It’s pretty safe to say that 2020 was a roller coaster of a year for contract therapists in the home health space. From staying on top of COVID-19 to navigating the transition to the Patient-Driven Groupings Model (PDGM), we’ve had our hands full since we put away the party hats and champagne flutes on January 1st.
As we enter the latter part of the year, some of the transitional dust from PDGM has begun to settle. And while most of us have been forced to be reactive to the changes all year, we’ve now got an opportunity to get proactive with some forward-thinking training.
We wanted to share some helpful tips and strategies to consider including in your team’s training to continue the successful transition to PDGM. By continually sharing our successes together, we can collectively see wins across the board.
1) Support the Big Picture With Small Details
When major changes come down the regulatory pipeline, it can feel like a scramble to try and get out ahead of things, regardless of the lead time provided. Most of our teams have done a great job grasping the bigger picture, but there are always opportunities to continue that growth. What we’d encourage contract therapy companies to do is to look into shifting their training focus to the smaller details to support that bigger picture.
As PDGM shifts reimbursement from a volume-based approach to a value-based approach, properly capturing the medical complexity of each patient is critical. With over 432 possible case-mix adjusted payment groups determined through five different variables, it’s a lot to learn.1
- Consider training your staff to identify less-common comorbidities.
- Look into working with your team on how best to test for functional impairments.
- Continue to look for ways to refine and improve the new coding process focusing on timeliness, inclusiveness, and accuracy.
2) Raise Awareness on LUPA Claims
An important change under PDGM is how Low Utilization Payment Adjustment (LUPA) claims are handled. In the past, the minimum threshold was standardized across the board. However, under the new PDGM plan, the minimum threshold that qualifies for a LUPA claim varies based on the patient.2 Additionally, thresholds now apply to the new 30-day payment periods instead of the prior 60-day periods.
While the primary focus of treatment plan development should always be the adequate amount of care for the patient, further educating our teams on these thresholds is important. Industry experts agree that CMS understands agencies will add one to two extra visits per 30-day billing period to receive the full reimbursement.
3) Create Two-Way Channels to Share Successes and Challenges
With the shift from volume-based to value-based treatment reimbursement, the efficiency of care becomes more important than ever. The biggest improvements and innovations in efficiency of care under PDGM will continue to come from our biggest assets—our staff on the front lines. Therapists are working with patients on a daily basis and can best see process improvements and creative ways to work smarter.
But as most of our therapists operate in remote environments, the communication channels are much less defined than they would be with an in-house operation. What this means is that we may have rock star therapists right now that are doing things to change the game that other members of the team are unaware of. Additionally, we may have therapists with challenges that other members of our team have already solved.
The best training programs are always two-way streets. If we can find ways to open up the lines of communication between our management team and our therapists on a regular basis, we can maximize the benefits of the innovation that is already happening. Some suggested starting points could be:
- Quarterly roundtable meetings or phone calls
- Clearly defined channels for sharing ideas
- Incentives for game-changing ideas
Learn how Optima Therapy for Home Health can help your contract therapists improve efficiency while managing the demands of PDGM.
1. CMS, Optima Therapy for Home Health, February 12, 2019.
