Home health providers are nearly two months into the “Volume to Value” transition marked by the installation of the Centers for Medicare & Medicaid Services (CMS) Patient-Driven Groupings Model (PDGM). Adapting to the new care production and delivery model presents challenges for the entire agency as traditional home care protocols will fail to produce the desired outcomes. As a result, all departments must be included in a successful PDGM value transition. Addressing intake and scheduling concerns are just the first steps to value outcomes, as they set the stage for an efficient clinical episode. Rewiring start of care OASIS admissions for accuracy in clinical profile deliver data for value-based plan of care production, identifying an initial care path to be managed on an in-episode basis for skill and value by quality assurance and utilization review personnel. By addressing the Low Utilization Payment Adjustment (LUPA) and Not Taken Under Care (NTUC) through compliance with CMS home health regulations, missed visits for value compromise, and patient scripting for outcomes and satisfaction, providers rewire areas that must be addressed for optimal outcomes.
This webinar will present initial PDGM results from providers seeking optimal outcomes through assertive management of the value areas listed above. Focusing on the basics of the IMPACT Act’s “Volume to Value” philosophy, they have seen promising clinical and fiscal results of early PDGM episodes. By assuming care responsibility of value elements of the Medicare model, they have been able to reduce clinical staff stress while managing programs successfully with an in-agency model. Value results in case-mix, plan of care costs and management, clinical outcomes have all improved, and significant gains have been seen in missed visits and timely documentation for coverage.
Don’t miss this progressive webinar to learn about initial clinical and financial results being posted during the PDGM “Volume to Value” transition.
After this webinar, the participant will be able to:
• Identify areas of focus when transitioning from a Prospective Payment System (PPS) home health model to a PDGM model.
• Describe various PDGM care development and delivery model modifications providers have employed to transition from the PPS era.
• Review PDGM results for providers adopting an agency-based care model.
• Understand long-term outcomes from agency-based care model as providers confront pending value reforms.
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This program will be applying for 1.5 continuing education units for Florida-licensed physical therapists and will provide 1.5 continuing education units for Florida-licensed skilled nurses, occupational therapists, and speech therapists.
Arnie Cisneros, PT, is President of Home Health Strategic Management (HHSM). Arnie has provided clinical services, program development, and management consultation in the areas of post-acute care, sports medicine, and episodic programming for more than 30 years. He is renowned for his adaptation of tradition-al care philosophies to address current and future health care reform initiatives.
HHSM is a leader in the establishment of a utilization review (UR) model for home health care development and delivery. The HHSM UR model, SURCH (Service Utilization Review for Care in the Home), was named the 2016 VNAA Innovative Home Health Care Model for its ability to successfully address and program care in terms of the quality requirements. The SURCH model routinely increases care-mix and Home Care Resources Group (HHRG) levels greater than 25 percent, decreases nursing staffing costs while improving productivity, manages care on an in-episode basis, and delivers 4.5-to 5-Star Ratings — all in an audit-proof manner.
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