Ready or not, PDGM is on its way for 2020. The adopted Patient-Driven Groupings Model has been adopted with essentially all of its details from the July proposal, although the final rules states its implementation as ‘on or after’ January 1st of 2020.
Now with the official go-ahead, FocusChart wants you to be as prepared as possible as these changes will most likely have a significant impact on your operation and your bottom line. To help, FocusChart has created a reporting tool to let you know where your agency lands on the PDGM spectrum. You can search your results completely free and find out now what changes you need to implement to survive this change in 2020.
The value-based payment system is an overhaul of Medicare’s current volume-based model and is going to bring big changes such as the new 30-day payment period. The new period will not change certification periods or OASIS time points, however. PDGM will rely on clinical characteristics to put patients into a payment category with five key factors. The first being whether the episode is ‘early’ or ‘late’; however, only the first 30-day episode can be considered ‘early.’ Each 30-day period will be labeled as ‘institutional’ versus ‘community,’ whether or not the patient had an acute or post-acute stay 14-days prior to the start of care. And lastly, patients will be categorized into clinical groupings depending on diagnosis and function level with different comorbidity adjustments.
There are a few exciting things coming our way… Agencies and certifying physicians should happily note that the recertification requirement of physicians estimating how much longer the patient will require in-home skilled services. PDGM has also set forth the adoption of remote patient monitoring costs as allowable on Medicare Cost Reports and CMS will begin phasing out the rural add-on with a step one revamping in accordance with the Balanced Budget Act of 2018.
This is all to strengthen and modernize Medicare, drive value, and focus on individual patient needs rather than volume of care, according to Seema Verma, CMS Administrator. “(The) proposal would give doctors more time to spend with their patients, allow home health agencies to leverage innovation and drive better results for patients.” “The redesign of the home health payment system encourages value over volume and removes incentives to provide unnecessary care.”
In conclusion, get on top of your preparation as this is the most significant change to homecare in 20 years. NAHC President, Bill Dombi has said, “This will revolutionize how home care operates.” But will this change put your agency in the green or dip your agency into the red? Let us tell you… FocusChart has created a reporting tool to let you know where your agency lands on the PDGM spectrum.