As of January 1, 2020, new changes for the Patient-Driven Groupings Model (PDGM) went into effect. The changes focus on how Medicare-certified home health agencies (HHAs) are reimbursed for care, significantly affecting staffing and presenting operational challenges that must be handled carefully to avoid revenue loss.
Let’s look at what’s changed under PDGM, and how a mobile workforce management platform can make meeting the new requirements easier on staff and better for your agency’s bottom line.
What the 2020 Medicare PDGM Changes Mean for Staffing
Prior to 2020, home health agencies received compensation for services, such as skilled nursing visits, based on the number of therapy visits provided—the more visits, the higher the payment rates.
Post the 2020 PDGM changes, HHAs’ reimbursement focus has shifted from volume-based payments to value-based care, diagnosis, and related comorbidities.
In light of PDGM changes, many HHAs have cut physical, occupational, and speech therapy services. It has translated into therapy staff layoffs under the premise that providers are closely monitoring the number of therapy visits provided. This is because reimbursement is bundled into one payment and the cost of providing these skilled services is high. Even patients who are severely ill may see their services cut back. To compensate for the decreased staff, some HHAs, such as Visiting Nurse Service of New York, are increasing the use of remote patient monitoring.
With decreased staff, more frequent and critical billing periods, and other changes with PDGM, HHAs are struggling to remain profitable and keep up with patient load. That’s where a mobile workforce management platform can step in.
How Mobile Workforce Management Can Help
Mobile workforce management in home healthcare can help providers manage these changes more effectively in several ways:
Accurate intake and faster referrals
With the PDGM changes, reimbursement depends on various factors, including billing accurately and within critical time periods during episodes of care. Errors and omissions may delay care, as well as result in missing a 30-day billing period, which means the HHA is not reimbursed.
A mobile workforce management solution helps facilitate accurate intake and faster referrals. With one source of truth for patient data management, healthcare providers can get faster referrals, match a provider’s skill set to a patient, easily manage staff schedules in real-time, and significantly reduce providers’ time on admin paperwork. Patients can start services sooner, and HHAs can assign the appropriate resources at Start of Care—both are key to beginning the billing period, which is in the HHA’s best interest.
On-time payment periods
PDGM keeps the 60-day episode of care and OASIS requirements. However, billing now is split into two, 30-day increments, which means missing a billing period means the HHA absorbs the cost rather than receives reimbursement.
To facilitate managing the increased—and more frequent billing periods—a powerful mobile workforce management tool reminds workers when assessments are due. It also alerts staff when appropriate requirements have been met—a key differentiator that helps the agency optimize revenue. As a single system of record, a mobile workforce management platform serves as a source of truth and helps agencies stay in control of the billing cycle while optimizing efficiencies for caregivers.
Real-time visit documentation
Medicare reimbursement depends on punctual documentation of patient visits. However, bogging down caregivers with this process can lead to missing and incomplete data. This creates lags in the billing cycle that can result in revenue loss.
With a mobile workforce management tool, a single, integrated view allows caregivers to capture documentation in the moment—from arrival and departure times to services rendered to patient visit notes and more. Staff can simply upload the information onsite through their mobile device and upload to the patient record. This saves time and reduces errors for providers and admin staff.
