The Patient-Driven Groupings Model (PDGM) home health payment system, which took effect in 2020, is still relatively new. But one home care organization that has been analyzing the program since implementation closely offered some early lessons learned.
“We got some things right and we got some things wrong,” said Brent Korte, chief home care officer of EvergeenHealth, based in Kirkland, WA, which has about 1,400 home health patients.
He spoke Wednesday during a webinar, along with Molly McDonald, EvergreenHealth Home Care program manager of quality and regulatory compliance, and Nick Seabrook, principal of SimiTree Healthcare Consulting. The National Association for Home Care & Hospice sponsored the webinar.
PDGM fundamentally changed the way home health agencies bill for care. Instead of billing every 60 days, the billing period is every 30 days. Of particular concern to agencies under this new model is avoiding Low Utilization Payment Adjustments (LUPAs) during the 30-day billing cycles.
Among EvergreenHealth’s takeaways from the two years since PDGM took effect are knowing the importance of educating employees — from referral to scheduling, clinical, coding, billing and reviewers — about the new system; the new role of business analyst, who bridges the gap between finance and operations; the need for data to support changes; and the value of making sure clinicians are on board, according to McDonald.
“This goes way beyond just buy-in,” said McDonald, noting that everyone in the field, along with those in the office, must support the system.
The necessity of clinical coordination is a major lesson from the model, she said. One change EvergeenHealth undertook that has made a major difference is the implementation of pods, or care teams who convene regularly in small groups. The pods help to improve communication among teams, ensure goals of patient visits are realistic and meaningful, and generally improve patient care. Initially, teams would physically get together for lunch or at the office. Now the meetings are remote, the speakers said Wednesday.
Data under the new system also is paramount, they said. “We want it in as real time as possible. We want it to be impactful, and we want it to be trending,” McDonald said.
PDGM ultimately represents the new world of value-based care. Quality of care, the patient experience, financial “goal posts,” readmissions and social determinants of health factor into the delivery of care, Korte said.
