Behavioral Adjustments Under Early PDGM

NAHC’s Bill Dombi replies to reports that patients across the country are being told they no longer qualify for certain Medicare services or that services have been cut or discontinued.

Kaiser Health News and other health care media outlets are reporting that patients across the country are being told they no longer qualify for certain Medicare home health services or that services have to be cut back or discontinued due to changes in Medicare scope of benefits.  On a call with state home care association executives this week, Bill Dombi, President of the National Association for Home Care and Hospice confirmed that they are hearing of such cases from patient advocacy groups, such as the Center for Medicare Advocacy.  If such behavior gives the industry “a reputation for putting bottom line ahead of patient care, it’s going to be bad long term for the home care industry,” said Dombi.

In terms of any shortcoming with the PDGM model, he said,  we want to be able to lay these at the feet of the model’s crafters at CMS, not having them come back at us for over adjusting behaviors even beyond what was built into the model. He further suggested that until proven otherwise it might be case of managers and field staff inaccurately translating direction from management as to what has changed. He suggested CMS might need to do some more education around what has changed (payment) and what has not (coverage).

NAHC will present a series of six new webinars – free to members and non-members – on PDGM in Real Time featuring an open forum in which attendees can share and gain insights with Home Care & Hospice Financial Managers Association (HHFMA) experts about what is working and not working in the early weeks of PDGM.

These webinars are designed to enable home health agencies to achieve “high performer” status through continuous operational improvements in financial, clinical, business analytics, and administrative operations as PDGM unfolds.

The schedule for the Wednesday webinars at 1 PM ET is as follows:

  1. February 12 at 1:00 PM ET Info Tech/EMR readiness
  2. February 19 at 1:00 PM ET PDGM coding
  3. February 26 at 1:00 PM ET PDGM cash flow & LUPAs
  4. March 4 at 1:00 PM ET Therapy in PDGM
  5. March 11 at 1:00 PM ET Clinical management of patient episode
  6. March 18 at 1:00 PM ET PDGM data analytics

Registration information can be found here.

Author: Pat Kelleher

Pat Kelleher is Executive Director of the Home Care Alliance of Massachusetts.

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