The Patient-Driven Groupings Model (PDGM), is the most significant change to the home health payment reform in the past 20 years. PDGM completely alters the methodology for calculating payments, and an example of this is the removal of therapy utilization as a component and the payment periods have been reduced from 60 to 30-days. In addition to the many clinical and overall operational modifications that will be required, these noteworthy changes in computing Medicare payment rates could also profoundly impact a provider’s PDGM reimbursement levels in comparison to historical PPS payment levels.
Moreover, as the CMS Rule’s label describes, all clinical processes (and related operational sub-processes) will require improvement initiatives that focus on achieving CMS’s Triple Aim Goals – achieving patient satisfaction, quality patient outcomes and cost-effective healthcare delivery. So, what does a provider need to do between now and the actual implementation of PDGM in 2020?
Providers should immediately develop a transitional PDGM implementation plan for the organization to achieve effective and complete operational readiness. Each transition plan needs to move away from the historical PPS protocols, identify the far reaching clinical, operational, and financial requirements under the PDGM Rule, and set specific processes and policies in place that are in alignment with the new requirements.
In summary, home health providers need to be proactive in identifying how the PDGM Rule will directly impact them financially, clinically and operationally. This three-part series will discuss important areas of focus for agencies to consider to ensure PDGM readiness. This series will provide the framework for agencies to develop and implement strategies that achieve operational readiness before the transition to the PDGM Model in January 2020.
Below are the back-office items providers need to consider to understand the impact of PDGM and what changes need to be made to better align with the new payment model.
DAYS TO RAP