{"id":28996,"date":"2020-09-11T20:18:13","date_gmt":"2020-09-11T20:18:13","guid":{"rendered":"https:\/\/dev.mtelehealth.com\/?p=28996"},"modified":"2020-09-11T20:18:13","modified_gmt":"2020-09-11T20:18:13","slug":"pdgm-covid-19-can-bring-new-opportunities","status":"publish","type":"post","link":"https:\/\/drmiltie.com\/at-home-testing\/pdgm-covid-19-can-bring-new-opportunities\/","title":{"rendered":"PDGM &#038; COVID-19 Can Bring New Opportunities"},"content":{"rendered":"\n<p>It\u2019s now been about nine months since the Centers for Medicare &amp; Medicaid Services (CMS) required a new payment model for home health care, representing the largest change to the payment model in decades.<\/p>\n\n\n\n<p>The new Patient Driven Groupings Model (PDGM) affects tens of thousands of agencies that provide therapy for millions of home health and hospice patients, and a great deal rides on the success of its implementation. For many, implementation has been more difficult than expected\u2014but the process has uncovered valuable lessons and even potential opportunities for achieving greater business success and demonstrating home health\u2019s value across the broader ecosystem.<\/p>\n\n\n\n<p>PDGM was mandated in the 2016 Cures Act and became a reality for agencies Jan. 1, 2020. Let\u2019s take a look at a few lessons we\u2019ve learned since that happened\u2014and some tools to help agencies moving forward.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>1.&nbsp;Referral Intake<\/strong><\/h3>\n\n\n\n<p>The No. 1 PDGM implementation issue for agencies I\u2019ve spoken with is referral intake. Getting intake right is a tall order in a short amount of time. With many people working from home due to the COVID-19 pandemic, it\u2019s harder than ever to reach referral sources. Furloughs and layoffs at a wide range of employers mean there\u2019s a risk that any patient\u2019s eligibility could&nbsp; change significantly. Payers and coding requirements may also be changing in real time, which is a lot to stay on top of from an operations standpoint.<\/p>\n\n\n\n<p>To be successful, referral intake has to be appropriate and accurate. That requires getting the primary diagnosis, payer information and eligibility right from&nbsp;the start. Otherwise everything else downstream in the process is put at risk.&nbsp;This became even more critical as organizations implemented solutions to comply with PDGM.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>2.&nbsp;Order Management<\/strong><\/h3>\n\n\n\n<p>Order management has long been a concern in this industry and it\u2019s where&nbsp;many focused when it came time to prepare for PDGM. A major issue in the home health care industry is a need to rely on partners that aren\u2019t always aligned, resulting in a dependency that\u2019s hard to control. To compensate, providers must continue to adhere to and own a strong process to keep everything moving in the right direction and on time.<\/p>\n\n\n\n<p>For instance, who is the one person in your organization whom you seek out to get a follow-up status? That person must be predefined and all team members should clearly understand their part of the process. And there must be a process. This is an area where a lot of organizations are still working out the details with PDGM.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>3.&nbsp;Claim Management<\/strong><\/h3>\n\n\n\n<p>The keys to success in claim management are frequency and followup. We recommend that organizations submit reimbursement claims as often as possible\u2014daily if possible\u2014to promote faster cash flow. Establishing a regular cadence of communication via email, Slack, a daily meeting, or a reports package helps keep teams accountable and aligned. New reporting requirements from PDGM make this level of communication more critical than ever.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>4.&nbsp;KPI Tracking &amp; Measurement<\/strong><\/h3>\n\n\n\n<p>Moving to PDGM is a massive undertaking with many intricate details that touch all corners of a business. While it\u2019s important to keep track of each one, organizations also need a broader set of metrics to monitor performance. Key performance indicators (KPIs) are a great way to track a team\u2019s progress and identify any roadblocks.<\/p>\n\n\n\n<p>A good place to start is with three to five KPIs that are core to a provider\u2019s business, such as days to claim, days sales outstanding, accounts receivable by payer, write-offs and\/or coding review. Having current, easy-to-read data on any of these metrics is important, particularly when transitioning to a new payment system. Once there\u2019s strong cadence around a core set of KPIs, providers can build on them for a fuller picture.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>5.&nbsp;Strong Change Management<\/strong><\/h3>\n\n\n\n<p>PDGM represents a major shift in how providers do business, calling for a strong change management program to help drive success. Change management was considered a luxury in the past; now it\u2019s almost a requirement with the upheaval and rate of change we\u2019re experiencing in health care. A successful program requires two things: communication and collaboration.<\/p>\n\n\n\n<p>Communication needs to involve everyone in an organization, from the executive team to the staff on the front line to direct and indirect stakeholders. To reach these groups effectively, a clear and concise message is key. It\u2019s important to ensure that everyone knows what the problems are, what you\u2019re doing to address them and what the timeline is for a solution.<\/p>\n\n\n\n<p>Collaboration is critical as well, because now, more than ever, the success of an agency is dependent on all parts of the ecosystem. Collaborating with other agencies, regulatory groups, technology companies and other outside resources emerging in health care is becoming the norm and a key to long-term success.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>PDGM &amp; COVID-19<\/strong><\/h2>\n\n\n\n<p>With the COVID-19 pandemic added to the mix, the industry is facing change from all sides, resulting in a constant balancing act. In addition to key policy and regulatory events, we\u2019ve seen PDGM\u2019s intersection with COVID-19 accelerate several technology trends\u2014especially telehealth.<\/p>\n\n\n\n<p>Telehealth has been on the scene for more than 15 years but has suffered from a number of adoption challenges, including long-standing complexities around reimbursement. The pandemic has forced the industry to reprioritize telehealth and adoption is rising dramatically as a result. According to MarketWatch, virtual doctor visits were up 50% in March, while research and consulting firm Frost &amp; Sullivan expects demand for telehealth to soar by nearly 65% in the U.S. this year alone.<\/p>\n\n\n\n<p>It\u2019s clear telehealth presents an incredible opportunity for the industry to maintain business continuity, but also to reach patients on their own terms and remain competitive. With all 50 states now accepting telehealth at some level, it\u2019s a good time to explore new opportunities in this space as it continues to quickly grow.<\/p>\n\n\n\n<p>Another shift is around payer management and the chance for providers to explore new opportunities with payers. This could mean exploring risk-based contracts or leveraging telehealth to deliver services on a per-member\/per-month basis.<\/p>\n\n\n\n<p>Importantly, we\u2019re also seeing home health shift away from being solely a post-acute care service to taking on pre-acute and even acute care, as hospital-level services are increasingly delivered in the home. This presents a powerful opportunity for the industry to demonstrate its value across the health care ecosystem.<\/p>\n\n\n\n<p>Without question, PDGM and its intersection with COVID-19 has presented a significant challenge for the home health and hospice industries. However, it\u2019s rare that a big change does not also bring big opportunities. The industry is off to a strong start and as soon as 2021, we\u2019ll start to see significant benefits from the hard work&nbsp;put in leading up to PDGM and throughout this year.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>It\u2019s now been about nine months since the Centers for Medicare &amp; Medicaid Services (CMS) 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