways to work together to come up with alternative solutions for delivering quality care to patients. This can include increased use of physical therapy assistants or implementing remote patient monitoring for patients who are able to manage their home regimen.
Patients will continue requiring improved outcomes, which means that cutting therapy simply isn’t an option. PDGM is an opportunity to find more effective and efficient ways to provide the care.
Step 3: Revisit and leverage market data targeting
Comprehensive market data analysis will be more important than ever as the entire industry tries to refocus its efforts on new patient populations and referral sources with the greatest potential for reimbursements under PDGM. The home health agencies that deeply understand market data and are leveraging drive their actions will be the most successful.
Under PDGM, providers must identify their ideal patients, assess precisely where their referrals are originating, and how those referrals contribute to total payments. With this knowledge, providers can determine what changes they must make to achieve PDGM referral targets and identify referral sources that can help them get there.
When coupled with an informed sales and marketing team, your agency can begin targeting this business well ahead of the 2020 implementation.
Step 4: Overhaul your agency’s customer service standards
Providing outstanding customer service to patients and referral sources will be more important than ever, particularly as many competitors in a given market vie for the same patients. The time for enhancing overall customer service philosophies and requirements is now.
The first step in this is a clear-eyed analysis of the current level of customer service. Your agency can spot opportunities for improvement by talking with patients, referral sources, care providers, and sales reps.
Develop strategies to increase patient engagement and improve the patient experience, including personalized and friendly contact before, during and after care. Identify new ways to cheerfully meet the needs of referral sources. By transitioning to service-focused care, a home health agency can differentiate itself positively from its competitors.
Incorporate comprehensive training and expectations across your staff, and check in regularly to see how this is working and rework the process as necessary.
When your home health agency acts early to prepare for PDGM, you can set your business up for an improved fiscal outlook in the face of one of the most drastic payment model changes the industry has seen in decades. The result will be increased business confidence, tighter and more profitable referral targeting, and better preparation than your competitors in 2020.
To learn more about WellSky’s partner, PlayMaker Health, visit www.playmakerhealth.com.