{"id":591,"date":"2019-01-11T16:01:54","date_gmt":"2019-01-11T16:01:54","guid":{"rendered":"https:\/\/advantagehcconsulting.com\/blog\/?p=591"},"modified":"2019-01-11T16:01:55","modified_gmt":"2019-01-11T16:01:55","slug":"take-these-10-steps-to-prepare-for-pdgm-before-it-rocks-your-world","status":"publish","type":"post","link":"https:\/\/advantagehcconsulting.com\/blog\/2019\/01\/11\/take-these-10-steps-to-prepare-for-pdgm-before-it-rocks-your-world\/","title":{"rendered":"Take These 10 Steps To Prepare For PDGM Before It Rocks Your World"},"content":{"rendered":"\n
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Don\u2019t let paradigm-shifting payment reform put you at risk next year.<\/em><\/strong><\/p>\n\n\n\n

A year from now, you\u2019ll be a few weeks into a radically revised payment system. To survive and thrive under the Patient-Driven Groupings Model, you need to start your preparations immediately, experts urge.<\/p>\n\n\n\n

\u201c2020 will be here faster than we know it,\u201d warns Rhonda Perrin Oakes<\/strong>, a regulatory analyst with electronic health record vendor Netsmart<\/strong>. Home health agencies should prepare now for the changes coming Jan. 1, Perrin Oakes says on Netsmart\u2019s Carethreads blog.<\/p>\n\n\n\n

\u201cWe have one year, but I just think that year is going to fly by when I think about the complexity of the rule,\u201d said Gina Mazza <\/strong>with Fazzi Associates<\/strong>in a Nov. 29 webinar on PDGM readiness. That\u2019s especially true because \u201cthere\u2019s very little \u2026 untouched by PDGM,\u201d Mazza said.<\/p>\n\n\n\n

HHAs hopefully are starting to try to figure out PDGM readiness now, says Julianne Haydel <\/strong>with Haydel Consulting Services <\/strong>and The Coders <\/strong>in Baton Rouge, Louisiana. And they should \u201cbegin faux implementation in the second half of 2019,\u201d Haydel urges.<\/p>\n\n\n\n

\u201cOrganizations that take steps today will find success in PDGM tomorrow,\u201d Perrin Oakes maintains.<\/p>\n\n\n\n

Don\u2019t underestimate just how much work it will be to switch to PDGM, Mazza added. It will require \u201clots of strategic thought and planning,\u201d she emphasized, comparing it to the switchover from fee-for-service billing to PPS billing in 2000.<\/p>\n\n\n\n

\u201cThis is a major change to PPS,\u201d Haydel underscores.<\/p>\n\n\n\n

\u201cPDGM is going to be a big change for HHAs,\u201d stresses Sandy McCleve <\/strong>with Advantage Healthcare Consulting Cost & Reimbursement <\/strong>in North Salt Lake, Utah. \u201cIt is extremely important for these providers to understand the new rules; otherwise it will most certainly lead to a negative financial impact on their agency.\u201d<\/p>\n\n\n\n

Consider this advice from the experts to make sure you are prepared when PDGM hits in less than a year:<\/p>\n\n\n\n

1. Study up. <\/strong>Now that the Centers for Medicare & Medicaid Services <\/strong>has finalized PDGM in the 2019 HH Prospective Payment System final rule, \u201cagencies should seek to gather information on all the changes that will be coming,\u201d advises consultant Joe Osentoski <\/strong>with Quality In Real Time <\/strong>in Troy, Michigan. Sources of information include the final rule and an upcoming PDGM call from CMS (see box, p. 11<\/em>).<\/p>\n\n\n\n

Major components of the rule are the switch to a 30-day billing period, eliminating therapy from case mix calculations, including source of admission as a case mix factor, and pay-rate reductions for behavioral adjustments (see more details in Eli\u2019s HCW, Vol. XXVII, No. 39-40<\/em>).<\/p>\n\n\n\n

2. Run your numbers. <\/strong>Along with the final rule, CMS has provided PDGM grouper and agency level impact tools. Use those to model the impact on your agency, Mazza recommended.<\/p>\n\n\n\n

Using the model will allow agencies to \u201csee how they would fare in a PDGM model of billing their current clients,\u201d Osentoski tells Eli<\/strong>.<\/p>\n\n\n\n

\u201cYou need to understand where you are right now\u201d on all the important measures, ranging from coding to Low Utilization Payment Adjustments, Mazza urged.<\/p>\n\n\n\n

