When it comes to the Patient-Driven Groupings Model (PDGM), it’s often the seemingly small changes that bring big results. That’s true even for some of the largest U.S. home health providers, including Amedisys Inc. (Nasdaq: AMED), Bayada Home Health Care, Encompass Health Corp. (NYSE: EHC) and Humana Inc. (NYSE: HUM).
While it’s still too early to learn any groundbreaking lessons following the implementation of PDGM on Jan. 1, executives from those four providers are already seeing positive signs linked to new strategies and fundamentals-focused approaches.
“A lot of the things that have been important in PPS (the Prospective Payment System) remain important in PDGM,” April Anthony, CEO of Encompass Health’s home health and hospice business, said Monday during a panel discussion at Home Care 100. “Although there’s transformation, it’s also important to make sure that you really maintain a focus on the fundamentals that have always been true.”
At Encompass Health, that has partly meant a heightened emphasis on coding, for example.
To better tackle PDGM and its complex system of 432 possible case-mix adjusted payment groups, the Birmingham, Alabama-based provider increased its team of certified coders from 13 to 25, according to Anthony. Encompass Health also changed the sequence of when those coders get involved.
Historically at Encompass Health, a home health nurse would go out and do a start of care, with a coder then coming in following that visit. Now, in the post-PDGM world, coding goes in front of the actual visit to support proper documentation and avoid questionable encounters.
“Our coders are actually pre-coding before the nurse ever goes out into the home,” Anthony said. “And now the nurse is validating.”
For Amedisys, some of its early PDGM success stories can be attributed to investments in revenue cycle management. Revenue cycle is a universal challenge under the overhaul, largely due to more rigorous intake processes and 30-day billing periods.
Avoiding questionable encounters and doubling down on wound care — a generally favorable reimbursement area under PDGM — have also been important for the Baton Rouge, Louisiana-based Amedisys.
“As PDGM came out and we started analyzing our episodes and our patients, we had a significant number of questionable encounters … [but] we eliminated virtually all of that,” Amedisys COO Chris Gerard said, joining Anthony on the Home Care 100 panel. “We doubled down on our wound care specialists to make sure that we actually have the subject matter experts and clinicians available as we have complex wounds so we can have the right outcomes and the right plan.”
Bayada has likewise invested on the revenue cycle and coding fronts.
Beyond that, the Moorestown, New Jersey-based nonprofit is leveraging more “clinical huddles” to get a grip on PDGM and break down silos between its nursing and therapy teams.
Broadly, clinical huddles are clinical manager-led meetings between nurses, therapists and others to help determine what types — and what number — of visits are best for patients.
Among their benefits, the huddles help nurses and therapists get on the same page — all for the sake of patient care.
“Rather than relying on old habits, we put our teams together and doubled down on conversation and communication — what we call the clinical huddle,” Mike Johnson, practice president of home health for Bayada, said during the Home Care 100 panel. “The goal is to make our field clinicians feel like they’re truly our greatest asset.”
Meanwhile, Humana’s PDGM mindset has largely been focused on the big picture.
Instead of a sudden payment overhaul, the Louisville, Kentucky-based insurer and provider sees the model as another step in the move toward value-based care. In line with that, Humana has taken a variety of measures to better serve patients with chronic conditions.
“We see PDGM as an important shift for the industry, one that’s beginning to point, to focus much more toward the chronically ill and toward a comprehensive clinical picture of the patient,” Kirk Allen, president of Humana At Home, said during the Home Care 100 panel.
For Amedisys, Bayada, Encompass Health and Humana, PDGM strategy goes far deeper than some of the relatively simple steps highlighted above. In addition to its pre-coding shift, for instance, Encompass Health has also ramped up its use of predictive analytics to assist with utilization planning.
“Obviously in the episodic-based world of PPS, maintaining controls around utilization was important, but those become even more important when you break it to shorter, 30-day periods and you look at some of the inherent cuts under the PDGM system,” Anthony said.
Specifically, Encompass Health has refined visit utilization through the use of Medalogix Care, a tool that uses data and clinical insights to recommend an optimal number of visits a patient needs to achieve a positive outcome.
Encompass Health is a minority investor in Medalogix and has been using the predictive analytics company’s capabilities for “a couple of years,” according to Anthony. It currently has 67% of its locations deployed on Medalogix Care, with plans to expand that to 82% by the end of the first quarter.