Medicare’s Patient-Driven Groupings Model (PDGM) system went into effect on January 1, 2020. How has the industry fared in the month since the “most significant regulatory and reimbursement reform” in recent memory?
For the 12th episode of the Talking Home Care podcast, we put that question to a live panel of three of the nation’s leading experts at the Northeast Home Health Leadership Summit: Chris Attaya of Strategic Healthcare Programs, Stacy Ashworth of Select Data, and Nick Seabrook of BlackTree Consulting. Slides from the discussion are available for download.
You may listen to the podcast by clicking any of the platform images above, clicking “play,” or downloading it directly (Length: 70 minutes; Size: 31 MB). If you enjoy the podcast, please give us a five-star review so others can find it.
Guests: Chris Attaya is the Vice President, Product Strategy of Strategic Healthcare Programs. Stacy Ashworth is the Executive Vice President of Clinical Innovationof Select Data. Nick Seabrook is the Managing Director & a Founding Memberof BlackTree Consulting.
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:
February 12 at 1:00 PM ET Info Tech/EMR readiness
February 19 at 1:00 PM ET PDGM coding
February 26 at 1:00 PM ET PDGM cash flow & LUPAs
March 4 at 1:00 PM ET Therapy in PDGM
March 11 at 1:00 PM ET Clinical management of patient episode
Did you know that National Government Service (NGS) is focusing one of the home health Targeted Probe and Educate on therapy utilization?
Therapy TPE Audits Lead to Home Health Denials
Did you know that National Government Service (NGS) is focusing one of the home health Targeted Probe and Educate on therapy utilization?
NGS is auditing home health rehab service concentrating on medical necessity, the timeliness of the 30-day reassessments that is performed in conjunction with an ordered therapy service, and the required reassessment content by each rehab discipline. For many of the denials, the reasons stem from the therapist not comparing the present assessment results to prior assessment measurements and failing to document the effectiveness of therapy, or lack thereof, as required by regulation.
It may be beneficial to review with your therapy staff the key components to the therapy reassessment documentation as outlined by CMS.
Each rehab discipline must document measurement results of functional reassessment compared to prior measurements
Each must also document why therapy should be continued or, if applicable, discontinued
Document therapist’s determination of effectiveness of therapy
Why therapy is beneficial?
Why does the patient need more?
Remember the re-assessment is only one component of the home visit; there must be evidence of an ordered intervention as well.
Document treatment performed the day of re-assessment
Re-assessment without care plan interventions is a not covered service
Be Aware…
If measurement results do not reveal progress toward goals and/or do not indicate that therapy has been effective — then, to continue therapy — there must be consultation with the physician and documentation showing why the therapist and physician determined therapy should be continued.
Don’t forget to confirm continuation of the therapy with the verbal order!
I hope to hear from folks who are experiencing any of these issues with the therapy TPE.
The quality measure Improvement in Pain Interfering with Activity is being removed from Home Health Compare as of the April 2020 Compare Refresh. However, home health agencies are still collecting data for this measure through CY2020.
This quality measure will also be removed from the Quality of Patient Care Star Rating which will be calculated using seven measures beginning April 2020. Make sure to check how this will impact your agency’s star rating, so check out your Quality of Patient Care Star Rating Provider Preview Report in your agency’s CASPER Folders
The January 2020 Compare Refresh will be available this week, on January 23. CMS is no longer publicly reporting Emergency Department Use without Hospital Readmission During the First 30 Days of Home Health, and Rehospitalization during the First 30 Days of Home Health on Compare beginning with this January 2020 Refresh.
Provide focused education to your clinical staff with Blueprint for OASIS Accuracy training hosted by the Home Care Alliance on April 15-16, 2020 at the Sheraton Framingham Hotel & Conference Center, 1657 Worcester Rd, Framingham, MA.
Registration fills up fast so be sure to register early.
The Alliance’s Home Care Speakers Bureau can bring presentations on careers and other subjects to nursing schools, job fairs, or student assemblies.
