An Unexpected Savior: How PDGM Prep Helped Home Health Agencies Mitigate the Impact of COVID-19


Home health agencies have spent 2019 prepping the Patient-Centered Groupings (PDGM) model – and that may have saved some of them from more disastrous outcomes related to COVID-19.

As providers transformed to become more efficient and tech-savvy, they inadvertently prepared for a public health emergency that no one saw coming.

“One of the things PDGM has done for us is to promote lifelong learning,” MaineHealth Care at Home President Donna DeBlois told Home Health Care News. “PDGM’s goal was to change the way we manage care. … And then when COVID happened, it was a bit of a parallel; we switched to focusing on controlling infections and other wrinkles.

MaineHealth Care at Home, based in Saco, Maine, provides home health services to eight different counties in the state and a handful of island communities.

Instead of being the “bogeyman” we expected him to be, PDGM ended up becoming an unexpected savior in some ways. Many home health lessons learned from the new payment model and COVID-19 overlap.

Dallas-based Axxess, a home health technology company that develops cloud-based software solutions for providers, has helped prepare agencies for PDGM. He also recognized the benefits of PDGM as a precursor to COVID-19.

“We hadn’t really given this concept a lot of thought,” Tammy Ross, senior vice president of professional services at Axxess, told HHCN. “But once we did, we found a handful of points where PDGM readiness would have helped prepare agencies for COVID. Some of them are very subtle, and some of them are quite egregious. “

The dominant theme between the two was change management, David Hoover, vice president of revenue cycle management for Axxess, told HHCN.

“I really think the preparation of some agencies – and the real understanding of their business – has helped them get through the change,” Hoover said. “It prepared them for PDGM and then for another big change with COVID. “

Suppliers knew there would be disruption to their cash flow once PDGM was implemented. Early payment delays and the reduction in upstream prepayment requests (PARs) have forced agencies to better understand their billing and the schedule surrounding it.

So once COVID disrupted billing, home health agencies across the country were better prepared to deal with it.

A thorough understanding of their business and how to manage their money also helped agencies appropriately manage government grants or loans during the public health emergency.

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“I think it helped them manage the funds that the government issued or made available to agencies,” Hoover said. “That way they knew what they needed and they knew what they could do with that money. And I think that has become a little advantage.

Additionally, agencies that found a way to predict what kind of money would come in during each payment period helped them predict changes in their income in 2020. Providers had a sense of what might happen to them. their bottom line, allowing them to skillfully manage sudden fluctuations in income.

“We spoke with vendors to prepare for possible Low Usage Payment (LUPA) adjustments as there was going to be an increase due to the PDGM,” Hoover said. “There were several issues getting people to continue visiting during the pandemic. And I think managing the schedule, really understanding that potential LUPA, being a little more detailed, and applying the right resources has probably helped them a lot during COVID. “

Staffing and points of contact

PDGM – and the shift from volume to value – adjusted the way providers viewed visits and staffing.

For MaineHealth Care at Home, it has evolved into an interdisciplinary team model where clinical managers work much more closely with clinicians during care management and planning.

“When COVID hit, it was actually hugely beneficial because people were working a lot more remotely – and we were discouraging them from coming to the office at all,” DeBlois said. “So this small team model, in fact, was a very good precursor.”

Yet rising unemployment benefits, fear of COVID-19, and workers infected or exposed to the virus themselves have all contributed to an even worse staff environment in 2020. This is why supplier efforts to manage staff and tours more efficiently in Q4 2019 proved to be useful later. to.

“They’ve already started to reinvent ways to get the same quality results, but maybe with fewer visits,” Ross said.

PDGM – then COVID-19 – pushed the home healthcare industry to rethink its staffing models, making operators more fluid and adjustable.

Reducing in-person visits has also been important as it minimizes points of contact between older people and workers as the virus spreads across the country.

“With PDGM, we started talking about how you could grow as needed and how you didn’t need all those full-time employees, but you might have people who want to fill in here and there, ”Ross said. “Well when the pandemic hit it got huge. Workers were even able to cross state borders as part of the emergency management system to meet the needs. … Because we started speaking this language when preparing for the PDGM, it really prepared the workforce to be used [efficiently]. ”

Technology adoption

The entire health system has hit the nail on the head since March of last year: the technological revolution is here.

Home care providers are offering many more telehealth visits than ever before. They have more employees who work remotely. They have to do business over the phone or over the computer more often.

“We used telehealth and reduced face-to-face contact to once a week,” DeBlois said. “So it worked really well. And due to our early adoption of telehealth, we were suddenly approached by other parts of our healthcare system and asked to help manage their patients with [remote care] at home.”

MaineHealth Care at Home was an innovator in the field of telehealth. But across the industry, PDGM has forced agencies to update their systems.

“In preparing for the PDGM, a lot of agencies really upgraded their platforms,” Ross said. “Some of the EMR platforms just weren’t doing what needed to be done for PDGM. So I think they’ve invested in upgrading their platforms which, again, put them in a much better place to control their operations during the pandemic. “


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