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.

Talking Home Care Episode 4: NAHC’s Bill Dombi on HHGM and Federal Home Health Policy

Pat Kelleher talks with NAHC’s Bill Dombi about PDGM, reduced CMS spending, and more.

Bill Dombi
Bill Dombi, Interim President of NAHC

For the fourth episode of the Talking Home Care podcast, Pat Kelleher talks with Bill Dombi, interim president of the National Association for Home Care & Hospice (NAHC). Topics include:

  • Background on the the Home Health Grouper Model (HHGM) and an update on its status;
  • Discussion of the $950M/year reduction in overall home health spending, as estimated by CMS (and estimated to be much, much higher by NAHC);
  • An update on NAHC’s lobbying efforts, specifically its support of a letter sponsored by Senators Nelson and Rubio to oppose the new model;
  • How we need agencies to contact their representatives immediately (by the end of the Monday, September 25);
  • How cuts may affect the home health workforce; and
  • Holding the Trump Administration to its promise to reduce paperwork administrative overhead.

You may listen to the podcast by clicking the play button above, downloading it directly, or subscribing through iTunes or Google Play. (Length: 29’00”; Size: 14 MB).

Links/Action:

Talking Home Care LogoHost: Patricia Kelleher is the Executive Director of the Home Care Alliance of Massachusetts.

Guest: William Dombi was appointed as NAHC’s interim president this past August, and served as its vice president for law since 1987. He is also director of the Center for Health Care Law, a nonprofit, public interest law firm established by NAHC, and executive director of the Home Care and Hospice Financial Managers Association. Additionally, he is a member of the advisory board of Bloomberg BNA’s Medicare Report.


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