The proposed PDGM model, also known as the Patient-Driven Groupings Model may be coming to a home care agency near you in 2020. While still proposed, 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.
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.
PDGM also suggests enhancements to remote patient monitoring, as CMS may begin allowing the cost associated with monitoring devices to encourage in-home technologies and overall data-sharing. With that also brings more possibilities for home infusion therapy as CMS is current seeking comments on the new home infusion therapy benefit category.
There are a few exciting things coming our way… Agencies and certifying physicians should happily note that it’s proposed to do away with the recertification requirement of physicians estimating how much longer the patient will require in-home skilled services.
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, this is the most significant change to home care in 20 years, so be sure to stay updated on the latest in all things PDGM. 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. Review here!