PDGM – Clinical-Episode Management is proudly presented to you by National Association for Home Care & Hospice. Thank you. We hope that you enjoy your course.
Survival is key, as home health providers brace for PDGM, the largest change to home health reimbursement since the implementation of PPS in 2000. The complexity of the new PDGM payment model is overwhelming, with 432 different case-mix groups, 12 different clinical groupings and LUPA thresholds ranging from 2 to 6 visits. When adding the significance surrounding the model’s shift to 30-day payment periods, providers need to be proactive in seeking support to effectively interpret and navigate this new and extensive regulatory payment environment. Agencies will be expected to significantly change day-to-day operational practices to ensure success under PDGM, which must start with further development of all executive and clinical leaders. A strong clinical episode management program is critical to ensure sustained, efficient, cost-effective and uncompromised quality care delivery under the PDGM program.
Learning Outcomes:
•Recognize the complexity of determining LUPA thresholds under PDGM;
•Discuss the relevance of front-loading, missed visits and refusals of care and services to LUPA prevention;•Explain scheduling strategies to prevent missed visits;
•Discuss necessary modifications to the intake and referral process under PDGM;•Examine clinical management responsibilities related to LUPA prevention;
•Explain the relevance of timely OASIS review, coding completion and clinician documentation under PDGM;•Identify strategies for improved physician interaction to ensure timely 30-day billing
•Discuss strategies to improve patient buy-in and adherence to the home health plan of care; and
•Outline strategic planning for implementation of clinical episode management best practices within the agency.
Faculty:
Carissa McKenna
Cindy Campbell, RN, BSNM, MHA