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Patient-Driven Groupings Model

Speaker(s): Melinda A. Gaboury, CEO

Category: Speaking Engagement

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Patient-Driven Groupings Model Jun 11
Hosted by
Kentucky Home Care Association & IAHHC

About the Event

The Patient Driven Groupings Model (PDGM) will go into effect January 1, 2020. This is the most massive change to the home
care industry reimbursement structure since the introduction of the current Prospective Payment System (PPS) in October 2000.
The new payment model dramatically impacts agency operations, processes and performance. Agencies must develop and
implement plans to successfully transition to PDGM. This workshop will discuss key areas, strategies and processes in preparing
an agency for PDGM.

This workshop will have a focus on best episode management and process improvement practices including
the referral, intake and scheduling processes, timely documentation, physician and patient communication strategies, all of which
are required to more tightly manage care within the shorter 30-day payment period. The change to a 30-day payment model will
also bring significant back office changes, specific to the claims processing and collections, which will be one emphasis of this
workshop. A strong clinical episode management program is critical to ensure sustained, efficient, cost-effective and uncompromised
quality care delivery under the PDGM program! This workshop will bring emphasis to the fact that every discipline is valued the same
and extra therapy visits does not equal higher payment. Lastly, this workshop will review the full blown emphasis of ICD-10 coding
under PDGM and how agencies will have to monitor to ensure the specificity of coding for their patient care plans.


1. Summarize key areas of agency operations affected by PDGM.
•Provide guidance on evaluating an agency’s current preparation status.
•Outline implementation actions in each key area.
•Explain scheduling strategies to prevent missed visits
•Discuss necessary modifications to the intake and referral process under PDGM

2. Present data to assist in determining financial impacts of PDGM on an agency.
•Review strategies for improved physician interaction to ensure timely 30-day billing
•Explain the importance of changing from 60 to 30-day payment periods under PDGM

3. Review the complexity of determining LUPA thresholds under PDGM
•Discuss relevance of front-loading, missed visits and refusals of care and services to LUPA prevention
•Review clinical management responsibilities related to LUPA prevention

4. Review the Impact of ICD-10 coding under PDGM
•Explain the relevance of timely OASIS review, coding completion and clinician documentation under PDGM
•Evaluate the specificity requirements of coding under PDGM
•Outline the Impact on case-mix weight with one code versus another

5. Review strategic planning for implementation of clinical episode management best practices within the agency
•Identify the significance of the removal of therapy thresholds under PDGM
•Establish how providers with lower therapy utilization are able to maintain quality outcomes both clinically and
•Review appropriate therapy utilization practices, discuss methods to evaluate current practices and implement changes,
including alternative approaches to ensure patients are receiving appropriate, cost-effective quality care
•Discuss strategies to enhance communication and collaboration between all disciplines