Post-acute Care

Patient-Driven Groupings Model (PDGM): What Home Health Agencies Should Know

Home health agencies have a lot to look forward to when it comes to upcoming regulatory requirements for reimbursements as proposed by the Centers for Medicare and Medicaid Services (CMS). Let’s dive in to learn more about what they can do now to prepare for new payment changes in 2020. What is Patient-Driven Groupings Model, or PDGM? PDGM has roots from the previously proposed Home Health Groupings Model, or HHGM, which CMS has described as focusing on the value versus…

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PDGM Proposal Merits Close Scrutiny

The Patient Driven Groupings Model (PDGM) recently released by CMS is a good news/bad news scenario for home health organizations. We’ve examined the proposal closely and submitted comments to the Centers for Medicare & Medicaid Services on behalf of our home health and hospice clients. The good news is that the proposal is budget-neutral. Under the previous Home Health Groupings Model (HHGM), which was withdrawn last year following the public comment period, organizations faced an estimated 15 percent cut in…

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Home Health Spending to Outpace Overall Growth

New spending projections bode well for the home health industry, a segment expected to see among the highest forecasted growth on a percentage basis. Each year, the actuarial office at the Centers for Medicare & Medicaid Services (CMS) creates a forecast for overall health spending, taking into account current law. Overall, the office predicts healthcare spending will grow at a 5.5 percent annual rate, reaching $5.7 trillion by 2026. That equates to a 71 percent increase over the next decade.…

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Electronic Visit Verification (EVV) Requirements on the Horizon

A lesser-known component of the 21st Century Cures Act is the electronic visit verification (EVV) requirement that goes into effect January 1, 2020, for personal care services (PCS), and January 1, 2023, for home health care services (HHCS). So, what is EVV and how can your organization prepare to comply with this requirement? One of the greatest impacts will be to PCS providers who offer opportunities to Medicaid beneficiaries to receive services such as activities of daily living (ADL) in…

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Revisiting a 2018 Highlight: Annual Cap Lifted for Therapy Services

The Bipartisan Budget Act of 2018, passed by Congress earlier this year, included a provision lifting the annual cap for physical, occupational and speech therapy services. The provision ends a 20-year back-and-forth between attempts to set a financial cap and efforts to prevent that from happening. It also cements an earlier settlement between patients (Jimmo) and the Centers for Medicare & Medicaid Services (CMS) that allows for continued therapy services for maintenance of mobility or activities of daily living, instead…

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Flourishing in Post-Acute Care With a Single Unified System

Regulatory pressures, complex reimbursements and staff shortages in healthcare are not going away. Post-acute care providers need to be nimble and agile enough to easily prove outcomes, measure results and integrate clinical and financial information to succeed in the modern landscape. Having one unified system to manage it all should be on your “must-do” list. Here’s why: It helps create more efficient care transitions. Transitioning care settings should be smooth and efficient for everyone involved. The right platform consolidates patient…

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Creating a Preferred Post-Acute Partner Network

It takes a village to care for an individual with health needs. From primary to acute to post-acute care and beyond, managed care organizations and health systems across the country are looking to create valuable strategic partnerships to achieve the best possible outcomes for all individuals. These systems look to their preferred provider network to improve quality of experience and cost of care and collaborate to make it happen. A critical decision for these organizations to make is to determine…

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Implementing the Second Electronic Health Record Part II

In Part I of our series, we examined common reasons why some healthcare organizations may decide to make a full replacement of their electronic health record (EHR) by implementing a completely different system. The most common reason is that the existing EHR is insufficient and doesn’t support the organization in the ways and means necessary. This can occur for reasons external to the organization as well as from within the organization. In this post, we’ll consider additional factors as to…

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Shaping Home Health and Hospice Through Advocacy

One thing that’s constant in healthcare is change. Both home health and hospice industries are certainly no stranger when it comes to making adaptions and adjustments on a regular basis. With ever-changing policies and regulations such as pre-claim review, electronic visit verification, home health groupings model, continuous reimbursement cuts and more, it’s important for providers to have a voice in the direction of the industry. After all, you have boots on the ground, seeing day in and day out the…

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Implementing the Second Electronic Health Record – Part I

A lot has been written about why organizations should upgrade from a paper-based system to an electronic health record (EHR). External standards and opportunities such as Meaningful Use (now Merit Based incentive Payments System, or MIPS) have been contributing factors. What hasn’t been explored is why organizations make the decision to switch to a new EHR — not simply upgrade to a newer version, but change software and vendors altogether. Data migration, staff retraining and other challenges make such a…

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