Medicare’s 2020 PDGM Changes: The Effect on Healthcare Staffing

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.

Providers, nurses and caregivers

With Skedulo, your mobile workers can spend more time with patients, and less time on administrative tasks.

Seamless orders management 

Under the 2020 PDGM changes, all orders and care plans from the healthcare provider must be completed and signed before submitting the final claim for each billing period. In reality, this could be cumbersome, as a patient’s health status and, therefore, a healthcare provider’s orders can quickly change. Further, updating and verifying changes can mean playing email and phone tag to get them done. This works against the HHA’s goal to provide timely care.

To help HHAs manage the process efficiently, a mobile workforce management platform securely captures care plan notes and physician orders. Just as importantly, it keeps staff up to date through seamlessly tracking care plan changes and obtaining healthcare providers’ orders in real-time.

Supply cost billing efficiency

The new PDGM requirements state that supply costs must be reported every 30 days with each final claim submitted. Manually tracking which supplies and equipment were used for which patients and when is time consuming and leaves room for error.

A mobile workforce management tool streamlines the process so that providers can quickly document onsite what supplies were used during patient visits. This allows HHAs to have more accurate and efficient supply cost billing, cutting out some of the manual labor and admin work typically involved.

Scheduling for LUPA thresholds

Prior to the 2020 PDGM changes, a Low Utilization Payment Adjustment (LUPA) had a threshold of five visits for a 60-day episode. If a patient received five visits within that time frame, the HHA received a full 60-day episodic payment. But, if there were fewer than five visits, the HHA only was paid per visit.

Under the PDGM changes, an HHA receives per visit payments, based on the volume of visits within a 30-day payment period. The number of visits depends on the 432 patient groupings—each has its own LUPA level that ranges from two to six visits for each 30-day payment period. Hence, a missed visit in a 30-day period could mean the HHA losing thousands of dollars per episode.

A mobile workforce management platform helps ensure that LUPA thresholds and the right provider and services are identified—and services are started sooner—in each episode of care, as well as the correct number of visits are applied and fulfilled for each episode of care. Also, a mobile workforce management platform makes it easier to track resource utilization and patient visits, as well as bill, more quickly and efficiently.

Comorbidity adjustment scheduling

A secondary diagnosis can impact reimbursement by adding a comorbidity adjustment to a HHRG score. To accurately indicate the condition of the patient, several diagnosis codes can be reported on each claim. 

A mobile workforce management tool promotes proper scheduling and documentation, which is critical to providing the necessary clinical resources for a care episode. This helps HAAs ensure that the appropriate resource is matched to the right patient based on the care that they need. Furthermore, any comorbidity adjustment can add an additional 15% payment to an episode of care. 

Easily Adapt to the PDGM Changes

The 2020 PDGM changes affect how and when HHAs are reimbursed for care. It no longer allows reimbursement based on the volume of therapy visits, but rather on claims data, diagnosis codes, OASIS, and comorbidity adjustments. Furthermore, billing must occur over two, 30-day periods, which significantly affects staffing and presents operational challenges that must be handled with great operational oversight and care for the patient.

From accurate intake and faster referrals to on-time billing periods to real-time visit documentation and more, a robust mobile workforce management platform helps your HHA navigate the PDGM changes and thrive.

Find out how Skedulo can impact your home health organization. Book a demo today.

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