Health care is moving out of the institutional setting and into people’s homes. Nursing and other allied health professional positions are following a similar path as the percentage of nurses moving into work a in hospital setting continues to decrease annually. Yet, newly graduated nurses often leave school not having been exposed to the nursing opportunities and high degree of complexity and independence in home health care practice.
Our Home, Not Alone campaign seeks to drive interest in, and confidence about, making a nursing career in home care or hospice.
Our dedicated speakers will bring presentations on careers and other subjects to nursing schools, job fairs, or student assemblies. Here is just a snippet of a presentation:
Last month, the Alliance recognized six outstanding individuals as our 2019 Home Care Stars. These are their stories.
Last month, the Home Care Alliance of Massachusetts gathered the industry at Granite Links in Quincy to honor six amazing individuals who represent the best of home care.
(L-R: Nicole Geddes, Me McBride, Vinette Tyme, Gerry Sanderson, Robin Pelletier, Sandy Hurley)
Since 1989, this fantastic event has celebrated the hard work of individuals and organizations who exemplify home care’s best values. More importantly, awardees are nominated by their colleagues and supervisors; winners are then selected by the Alliance’s Membership Committee.
Here’s a look at this year’s awardees, with excerpts from their nominations:
Me McBride, South Shore VNA, Aide of the Year
Imagine being the family member of a once-strong, determined man whose mind has been crippled by Alzheimer’s. You pray for help, and your prayers are answered in the form of an “earthly angel” named Me McBride.
She enters your home and takes charge with compassion and experience but — most of all — with respect for your loved one. For Me, the patient always comes first.
Vinette Tyme, HouseWorks, Aide of the Year
Vinette is a passionate home health aide, often described by colleagues and clients alike as “a dream” to work with, due to her dedication and exceptional skillset. She has an innate ability to anticipate clients’ needs and form personalized and effective strategies that work for them.
No task is too big or too small for her.
Gerry Sanderson, RN CDP, NVNA and Hospice, Clinician of the Year
Gerry has cared for hundreds of patients and families in the South Shore and her devotion to her patients is second to none.
Her approachable and positive demeanor is reflected in the way her patients interact with her, creating a safe and nurturing environment for all involved.
Nicole Geddes, LPN, Aberdeen Home Care, Clinician of the Year
Nicole delivers care, no matter what. If there is a need, she is there. She’s a roll-up-your-sleeves nurse, willing to jump-in and help an aide when needed or to manage a crisis in the middle of the night, on a weekend, or on Christmas Day.
She knows what to do and does it with tremendous skill.
Robin Pelletier, RN BSN, Southcoast VNA, Manager of the Year
Robin has successfully led Southcoast VNA’s Supportive Care Center since October 2016, where she guides an interdisciplinary team of 75 people. Her greatest accomplishment has been the extraordinary growth and quality of hospice services, doubling Southcoast’s average daily census and average length of stay.
Sandy Hurley, Commonwealth Clinical Services, Home Care Champion
Sandy embodies everything we value about nursing in the community. She is best known for “doing what needs to be done” from home visits, to setting up clinics, to teaching high school students about healthcare, to playing the piano at just about any function.
This year, Sandy extended her professional talents and skills to the mountains of the Dominican Republic, helping provide over 100 patients a day with health assessments, medications, and critical supplies.
As 2019 comes to a close and the industry prepares for a historic year of changes, the Star Awards allows us to pause and remember the dedicated workforce that makes home care such a success.
Congratulations and thank you to the 2019 Star Award Winners.
Changes to the OASIS data set will be incorporated into OASIS-D1 effective January 1, 2020. To help home health agencies understand these changes, Qualidigm has itemized the list of data set changes in a one-page document and four 90-second videos.
A number of changes to the OASIS data set have been made and will be incorporated into OASIS-D1 effective January 1, 2020 (click here for data submission specifications). These changes align with the new Patient-Driven Groupings Model (PDGM). Under this new model, OASIS accuracy will continue to be important with Functional Impairment Level derived directly from OASIS items.
