Home Health Providers have completed the first quarter of care delivery under the Patient-Driven Groupings Model (PDGM) reform that brought the Centers for Medicare & Medicaid Services' (CMS) “Volume to Value” transition to our doorstep. Though recent coronavirus concerns have challenged all health care Providers in ways we never could have expected, success under the PDGM is still tied to efficient care production and delivery. Adapting to the new care production and delivery stresses the entire agency, as traditional Prospective Payment System (PPS) care protocols will fail to produce the desired outcomes under the Value-Based model that is the PDGM.
In order for Home Health Providers to succeed under the PDGM and future CMS reforms, they need to rewire all elements of their care production, delivery, and management. Starting with intake to referral and schedule management, setting the stage for a Value-Based Plan of Care (POC) is essential. By reinventing the Start of Care OASIS admission through clinical accuracy practices that outline a PDGM-compliant care plan, a Value-Based Care Path is identified. This PDGM POC is managed on an in-episode basis for skill management, POC adaptation based on care and results to date, and propulsion to desired clinical results.
This webinar will review how these Home Health Providers are faring under the PDGM, both in terms of clinical and fiscal outcomes. By operationalizing the IMPACT Act “Volume to Value” philosophy, these Providers are posting results that exceed traditional Home Health PPS era expectations. Those outcomes include the PDGM episodic margins that exceed the PDGM Grouper predictions by more than 35%, 4+/5 Star/Home Health CAHPS ratings with single-digit readmissions, Potentially Avoidable Events decreased by over 50%, near-elimination of NTUC (Not Taken Under Care)/LUPA (Low Utilization Payment Adjustment) episodes, staff savings of greater than $500/episode, and denial-proof care. In addition, by rewiring their agency for the Value-Era, all requirements of Value-Based Purchasing expansion, Pre-Claim Review, and Post-Acute Care PPS have already been addressed.
Don’t miss this progressive webinar to learn about initial clinical and financial results being posted during the PDGM “Volume to Value” transition. Gain insights into care outcomes that exceed expectations, and evolve the PPS-era mindset into the PDGM Value model for success on the care path of today and tomorrow.
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- Identify areas of focus when transitioning from a 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 the 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.
- Arnie Cisneros, PT, President, Home Health Strategic Management (HHSM)
- Kimberly McCormick, RN, BSN, Executive Clinical Director, HHSM
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