The PDGM Era: Four Key Considerations for Better Communications

 In Reimbursements

Is your home health agency ready for the seismic shift Patient Driven Groupings Model reimbursement will bring at the start of 2020?

No doubt you’ve already had plenty of planning meetings, education sessions and countless side conversations about how PDGM will impact your care delivery model and payment.

But have you thought about and discussed the changes you’ll need to make in how you communicate with referrers, patients, families and even your own team because of PDGM?

Transcend Strategy Group encourages you to consider these four ways to improve communications for facilitating and maximizing the PDGM era:

1.  Help discharge planners communicate benefits of home health more clearly and accurately.

According to 2017 CMS data, about 40 percent of patients coded for home health at hospital discharge do not receive any home health services. A major culprit for this unfortunate disconnect is the lack of understanding among patients and families about what home health truly provides. Hospital discharge planners and hospitalists are as busy as you are, averaging up to 10 discharges per day. They often don’t have the time to explore each patient’s understanding of recommended follow-up care. Many patients and families misperceive home health as “help around the home” – not the valuable clinical and therapeutic services you provide – and avoiding these services may put the patient at risk. Do you have the opportunity to provide literature that hospitals can include in a discharge packet explaining the importance of home health services (you may need to avoid heavy branding on such materials, but make them educational in nature with a simple “brought to you by” line that includes your brand name and contact information, if allowed).

2.  Politely probe physicians for the most accurate and complete assessments of primary diagnoses and ALL appropriate secondary diagnoses/comorbidities. 

More than ever in the PDGM era, accurate coding will be king. During the face-to-face patient review with the referring physician, make sure your liaisons are highly trained in “politely probing” for the most detailed and relevant information about the patient’s complete current condition. Properly identifying the primary diagnosis and all appropriate comorbidities is crucial to providing the best possible treatment and capturing the greatest reimbursement for your services. Also, by nailing the primary and secondary diagnoses up front, you can submit an accurate RAP early to help maximize your reimbursement – and cash flow.

3.  Communicate comprehensively with patients and families for the most accurate assessments.

This pointer may seem like it’s coming from Captain Obvious. Many times, however, home health teams do assessments only verbally by asking questions – and observation is the only truly accurate method for reliable assessments. (Once again, time pressures are typically a major factor in how assessments are handled.) For instance, when asked if Mom can walk unassisted to the bathroom without the aid of her walker, Mom and her family may say, “Yes, all the time!” But if you ask Mom to show you, she indeed leaves the walker by the sofa – then uses her hand to support herself on the sofa arm, a chair back, a sofa table, and the hallway wall on the way to the bathroom – the assessment changes in an instant. Discipline-neutral competence in the OASIS assessment process is critical to gain and sustain accuracy for both outcomes reporting and reimbursement.

4.  Make sure your interdisciplinary team is communicating the most effectively to note changes, maximize outcomes and capture performance data.
With PGDM’s new limitations on home therapy visits and other significant changes to the rules of care delivery, your internal team will need to be more diligent than ever in collaborating on providing the best care in ways for which you will still be compensated. As each patient’s condition changes, transitions in care become necessary, and assessments evaluate the patient’s status at the end of each episode, be sure your team is communicating clearly with consistent language. The more your entire team stays on the same page with the same language, the more you can capitalize on providing the most appropriate care for the best outcomes and highest reimbursement.

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