WHAT TO KNOW AND HOW TO PREPARE

PDGM - Solved

Better Data. Better Insights.

Are you ready for Patient-Driven Groupings Model (PDGM)? What effect will PDGM have on your agency and how can you strategically plan and prepare? The key to success with PDGM is to have real-time data that is constantly pushed to you, which will give you the needed advantage to thrive with the PDGM model.

SIDE BY SIDE ANALYSIS

How Better Preparation Happens.

Compare a patient under the current PPS model to that same patient on January 1, 2020 under the PDGM model.

Revenue Analysis

Total revenue under PDGM for the 60-day episode.
HHRG Calculations

Overview of the elements that make up the HHRG are calculated i.e. source/timing, clinical group, functional impairment level, comorbidity adjustment, HIPPS code, wage index, case-mix weight.
Reimbursement

Reimbursement amount for each 30-day period with care type.
LUPA Threshold

LUPA threshold calculated for each 30-day period and warning if your current planned visits will not meet the LUPA threshold.
Visit Utilization

Visit utilization planned/actual for each discipline listed with total.
Primary Diagnosis

Specific primary diagnosis information with the clinical group listed and a warning if the diagnosis does not fall into one of the 12 clinical groups. A warning indicates you are at risk that the claim will be returned to provider for more specific coding.
Secondary Diagnosis

Up to 24 secondary diagnosis codes with comorbidity subgroup listed and calculated based on the number of diagnosis that fall into one of the approved groups. There are 3 levels of comorbidity adjustment (none, low, high).

PDGM DASHBOARD

Real-Time PDGM Workflow Information

Get real-time comprehensive information and alerts to ensure you are able to manage the PDGM workflow. The KanTime PDGM specific dashboard will provide you with real-time comprehensive information and alerts to ensure you are able to manage the PDGM workflow. Each dashboard widget and counter will allow the user to monitor and act on key elements related to PDGM as needed to ensure quality care for the patient and timely processing of claims.

Patient

See patients who are affected by PDGM, at high risk for fall or re-hospitalization, pending evaluations by other disciplines.
Clinical Grouping

Review patients that fall into each clinical grouping.
Metrics

Metrics that help monitor efficiencies and workflow problems for days to admission and evaluation, days to assessment locking.
Alerts

Get alerts for non-qualified diagnoses, potential LUPAs, assessments not locked or orders not signed.
Alerts

Coordinate care for multiple discipline patients and those without care coordination notes.
Alerts

Monitor and track orders not sent, outstanding orders, and physician portal orders.
Alerts

Analyze financial metrics such as cost per episode/visit, time for RAP and claim.
Alerts

Identify institutional vs community referrals to see where marketing efforts are best utilized.

Questions

Answers To Common Questions

What is PDGM and how will it affect me?
The Patient Driven Groupings Model (PDGM) is a new payment model for all Medicare certified home health agencies that will go into effect January 1, 2020. PDGM will shift 60 day episodes to 30 day units of payment, and a new case mix methodology will be used.
How does PDGM change a LUPA?
LUPAs will continue under PDGM, however, the shorter periods for payments means the threshold for reaching a LUPA will change (will range from 2-6 visits).
What will happen to therapy?
Therapy will not go away and will be just as important as it always has been and agencies will need to make sure staff is trained in OASIS-D and coordination of care between disciplines is taking place.
Is there a change in the calculation of payment in the PDGM model?
There is a change in the calculation of payments under PDGM to consider up to 24 secondary diagnoses in contrast to the PPS model that only considers 5 secondary diagnoses.
What actions can agency leaders take to prepare for PDGM?
Educate your staff on PDGM and the change in workflows. Use data analytics to determine the impact PDGM will have on your agency so you can be better prepared.
KanTime is imagination realized. What do you imagine for your agency?