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.

The CY 2019 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. In our blog we provide a summary of changes to the model, such as the expansion of clinical groups from six to twelve, as well as home health PPS Case-mix updates and significant HHVBP changes confirmed in the final rule.

We are excited to announce the release of the Hospitalization Patient Detail report to our SHP for Agencies customers. This powerful new report provides a complete picture of the home-health stay for any patient, including: hospitalization risk, transfer history, and discharge details, with one row of data for each SOC/ROC to any available Transfer/Discharge. Also included are indicators for 30-Day Rehospitalizations, 60-Day Hospitalizations, Emergent Care, Hospitalization outcome details, and more.

In the CY 2018 Home Health Proposed Rule, CMS is dramatically changing the scoring methodology for the pilot program known as the Home Health Value-based Purchasing Program (HHVBP). What is striking to me is that these changes are being made during the fourth year of the five-year program, where up to 7% of Medicare revenues are at risk.

In the CY 2019 Home Health Proposed Rule, CMS shared a level of detail not seen before – an agency specific list of how agencies will fare under the changes they are proposing. Wow. CMS shared the agency revenue impacts of the Patient-Driven Groupings Model (PDGM) versus the current 153-group PPS reimbursement revenue. The range of the revenue impact is quite wide. Looking at the SHP national database for CY 2017, about 17% of the 3.6MM payment episodes in our database had a primary diagnosis code that would be considered a QE under PDGM.

SHP is pleased to announce Brightree recently incorporated our OASIS Integrated Alerting functionality into their iPad point-of-care app. This enhancement gives our joint customers the tools they need to improve speed and efficiency, while continuously providing high-quality care to patients.

SHP recently made improvements to the hospice portion of the Dashboard to include a new widget and two new preconfigured views that display quality measures for all of the same data types as the Hospice Scorecard, including: Provider, Case Manager, Team, Primary Diagnosis Category, and many more. Aside from the ability to group by all of our standard data types, the new widget can also be configured to report on all 22 of the HQRP and CAHPS quality measures available in our reporting.

With the OASIS-D assessment form going into effect on January 1st, 2019, SHP is pleased to provide home health agencies with a complete side-by-side comparison of the OASIS-C2 and expected OASIS-D assessment forms. This easy-to-follow guide is an excellent reference for anyone who works with OASIS Assessments and will improve accuracy, help reduce coding errors, and potentially reduce the number of returned claims.

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 2017 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 2017 calendar year.

July usually starts the month off with fireworks, but this year the proposed rule was issued on July 2nd with its own bang at just under 600 pages. The big news - Home Health Groupings Model (HHGM) is now the Patient-Driven Groupings Model (PDGM). Below are a few other highlights from the proposed rule related to the Home Health Value Based Purchasing (HHVBP) program, Home Health Quality Reporting Program (HHQRP), new Home Infusion Benefit and the changing HH PPS case-mix weights (CMW).