Q: What can our agency do to prepare for PDGM?
The March/April 2019 Home Healthcare Now article "What is PDGM?" (Pierotti, 2019) provides a befitting introduction to home healthcare's new reimbursement model, the Patient-Driven Groupings Model (PDGM). As a masters-prepared home health nurse educator with over 30 years of related experience, I appreciate that the article acknowledged the significance of the clinical home care team assessment and Outcome and Assessment Information Set (OASIS) documentation in capturing patients' functional level scores within this new model. Currently, all home healthcare agencies are experiencing the influx and confusing OASIS-D documentation requirements newly implemented this year. These include the new implications of risk-adjustment and patient-predicted scores that the home care clinical team must clearly understand prior to the onset of the 2020 PDGM model. Now, more than ever, the impact of the OASIS-D Start of Care/Resumption of Care (SOC/ROC) ratings is one of the largest factors contributing to the final risk-adjusted score for patient outcomes. These scores are calculated by the Centers for Medicare and Medicaid Services (CMS) for each of the seven Home Health Compare improvement outcomes: improvements in bed transferring, ambulation, bathing, oral medications, surgical wounds, and pain. These OASIS items affect the predicted improvement rates for patients based on how they are scored. Selecting the responses to these items can influence the risk adjustments, either positively or negatively (Clayton & Attaya, 2018). Once the PDGM takes effect, these risk-adjustment scores become even more complex. Although the role of coding will be significant during the transition from Home Health Resource Groups (HHRG) scoring to value-based scoring, the assessment skills of the home healthcare clinicians remain paramount.
Therefore, all home healthcare agencies must look closely as to how they are supporting home healthcare clinicians in tackling these complex outcome and reimbursement models. It is imperative that clinicians receive ongoing OASIS training with repeated education at specific intervals. "The Oasis Walk" is an excellent resource (Fazzi Associates, 2009). Used as a guide, it teaches home healthcare clinicians to capture an accurate picture of the patient and correctly reflect the acuity level within that documentation. The acuity status of patients and complexity of care that home healthcare clinicians provide are oftentimes not reflected in the OASIS responses. Following the OASIS guidance offered by CMS and disseminating this knowledge in real time to clinicians will be effective in guiding them in validating precise patient acuity levels.
In the wake of transforming home healthcare reimbursement from volume-based to value-based, a closer look at the productivity requirements of home healthcare clinicians should also be a consideration. Home healthcare clinician workload plays an important role in the accuracy of their patient assessments and documentation. Providing clinicians with the time they need to complete "The OASIS Walk" with their patients will promote the efficiency, accuracy, and timeliness of OASIS documentation. Illustrating a patient portrait that justifies all necessary home care services is crucial.
Home healthcare clinicians are invaluable not only in the holistic care provided to patients, but in the manner in which they perform their assessments. It is essential to support clinical home care teams in their endeavor to improve patient experiences and outcomes. With the intense combination of Oasis D and the PDGM, a perfect storm awaits home healthcare agencies. Let's provide clinicians with the tools they need to ride that storm.
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