Watch out: <\/strong>You should also factor in elements that won\u2019t show up in the model. For example, take a close look at your length of service in relation to the new 30-day billing period, Haydel says. Many episodes that would count as two 30-day periods in the model may actually get shortened to just one, or one with a LUPA. \u201cFor years, we have been preaching that shorter episodes are better,\u201d Haydel notes. \u201cBut a 45-day episode could easily turn into a LUPA.\u201d<\/p>\n\n\n\n

3. Form a PDGM implementation committee. <\/strong>You need a group of \u201chorizontally and vertically\u201d integrated staffers to \u201cchampion PDGM\u201d in your agency, Mazza counseled. This \u201cshould not be a management function,\u201d but rather have representatives from all your agency\u2019s \u201ccore competencies,\u201d she said.<\/p>\n\n\n\n

4. Make your PDGM plan. <\/strong>Using the analysis you have gathered, you need to \u201cbreak down the needs into a plan that will have an accomplishment date of December 2019,\u201d Osentoski recommends. Mazza emphasized the need for a \u201cstrategic approach\u201d in formulating your PDGM action plan.<\/p>\n\n\n\n

5. Focus on diagnosis coding. <\/strong>Every agency\u2019s plan will look different, based on its individual needs. But providers can count on diagnosis coding being a big feature, thanks to PDGM\u2019s focus on the area. In the final rule, \u201cCMS affirms the importance of \u2018precise coding\u2019 in the new model, so assuring that your coding resources are up to the task will be extremely important,\u201d Osentoski stresses.<\/p>\n\n\n\n

Pinpoint: <\/strong>\u201cCollecting complete health histories with a complete recording of comorbidities\u201d will be a must under PDGM, thanks to the payment adjustment for comorbidities, Perrin Oakes notes.<\/p>\n\n\n\n

6. Emphasize OASIS. <\/strong>Likewise, accurate OASIS coding will also be paramount under PDGM. \u201cDeveloping a strong understanding of OASIS requirements by clinicians and coders\u201d will be key, Perrin Oakes emphasizes.<\/p>\n\n\n\n

Why? <\/strong>Accurate OASIS collection lays \u201cthe foundation for capture of acuity, revenue and [lays] the pathway to effective care planning,\u201d according to an earlier PDGM webinar by Mazza. It also determines risk stratification.<\/p>\n\n\n\n

7. Target effective care coordination and discharge planning. <\/strong>Most HHAs will need to focus on these areas in their PDGM transition, experts predict. Providers will need to be \u201ccollaborating between cross-functional teams to provide coordinated care,\u201d Perrin Oakes advises.<\/p>\n\n\n\n

Are you \u201cusing accurate acuity capture to drive and execute evidence-based, interdisciplinary best practice care plans?\u201d Mazza asked.<\/p>\n\n\n\n

8. Secure buy-in. <\/strong>Drafting a comprehensive PDGM implementation plan isn\u2019t enough. You need to get your staff on board, Mazza emphasized in the webinar.<\/p>\n\n\n\n

That means rolling out early education to leaders and employees, who need to understand why they are doing things. Your agency-wide committee should be able to help in this area.<\/p>\n\n\n\n

9. Achieve optimal productivity. <\/strong>You may want to borrow from Encompass Health\u2019s <\/strong>PDGM prep list. The 30-state chain includes \u201censure productivity levels are realized for full-time staff\u201d on its to-do list for 2019, according to its Jan. 8 presentation at the J.P. Morgan Healthcare Conference.<\/p>\n\n\n\n

Plus: <\/strong>Using technology to \u201cdrive incremental efficiencies\u201d also made Encompass\u2019 PDGM preparation list.<\/p>\n\n\n\n

10. Stay tuned.\u00a0<\/strong>2019 \u201cmay see further refinement of the regulation before it goes into effect,\u201d Perrin Oakes cautioned. The industry is lobbying hard for certain changes, such as\u00a0elimination\u00a0of the preemptive behavioral assumption reimbursement cut. Keep on top of new information CMS issues.<\/p>\n\n\n\n

Source- SuperCoder<\/a><\/em><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

Don\u2019t let paradigm-shifting payment reform put you at risk next year. A year from now, you\u2019ll be a few weeks into a radically revised payment system. To survive and thrive … Continue Reading →<\/a><\/p>\n","protected":false},"author":1,"featured_media":592,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8,5],"tags":[24,23,28],"class_list":["post-591","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-compliance","category-reimbursement","tag-homecare","tag-homehealth","tag-pdgm"],"_links":{"self":[{"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts\/591","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/comments?post=591"}],"version-history":[{"count":1,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts\/591\/revisions"}],"predecessor-version":[{"id":593,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts\/591\/revisions\/593"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/media\/592"}],"wp:attachment":[{"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/media?parent=591"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/categories?post=591"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/tags?post=591"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}