To help home health agencies understand these changes, Qualidigm has itemized the list of data set changes outlined in this one-page document. Additionally, Qualidigm recently released its Quality Quick Minute video series focused on the OASIS-D1 changes. The videos series is comprised of four brief, 90-second information videos outlining these changes to assist with preparation in anticipation of the January 1 effective date.
The OASIS-D1 Quality Quick Minute video series includes the following:
The Home Care Alliance of MA will honor excellence in home care when we present the 2019 Innovations Showcase and Star Awards at the “Our Time to Shine” celebration on Tuesday, November 19, at the Granite Hills Golf Club, Quincy.
The Home Care Alliance of MA will honor excellence in home care when we present the 2019 Innovations Showcase and Star Awards at the “Our Time to Shine” celebration on Tuesday, November 19, at the Granite Hills Golf Club, Quincy.
What a better way to show your staff appreciation during home care month then treating them to an afternoon of celebration, food and a special inspiration keynote by Tim Cunningham, an intrepid survivor and best-selling author.
Together, we can celebrate our people and our pioneers by recognizing how they make life better for thousands of patients and their families. In celebrating individual achievement, we shine a light on our collective accomplishments.
2019 Star Award winners are: Champion: Sandy Hurley, President/Administrator, Commonwealth Clinical Services, Winthrop
Clinicians of the Year: Nicole Geddes, LPN, Aberdeen Home Care, Danvers Gerry Sanderson, RN CDP, NVNA and Hospice, Norwell
Manager of the Year: Robin Pelletier, Director of Supportive Care Services, Southcoast VNA, Fairhaven
Aides of the Year: Me McBride, CHHA Team Leader, South Shore VNA, Rockland Vinette Tyme, Care Coordinator, HouseWorks, Newton
Innovation award winners: Connected Home Care, Concord: Oz Documentation System O’Connell Care at Home, South Hadley: Advanced Internal In-Service Training Maxim HealthCare Services, Plymouth: Novice Nurse Program
Join us on Tuesday, December 10th at the Beechwood Hotel in Worcester, MA for our Annual Financial Management Conference. Take a deep dive into the current trends and issues happening in the Home Health industry as you prepare for 2020.
Join us on Tuesday, December 10th at the Beechwood Hotel in Worcester, MA for our Annual Financial Management Conference. Take a deep dive into the current trends and issues happening in the Home Health industry as you prepare for 2020. This is the perfect conference for CFOs, CEOs, and Clinical Directors!
The 2019 Agenda Includes: Hindsight is 2020: Hone into Home Health & Hospice Payment Compliance in the New Decade, Kathleen Hessler, Simione Healthcare Consultants The HHS Office of Inspector General (OIG) continues its intense oversight and scrutiny of the Medicare home health and hospice programs by analyzing the rich sources of data available to them. With increase in survey and audit activity —including Targeted Probe and Educate (TPE), UPIC and SMRC audits, learn what your agencies need to do to ensure payment compliance in the new decade. The session will cover types of government audits, recommendations for internal-self monitoring, as well as what to do if your agency identifies an overpayment.
HHVBP Trends & Data, Chris Attaya, SHP Data As we close out year 2 of the Home Health Value-Based Purchasing Demonstration, Chris Attaya will take a deep dive and identify the latest updates and trends in HHVBP and Star Rating measure scores. Attaya will also discuss data points specific for Massachusetts state agencies.
PDGM Check Point, Mike Carr, Axxess PDGM is almost here, now is the time to ensure you are ready for the changes. This session will review where you should be, and how to get there if you’re not. Carr will provide a high level overview of PDGM as well as understanding how past performance will be impacted by PDGM. Other elements to be discussed include technology challenges, therapy impact, and measures for survival.
Making Home the Center of Care: Opportunities & Challenges of Public Priorities, Mike Canter, Carecentrix & Reactor Panel Recent public policy trends focus on cost containment, integrated care, and quality outcomes. Home care is in a unique position to thrive in this emerging environment. Is your agency poised to seize the opportunity?
PDGM is coming January 1, 2020 – HCA has numerous education opportunities to help you prepare and progress!
