The news surrounding the launch of PDGM has been primarily focused on the impact on Home Health Care (HHC) providers, and rightly so. Nonetheless, there are other groups directly impacted by the proposed changes, and doctors in particular, have likely not received much information on the how PDGM will impact them.
What is the direct impact to doctors
Right or wrong, CMS is changing case mix calculations and is giving focus to the referral source. This is due in part to CMS collected data and the agency’s belief that patients coming from institutional settings are typically sicker and, thus, need more care and resources. While critics are quick to point out challenges to that line of reasoning, it currently appears that the case mix calculations will be set so that a case mix weight for a community episode will be 0.8782 compared and an institutional referral will be 1.1855. This means that some doctors will find that the HHCs they have worked with in the past will need to shift their referral mix way from the community-based settings to more institutional based settings.
Big changes with LUPAs
Low Utilization Payment Adjustments (LUPAs) are where most doctors will see changes and will likely have the most questions. The first immediate change is the 60 day episodes will be a thing of the past. CMS is moving to a 30 day episode with the belief that this time change will give patients a higher standard of care. Within the 30 day episodes, LUPAs are being redefined so that instead of the standard 4 or fewer visits, the new rules will break down LUPAs in 216 scenarios, each with a new LUPA standard that could range from 2-6 visits. What that means is agencies used to a four-visit threshold over 60 days may have to start thinking about a 12-visit threshold over that same amount of time. Doctors will want to know about these changes and begin adjusting their expectations as well as that of their patients.
Not only will agencies find themselves challenged in managing the new 30 day episode, they will likely need to educate the MD’s they work with on regular basis. It is unclear how much information doctors will receive about the PDGM changes, and thus agencies will need to educate doctors about how LUPAs and the 30 day episode not only impacts the agency’s business, but how it can also positively impact patient care.
How can Viscare help? With market defining technology that lowers readmissions
At Viscare, we see the challenges doctors face with managing their daily caseloads and keeping track of patient progress during while being served by home health care. With our ground breaking “Ortho App” we are able to provide doctors with the real time progress of their home health care patients, as well as confidential photos of the patient’s treatment and a direct line of communication from the HHC provider to the doctor should there be a patient emergency during a treatment session. This market defining technology decreases the patient’s rate of readmissions and thus gives doctors the ability to lower their readmission goals. Only with the “Ortho App” will physicians have a real time view in their patients home health care, and giving patients better control of the patient’s care, and ultimately to a much better experience for the patient.
Give us a call today and let’s discuss how Viscare can help you provide better care for your patients.