Home Health Provider Prepares for PDGM; Reduces LUPA by 40% through Episode Management

Client Profile

A large, not-for-profit provider of home health, visiting physicians, hospice and community-based care servicing the Northeastern United States.

The Challenge

The home care provider was experiencing a high LUPA rates that consistently exceeded 15%. A staffing shortage, particularly with nurses, combined with communication challenges throughout the provider made it difficult to achieve positive patient outcomes. The provider turned to McBee to investigate staffing practices in each department to understand the nature of the gaps in the hiring process, identify which departments need the most improvement, and recommend the next steps to significantly turn around the onboarding process. In addition, the provider’s episode management process needed improvements in place to adequately manage the LUPA rate and effectively transition their Episode Management process for the new Patient-Driven Groupings Model (PDGM).

The Approach

Through a robust investigation of the provider’s operations, McBee performed a comprehensive assessment to identify the gaps in staffing, including where education and training for staff was needed. Our team presented an action plan to resolve the ongoing operational, financial, and clinical challenges. After the initial assessment was performed, the consulting team routinely conducted episode management review calls to provide in-depth recommendations and advise on best practices. The team developed educational materials for distribution to staff and conducted onsite education to senior management, clinical managers, case managers, therapists, hospital discharge planners and schedulers to help guide the staff on how to properly manage the episodes. McBee continues to provide the provider ongoing education and support to help ensure a smooth transition for the Patient-Driven Groupings Model (PDGM).

Results

Through an extensive review with the provider’s staff, their employees now have a working knowledge of how to appropriately manage episodes and the LUPA rate was reduced by more than 40%. This education has led to overall improvement of patient-centered care. Furthermore, the provder saved $3M in additional revenue and ongoing education and support for the PDGM transition.