Introduction:
As the healthcare industry continues to evolve, it’s important for home health agencies to stay up-to-date with the latest changes. One such change is the implementation of the Patient-Driven Groupings Model (PDGM) in 2020. The PDGM is a new payment model for home health services that will have significant impacts on the industry. To help your agency successfully navigate this change, we’ve put together the top 5 tips for implementing PDGM.
Tip 1: Understand the PDGM payment model:
PDGM is a significant change from the previous payment model, and it’s important to understand how it works. It’s a case-mix classification system that places patients into payment categories based on clinical characteristics and other patient information. The payment amount for each patient is then determined by the complexity of care needed and other factors. Understanding the details of PDGM will help your agency optimize reimbursement and improve care.
Tip 2: Evaluate your agency’s operations:
PDGM will require agencies to evaluate their operations and make changes as needed. For example, agencies will need to closely monitor their clinical documentation to ensure that it accurately reflects the complexity of each patient’s care needs. They may also need to adjust staffing models and refine their referral and intake processes. By taking a critical look at your agency’s operations, you can identify areas for improvement and implement changes that will ensure success under PDGM.
Tip 3: Focus on patient outcomes:
Under PDGM, patient outcomes will play a larger role in determining payment rates. Agencies that can improve patient outcomes will be able to achieve higher reimbursement rates. To achieve this, agencies should focus on delivering comprehensive, personalized care that addresses the unique needs of each patient. This may include implementing evidence-based practices and leveraging technology to improve care delivery and communication.
Tip 4: Build strong partnerships:
PDGM will require agencies to collaborate with other healthcare providers, including referring physicians and hospital systems, to succeed. Building strong partnerships with these stakeholders can help agencies achieve better patient outcomes and improve communication. In addition, agencies may need to collaborate with payers to negotiate rates and explore alternative payment models.
Tip 5: Invest in education and training:
Finally, agencies need to invest in education and training to ensure that their staff is prepared for PDGM. This may include training on documentation, coding, and billing requirements, as well as education on evidence-based practices. Agencies should also encourage staff to pursue ongoing education and certification to stay up-to-date with the latest developments in the field.
Conclusion:
Implementing a major change like PDGM can be daunting, but with these five tips, your agency can navigate the transition successfully. Understanding the payment model, evaluating operations, focusing on patient outcomes, building strong partnerships, and investing in education and training will position your agency for success in a rapidly changing healthcare landscape. By taking a proactive approach to PDGM, you can achieve better outcomes for your patients and your agency.
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