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.

On April 25th, the Centers for Medicare & Medicaid Services (CMS) posted their proposed FY 2020 payment rule for hospice on the Federal Register. In our blog we summarize what you need to know such as the potential rate impact between 2019 and 2020, additions to Hospice Compare, and new “high priority” measures they are considering adding to their Hospice Quality Reporting transparency.

Given the significant role that hospitalization rates play in publicly reported scores, star ratings, and value-based purchasing calculations, preventing unplanned hospitalizations is one of the top priorities for home health agencies. To ensure that our clients have the best possible tools to identify patients that are at risk of being hospitalized and help prevent unplanned hospitalizations, SHP has released a major update to our acute care hospitalization risk model.

An informative report from the United Hospital Fund described the overly complex process patients and their families go through to navigate Post-Acute Care (PAC) options such as skilled nursing facilities (SNF) and home health agencies (HHA) after a hospital stay. SHP's CareStat product addresses current challenges with transitioning care by providing hospitals and ACOs with real-time home quality and patient data.

Now that we know the Patient-Driven Groupings Model (PDGM) will officially start January 1, 2020, it’s time to dig a little deeper into understanding how the case-mix weights of the 432 PDGM groups were established.