Successfully Navigating PDGM in 2023

Information and strategies to master PDGM for home health agencies

After lots of talk on and offline, webinars, blogs, and articles, with PDGM we are now three years in. Has your agency been successful under PDGM? In this blog, we’ll cover best practices and information to consider to make sure your agency is successfully navigating CMS’s payment model as we head into the summer of 2023.

Mastering PDGM in 2023: Keys to Thriving in Home Health Care Industry

Home health agencies can master the Patient-Driven Grouping Model payment structure to thrive in 2023. The Centers for Medicare & Medicaid Services (CMS) implemented PDGM in home health on January 1, 2020. After three years have passed, is your organization thriving under PDGM?

It may be time to assess your progress and revise current strategies to maintain your success under PDGM in 2023. Home health agencies must adapt to the payment structure to succeed in this industry. Let’s go over a few strategies and approaches to help you successfully navigate CMS’s payment model.

Focus on patient-centered care

Payments in home health are based on specific patient characteristics such as diagnosis, functional level, and comorbidities under home health PDGM. As a result, this model incentivizes HHAs to provide efficient and effective care tailored to each patient’s specific needs.

The primary benefit of the PDGM payment structure is that it rewards HHAs for providing high-quality, patient-centered care. Agencies can increase reimbursement rates and improve patient outcomes by focusing on high-quality care that meets individuals’ needs and goals.

Organizations must place a premium on patient-centered care. This entails taking the time to consider each patient’s unique needs, preferences, and treatment goals. Training clinicians, particularly therapists and RN case managers, to provide personalized care can improve patient outcomes and decrease hospital readmissions, potentially leading to higher reimbursement rates.

Individualized patient care must remain at the forefront of care planning and delivery to improve patient outcomes and achieve higher reimbursement rates.

Prioritize documentation

Home health agencies must prioritize documentation to succeed under the PDGM payment structure. Accurate, complete, and timely documentation is essential for ensuring that payment accurately reflects the characteristics of each patient and the services and care provided. That includes all OASIS and therapy assessments, care plans, and progress notes.

Timely documentation is often a challenge for agencies. One way to address the problem is to educate nurses, therapists, and physicians on the importance of accurate and timely documentation and the agency’s specific documentation requirements.

Training should include the following:

• Detailed instructions on how to complete notes
• Advice on what information should be included or omitted
• Best practices for document management

In addition, to optimal reimbursement, proper documentation ensures that HHAs can defend their claims and billing practices in the event of an audit. It can also help home health agencies identify potential billing issues more quickly.

Timely documentation and billing prevent payment delays and reduce the risk of billing errors.

Optimize staffing

Businesses must optimize staffing workflows to ensure they can provide high-quality care efficiently. Unfortunately, many HHAs struggle when it comes to managing clinician schedules and ensuring adequate staffing levels.

Some factors, such as a labor shortage, are unavoidable. Agencies, on the other hand, can concentrate on issues over which they have control.

Staffing workflow optimization can be improved with digital technology. Good scheduling software and processes help agencies manage employee schedules more easily, reduce scheduling errors, and help ensure adequate staffing levels.

Agencies should also encourage a team-based approach to care delivery. In this method, clinicians work together, each team member contributing their unique skills and expertise. This method improves workflow efficiency, reduces burnout, and ensures patients receive the most comprehensive care possible.

Take advantage of technology

Technology is a powerful tool for PDGM in 2023. HHAs can improve efficiency and reduce costs while improving patient outcomes by leveraging technology.

EHR systems can help streamline documentation and improve accuracy. Today’s home health software programs have built-in PDGM tools and features that can help agency owners with the following:

• Improve accuracy on OASIS assessments
• Ensure compliance with scheduling, assessments, and coding
• Track patient outcomes

Some also provide specialized reporting capabilities that can assist agency owners in monitoring agency performance and making critical decisions.

Your agency needs technology that is compliant, easy to use, and scalable. If you’re thinking about switching your EMR, proper planning is key. Read about the six steps to a successful EMR transition here.

Here are a few more examples of how agencies can use technology to enhance patient care and increase monitoring.

Mobile Applications

HHAs can benefit from mobile applications that help them streamline communication and documentation processes. These applications enable HHAs to document patient information in real-time, reducing documentation errors and improving billing accuracy.

Remote Patient Monitoring

Remote patient monitoring (RPM) can assist HHAs in monitoring patients outside of routine visits. It also leads to earlier detection of problems and a reduction in the need for emergency care.

Home health advocates have long urged CMS to begin reimbursing for RPM in the home. CMS is gathering data and investigating the viability and value of remote monitoring in home health.

Although telecommunication services cannot replace a home visit ordered by the care plan, nor can they be used to determine eligibility or payment, changes in the 2023 Home Health Prospective Payment System Rate update appear to be another step toward providing such coverage in the future.

Telehealth

HHAs can use telehealth technologies to connect with patients without traveling. Creative use of telehealth can help improve patient access to care while reducing the need for in-person visits — which can maximize staffing. If you choose to incorporate telehealth into your care plans, remember that CMS will require HHA’s to report specific G-codes on home health claims effective July 1, 2023.

The Take Away

Despite the challenges, HHAs can thrive under PDGM in 2023. Agencies can continue providing high-quality care while achieving financial sustainability by using a patient-centered approach, prioritizing documentation, optimizing staffing workflows, and leveraging technology.