The installation of PDGM in 2020 rewired the Home Health care production and delivery model under the Impact Act's Volume to Value (V2V) reforms. The V2V specifics of the HH reforms address traditional areas of the previous PPS Model that failed to produce increased outcomes. OASIS accuracy, splitting the 60-day certification period, and reduced payments for Community-based referrals were all included in the Patient-Driven Groupings Model. But the changes to HH Rehab services were the most impactful, as Providers found that the value of the patient episodes were no longer defined by the number of rehab visits on the case.
Prior to PDGM's installation, most of the preparatory educational offerings focused on the structure of the model, or fiscal billing and cash-flow specifics. There was little available in the way of operations, and with Covid's appearance shortly after PDGM's installation, many operational changes required for success were never fully addressed. As a result, most HH Agencies have great opportunities in terms of managing rehab services to higher levels of clinical outcomes with decreased falls and decreased readmissions. In addition, the exact clinical management required for rehab success also produces 4+/5 Star Agencies with single digit readmissions and unexpected PDGM Episodic fiscal returns. That's the little-known fact that changes the entire PDGM experience for informed Providers; EFFICIENT PDGM REHAB MANAGEMENT CREATES 5 STAR PROVIDERS!
PDGM was developed to create value-programming individualized to the patient in question, and that required the elimination of volume practices from the HH PPS model. First to address was the use of therapy visit volume as the primary payment factor in Home Health. It has long been a belief that OASIS SOC accuracy suffered because it wasn't connected to payment; a HH episode could still be financially successful despite a wildly inaccurate SOC OASIS as long as enough therapy visits were included. So, the first order of PDGM was to disconnect therapy visits from the payment model and focus payment (and clinical outcomes) on OASIS accuracy at SOC and DC.
Most HH Providers have internalized the new changes in terms of OASIS admissions, but don't understand yet how therapy works under PDGM. How are therapy costs covered under PDGM? How would that relate to rehab visit totals per episode? What is the Functional Impairment Level (FIL) and how does it guide therapy under PDGM? Why should I check the FIL per patient to direct rehab programming?
PDGM employs a refined OASIS profile to develop an acuity-based rehab score of Functional Impairment Limitations (FIL). The FIL determines the expected visit range of therapy visits and includes payment to cover those costs. By assuring therapy visit content follows a Value-based (vs. Volume-based) care path, elite clinical outcomes are produced accompanied by a positive margin for the HH Provider.
PDGM aligned OASIS accuracy with therapy acuity and payment while employing a value-based care path to desired outcomes. Successful agencies understand the need to rewire operations for PDGM outcomes, particularly therapy visits, value-based rehab clinical content, and in-episode management clinical rounds for todays and tomorrow's reforms. Get started today on your path to utilize PDGM therapy management to achieve 5-Star Outcomes.
Join us this Thursday, March 31 for a 2-hour webinar on updating your rehab programs for PDGM success "Managing Rehab Under PDGM".
Can't make it live? No worries, register anyway and get the recording straight to your inbox when it is made available!
It will be lead by Arnie Cisneros PT, the Founder & President of Home Health Strategic Management; he has 30+ years of experience as a Physical Therapist across the care continuum, and he serves as a Post-Acute Consultant for multiple Pioneer ACO systems. He is renowned for his adaptation of traditional Healthcare operations to address ongoing CMS reforms.