PDGM IS HERE, NOW WHAT?

For most of 2019, we have been hearing about all the fears that PDGM will bring our home health agencies. We have heard issues with cash flow, 1/3 of the companies going out of business, and rumors of agencies that won’t survive with Rap Payments decreased to 20%.

I really felt like we were in the Chicken Little Movie, with the chicken running around screaming, “The sky is falling!” Now, the first week is here and the sky is still in place.

Let’s review what is going to help support our agencies operationally

First, we need to make sure that (with every referral) we get a list of all the possible diagnosis codes. This is going to help with getting the correct clinical group and capture the additional reimbursement for co-morbidities.

Next, we need to make sure that we have everything needed to support the face-to-face documentation. We don’t want anything to slow down the billing process or admission process. It is critical that every referral can become an admission and we don’t want to have the face-to-face encounter making our intake offices have a delay in accepting patients.

Now, what if they are for heavy therapy? Hopefully you already have a plan in place but if not you want to keep reading…

You must look at the referral sources and decide on how to service the patients without losing your shirts. You must know that you have the right therapist who will treat the patient according to what they need to keep out of the hospital and recover safely at home. You want to make sure you have therapy assistants working with your therapist to keep the cost of servicing the patient down.

You may need to add home health aide services to support patients more on days that the therapist isn’t seeing the patient. There may be opportunity to land some of the accounts from competitors that are fearful of taking therapy cases as well. If you can figure out how to do it without losing money, you may quickly become a preferred agency from your referral sources.

Another vital step to prepare for

We need to make sure that our staff is scoring the functional assessments correctly. That each nurse is reading the OASIS answers from the bottom up when completing the assessment. Too many times the nurse reads the possible OASIS answers from the top down and they underscore the patient’s functional status.

If your nurse still has questions about how to score functional assessment you can have one of the physical or occupational therapist and the nurse collaborate on possible answers. The OASIS Guidance Manual is the best resource out there. I am always shocked when I ask clients how they train their staff on OASIS and many clients never mention one of the best resources available to agencies and it is free!

You can find it here:  https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Downloads/OASIS-D-Guidance-Manual-final.pdf.

The OASIS Guidance manual shows the items intent, and response-specific instructions. It also provides data sources and resources for answering the functional assessments. I always make sure each new nurse knows how to answer the functional assessment questions.

Final tip for PDGM

If you are a salesperson, you may be pressured more than ever to bring in new business. You may be pressured to bring in facility referrals because they reimburse the agency at a higher level. You will not be successful out selling without a repeatable sales process that is proven to give you results.

If you haven’t gone through our High-Performance Sales Academy this is the time to do it! If you are an owner and finally realized that you must have a salesperson help your organization grow, know we have the products that can help support you!

Go check out our website at www.homecaresales.com and find the solution to grown challenges! Happy, healthy, and prosperous New Year to all!

By Cheryl Peltekis, RN “The Solutionist”

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