Blueprint for OASIS Training & Certification, November 4-6 Training, Devens, MA
Experience the comprehensive and nationally acclaimed two-day Blueprint for OASIS Accuracy workshop and learn to confidently teach, audit, and collect OASIS-D items accurately. Through guided, expert instruction, and participation in problem-solving discussions and application scenarios, achieve mastery of the OASIS items, conventions, and the latest data collection rules. Rather than provide opinions, assumptions, or unfounded interpretations, the “Blueprint” presenters will model reliance on CMS guidance documents and provide and demonstrate strategies for how to find defendable answers to your OASIS questions.
PDGM Comittee Meeting, November 18 Networking Meeting, 10:00-12:00, Milford, MA
Clinical Leadership Development and Care Coordination Under PDGM
PDGM introduces complex challenges and heightens the importance of efficient discipline utilization while maintaining quality care outcomes. The role that the clinical manager plays in this care management process can make or break success under the new model. This session will cover strategies for effective collaboration of care and agency leadership development in order to maintain focus on patient-centered quality care delivery.
Registration: FREE HCA MEMBERS ONLY!!
PDGM Clinical Episode Management Webinar, November 21 Online Webinar, 2:00-3:30PM
Clinical episode management takes on an even more critical role under PDGM. This session will describe how effective clinical episode management is the foundation for improving both patient and agency outcomes as well as improving regulatory compliance. We will review tactics for management of the 30 day payment period and explain the new LUPA thresholds and show that effective clinical episode management will be key to ensure patients are receiving appropriate, cost-effective, quality care. We will discuss strategic planning for implementation of clinical episode management best practices within the agency, and strategies to enhance communication and collaboration between all disciplines.
PDGM is fast approaching and a lot of changes are coming with it. HCA has partnered with Melinda Gabourey, CEO of Healthcare Provider Solutions, to put on a 4-part webinar series, each 90-minutes long! The series will run daily from 11:00AM-12:30PM. Sessions include: • PDGM Structure & Financial Impact • PDGM Coding & OASIS Integrity • PDGM Operational Decision Necessities • PDGM Revenue Cycle Changes
REGISTRATION HCA Members: $79/Line per Webinar -OR – $299/Line for Full Series Non-Members: $149/Line per Webinar -OR – $549/Line for Full Series
2019 Financial Management Conference, December 10 Conference, Worcester, MA, 9:00AM-4:00PM
This years financial conference will cover topics on PDGM, VBP, Billing Compliance, and Managed Care. The following PDGM session will be by Mike Care of Axxess: PDGM is almost here, now is the time to ensure you are ready for the changes. This session will review where you should be, and how to get there if you’re not. Carr will provide a high level overview of PDGM as well as understanding how past performance will be impacted by PDGM. Other elements to be discussed include technology challenges, therapy impact, and measures for survival.
2020 Leadership Summit Pre-Conference, January 28 Conference, Boston, MA, 1:00-4:30PM
Vision Quest: Refining Your Personal Leadership Style for Success Under PDGM and After We will start the summit with an interactive exploration of what industry and leadership issues you are hear to work on! After breaking it all down, we will engage in some self reflection on your leadership journey to date and how that has or has not got your prepared to meet today’s challenges. The session will continue with an instructional tutorial that will help to make you a better more confident and ultimately successful leader. Put it all together with a set of top industry experts on the journey to PDGM success.
PDGM Impact on Therapy Practice, March 5 Online Webinar, 1:00-2:30PM
CMS has changed the PPS case mix system “to rely on patient characteristics to set payment for therapy and non-therapy services and should no longer use the number of therapy visits as a payment factor.” The practice patterns and therapy compensation creep associated with the PPS methodology up until 2020 will fit poorly with a case mix system not relying on a therapy visit number. However, practice pattern changes do not occur as abruptly as payment changes. This session will review the new Patient Driven Groupings Model (PDGM) and how therapy can and should impact the groupings within their own agency. We will then apply reasonable and necessary plans of care to typical home health conditions and link them to the outcomes agencies strive to achieve. Participants will learn to prepare changes in practice and to demonstrate the value therapy services can bring to the home health agency.
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