Finally, after a couple of years of preparation and anticipation, the Patient-Driven Groupings Model (PDGM) is underway. It’s a little early to get a read on how agencies are doing under PDGM, but one area I was curious about was how much agencies improved on coding “unacceptable” diagnoses (formerly known as Questionable Encounters, or QEs).

The CY 2020 Home Health Payment System Rate final rule was published last week and, as expected, the Patient-Driven Groupings Model (PDGM) will be implemented for 30-day periods of care starting on or after January 1, 2020. The good news is that CMS reduced the behavioral adjustment to 4.36%, just over half of the revised 8.39% estimates. Read our blog for highlights on the final rule, plus insights and predictions for what's to come.

SHP is pleased to announce the release of the PDGM Preview report to help home health agencies prepare for the January 1st, 2020 implementation of the Patient-Driven Groupings Model (PDGM). The PDGM Preview report provides a view into your 2019 payment episode information, as applied to PDGM 30-day payment periods, and grouped by HHRG. The report includes period breakouts by distribution, visit information, and LUPA rates, with state and national benchmarks.

We are pleased to welcome Columbine Health Systems as one of our first SNF customers. We look forward to working together to help Columbine optimize its resources under PDPM, improve readmissions, outcomes and relationship with referring entities.

PDPM is almost here and will drive a shift in the way SNFs think about provide care. The complexity of PDPM will require a cookbook of recipes that are more sophisticated, allow for individualization, and require a higher level of monitoring and tweaking to achieve the best outcome. To be successful, new tools and the right data will be essential to help SNFs optimally distribute resources, achieve desired outcomes, and maximize reimbursement. How is your SNF going to determine the right "recipes" for care?

SHP is pleased to announce the release of a new Unacceptable Diagnosis Alert to help home health agencies prepare for coding requirement changes under PDGM. Come January 1st, 2020 primary diagnosis codes will be categorized as either “acceptable” or “unacceptable”. Our new alert will notify users whenever an unacceptable primary diagnosis code is entered. This will help agencies train their staff now to be ready for PDGM and avoid the delays and lost time associated with claim rejection and recoding.

Strategic Healthcare Programs (SHP), a leading provider of post-acute data and analytics, has expanded its portfolio of products by introducing the SHP for Skilled Nursing℠ software solution. The Patient-Driven Payment Model (PDPM) and a continued focus on cost and quality has enhanced the need for real-time data in the SNF setting. This new automatic, real-time reporting suite enables SNFs to better manage and improve readmissions, referrals, and outcomes so they can succeed under PDPM.

In the CY 2019 Home Health Prospective System Rule Update, CMS finalized the ICD-10 codes that would be “acceptable” to use as a primary diagnosis code under the Patient-Driven Groupings Model (PDGM). The term "Questionable Encounters" (QE) was absent from the proposed and final rules, now there is only “acceptable” or “unacceptable” codes. Learn more and see whether SHP agencies are already phasing out unacceptable codes.

The annual SHPBest™ recognition program was created to acknowledge home health and hospice providers that consistently provide high quality service. SHP would like to congratulate the 2018 SHP Best-of-the-Best winners, who have been recognized for achieving the highest overall HHCAHPS patient satisfaction or CAHPS Hospice caregiver satisfaction scores of all eligible SHP clients during the 2018 calendar year.

The home health industry is six months away from the new Patient-Driven Grouping Model (PDGM). There is a lot of educational content available to help agencies prepare but much of it reports on PDGM metrics and payments using average values. Using 30-day periods as an overall average can be misleading. It is more meaningful to break out this data into the sequence of periods across groupings like clinical category. In this way one can analyze the impacts of periods to help define the clinical and operational improvements necessary to manage your agencies under PDGM.