The transition to the Patient-Driven Groupings Model (PDGM) has magnified the significance of the 30-day billing period in home health care. With potential LUPA evaluations occurring twice within the traditional 60-day episode, agencies face the pressing challenge of ensuring each 30-day window is optimized to prevent LUPA adjustments. Effectively managing these shorter periods is critical to both clinical and financial success. Here’s a guide on mastering this aspect of care under PDGM:

In-depth Patient Assessment

The initial assessment sets the tone for the entire care episode. Understanding the patient’s needs, comorbidities, and potential challenges is vital early on. Having an understanding ensures the care plan is robust and minimizes the risk of unplanned changes that might trigger a LUPA.

Strategic Visit Planning

Under PDGM, every visit counts, especially in the initial days. Front-loading visits – scheduling more frequent stops at the episode’s start – can stabilize patients quicker, reducing the risk of readmissions and potential LUPAs.

Continuous Monitoring

Real-time monitoring of patient progress is crucial. By closely monitoring the patient’s status, agencies can adjust the care plan as needed, ensuring that the visit count aligns with the LUPA threshold. 

Harness Technology

Technological tools, like Electronic Health Records (EHR) and predictive analytics, can be invaluable. These tools can alert potential LUPAs, allowing agencies to take corrective action promptly.

Efficient Resource Allocation

Understanding which resources (nurses, therapists, aides) are needed for each patient type and when can make a difference. Aligning resources with patients ensures quality care without unnecessary visits.

Collaborative Care Approach

Promote collaboration between disciplines. A cohesive team approach – where nurses, therapists, and aides work together – ensures holistic care and can reduce the risk of missed visits.

Patient and Caregiver Education

Empower patients and their caregivers with knowledge. Educated patients are more likely to adhere to care plans, reducing the risk of hospitalizations and LUPAs.

Proactive Addressal of Issues

Whether it’s staffing challenges, patient refusals, or scheduling conflicts, addressing issues proactively can prevent missed visits. Create a rapid response system to handle such challenges.

Data-Driven Insights

Regularly review historical data to identify patterns. If certain types of cases or specific periods consistently lead to LUPAs, take preemptive measures.

Continuous Quality Improvement

Adopt a mindset of constant improvement. Regularly review and refine processes based on feedback and outcomes to ensure the agency remains agile despite evolving challenges.

In summary, while challenging, the 30-day LUPA period presents opportunities for agencies to showcase agility, innovation, and patient-centered care. With the right strategies and a proactive approach, agencies can ensure clinical excellence and financial stability in PDGM.

More Information

This is the third article in a 5-part series on LUPA under PDGM. If you’re joining us mid-way, consider reading Part 1: Transitioning to PDGM and Part 2: PDGM Factors. Don’t miss Part 4: Optimizing Practices and Part 5: Strategies for LUPA Management to gain more insights and better manage your practice.