Home Health Care Clinical Managers/Supervisors of Clinical Services, Quality Management staff and Clinical Educators will play a key role in the successful implementation of the new Medicare Patient Driven Groupings payment Model (PDGM). In this interactive session, attendees will learn the four key elements of the PDGM scoring system: admission source and timing, clinical groupings, functional levels and comorbidities. Managers will leave with specific techniques for obtaining accurate information to support coding, scoring and billing. All, while using the least resources to produce the best outcomes.
Areas covered include: optimizing complex care, episode utilization and case management, interdisciplinary teamwork, care coordination and collaboration. The session will also describe key PDGM measures and monitoring techniques to optimize efficiency, achieve success and prevent pitfalls.
PROGRAM OBJECTIVES (At the completion of this session, participants will be able to….)
Describe key elements of Medicare’s PDGM payment model
Explain the impact of the new regulations on clinical operations and clinical managers
Identify key clinical operations changes that will be required for PDGM success
Create an initial action plan for successful PDGM implementation
ABOUT THE SPEAKER: Barbara Katz, RN, MSN is an experienced clinician, manager, trainer and health care consultant. Barbara has been a hospital registered nurse, an APRN in internal medicine, a site manager for a Kellogg Foundation self-care education grant, a training manager and a manager of clinical operations for a network of medical practices. She has been Vice President for Clinical Program Development in a large home health care agency where she founded a family caregiver support network. Barbara provides training in leadership for value based payment, patient self-management support, family caregiver support, process improvement tools and techniques, population health strategies, the use of data in daily work, communication, teamwork and motivational interviewing.
“To get others to be involved: This conference was an eye opener to areas we need to improve upon and the tools provided will help in the process. This really brings it all together and a better understanding of PDGM.”
“This was excellent very informative. Made PDGM clear & understandable. Great tips to get started & to stay on task. Barb is a great presenter & her use of handouts was helpful.”
Join us for our first annual Quality & Compliance Conference being held on Thursday, March 29th in Worcester, MA. This conference has been created due to the overwhelming new regulations that agencies need to understand to remain compliant.
After surveying members, HCA determined some of the most important topics that will be discussed during this full day conference.
Members are able to register for the LOW price of $50/person.
5 Nursing CEUs will be awarded!
The agenda is as follows:
ADRs, Pre-Payment Reviews, Post-Payment Audits and Suspensions – Navigating Medicare’s Administrative Appeal Process. Robert W. Liles, J.D., M.B.A., M.S., Managing Member, Liles Parker Attorneys & Counselors at Law
Pre-payment reviews are now being conducted by both UPICs and ZPICs. While the government has placed some restrictions on their use, contractors continue to exercise great latitude in their scope and the length that they are imposed. Similarly, contractors remain in control of post-pay-ments conducted and suspension actions recommended to CMS. In this presentation, Robert W. Liles, J.D., will discuss these enforcement actions and outline the adverse impact each action can have on your agency and discuss your rights under the Administrative Appeal Process.
The COPs are Here, is Your Agency Complying? Susan M. Filshie, RN, Director of Clinical Consulting, QIRT
The Conditions of Participation have been here since January, here is what we are seeing that is wrong! Quality in Real Time consults their clients regulary on the new home health standards. Filshie will take a deep dive into what what they have seen regarding the COPs and will give you the steps needed to ensure you are complying with the new regulations. A major focus will be spent on Patient Rights, which has been pinpointed as one of the more “heavy hitters” for the industry.
Developing a QAPI Project and the Fundamentals to Make it Successful Cheryl Pacella DNP, HHCNS-BC, CPHQ, COS-C, HCS-D, CAP Consulting
We all celebrated the fact that quarterly record reviews and an annual agency evaluation are no longer required under the new Conditions of Participation. HOWEVER, agencies do need to comply with a robust Quality Assessment and Performance Improvement (QAPI) program. We need to utilize data from record reviews and various reports to prioritize Performance Improve-ment Projects (PIPs). Agencies need to identify at least one QAPI project by July 2018. So where do you start? The goal of this program is to help you identify target areas and provide you with the tools to implement a successful Plan of Action.
Panel Discussion: Real Examples of Successful Performance Improvement Projects Suzanne Clark, PT, DPT, GCS Direction of PI & Education, NVNA and Hospice Melinda Monteverde, RN, MSN, WCCN, Executive Director of Nursing Operations, Steward Home Care Kate Mercier, Vice President of Operational Excellence, Brockton VNA
Three Home Health Agenices in Massachusetts have been put together to show real example of successful Performace Improvement Projects. Panelists will explain how they implemented their projects, what worked, and what didn’t. Q&A time will be available!
The Alliance hit a milestone this week, with a new total of 70 agencies currently Accredited! To earn accreditation from the Alliance, each of those agencies submitted documentation demonstrating their compliance with fifteen separate measures covering client rights and protections, caregiver qualifications and skills, insurance coverage, and employment practices. Details about the Accreditation standards are available on the Accreditation Page of the Alliance’s website.
The Alliance developed the Accreditation program because Massachusetts does not have a licensing program specific to home care agencies. By their adherence to the fifteen Accreditation standards, private care home care agencies demonstrate their commitment to quality.
A complete list of Accredited agencies is available here.
Updated Home Health Compare data has been posted to the PatientCareLink website. Home Health Compare data allows consumers to compare the quality outcomes of Medicare-certified home health care agencies on a variety of standardized quality measures. See how the agencies in your area compare to other agencies and to national average scores.
Hospices will be mandated-for the first time-to collect data on specific quality measures during the final calendar quarter of 2012 as part of the Hospice Quality Reporting Program. Failure by a hospice to submit the required data will result in a 2 percent reduction to that hospice’s payments during fiscal year 2014