Serving the home health, home care and hospice industry since 1999.

by Darcey Trescone, RN, BSN

In business, as in life, big change drives us to look at the big picture, sometimes turning to innovation in order to cope. Looking for innovations to help the industry cope with PDGM, the Patient-Driven Groupings Model that will change the way home health is paid starting next year, we have been meeting with representatives from leading software vendors. This week, we mostly step out of the way and let Netsmart, Axxess and OperaCare discuss their viewpoints and what they are doing to support the industry in their own words.

PDGM Industry Impact

“PDGM is not about just one thing,” asserted Billie Whitehurst, MS, RN. She is the VP and GM of Home Care Solutions at Netsmart. “It is really about changing the way home health works. Ultimately, it is a journey toward value-based care, driven by CMS. PDGM is a step along the way to drive focus on patient-centric care and outcomes. PDGM brings more complexity, so, as a vendor, our job is to support organizations of every size by providing insights, automating processes, and making the transition easier.

Tammy Ross, SVP of Professional Services, Axxess, told us, “PDGM is about efficiencies and solving issues. We are managing chronic care patients in home health and our goal needs to be pre-acute focused, preventing the acute episode that requires hospitalization. We are not only post-acute care providers anymore and the technology needs to support this.”

Kristi Bajer, RN, BSN, VP of Clinical Operations, OperaCare, said, “PDGM requires the clinicians and QA teams to implement rapid RAP and EOE billing cycles. With that said, the first metric to measure will be your home health agency’s current “Days to RAP” submissions metric. Days to RAP is defined as the amount of time it takes from the SOC clinician walking into the patient’s place of residence until the claim is submitted for RAP payment. The national average for this metric is currently hovering around 12days. As this amount of time consumes almost 50% of the first 30-day period of care, this is the place to start your readiness.”

PDGM Preparations

Netsmart’s Whitehurst added, “PDGM will be all about efficiency. Software vendors need to support streamlined workflows within an agency while providing analytics and oversight. We have reviewed our product workflows, from referral through claim submission, with an eye on simplification and ease of use.”

Stephen Rhoades, a Netsmart Operations Consultant, added, “We have created customizable roadmaps for our client agencies. Some are deploying tools complementary to the EMR such as our revenue cycle management or coding services."

Tammy Ross spoke of the Axxess preparations. “Our focus is the design of the system and education/coaching to support PDGM. Our client success coaches are utilizing our tools to help identify opportunities to work with our customers on PDGM readiness. In addition, we have involved our online support center to discuss key PDGM topics, such as LUPA management and coding with every support request we get. Home health agencies are looking for simple solutions and we are giving them operational processes that work.”

OperaCare VP of Clinical Operations, Kristi Bajer was even more specific. “Our focus is on episode management and identifying at-risk scenarios early on. Utilizing this information, we work with our customers to improve time consuming workflows and create defensible documentation that is in line with the plan of care. As we implement these workflows and achieve same day or 24 to 48-hour RAP submissions in our client base, we see dramatic increases in physician, patient, and clinician satisfaction in addition to PDGM readiness.”

PDGM Innovations

“Interoperability and tools that support it are important,” Whitehurst said, regarding Netsmart’s innovation approach. "Our role as a vendor that services post-acute, health and human services, and behavioral health is to facilitate communication with referral partners and other providers along the care continuum. Our focus with interoperability is pulling the most valuable information and presenting it in a usable fashion. With aggregated information and complementary tools such as referral management and emergency department alerts, providers are able to make informed care decisions, which supports better care coordination at the population health level. Together, these tools allow providers to confidently take on risk sharing, critical as the industry shifts from fee-for-service to value-based care."

Whitehurst continued, “We are also delivering analytics tools that will help coach operational and care staff toward enhanced decision-making and accurate documentation. These tools will have prompts and reminders aimed at improving consistency and efficiency as well as referral sources and guidance about diagnostic categories that will no longer be supported under PDGM."

Tammy Ross with Axxess explained, “In addition to our PDGM Modeling tool, we are looking at home health agency operational processes. One simple example is we have added pop-ups in scheduling that let the end user know the LUPA threshold for each clinical grouping. Clinically, we have built episode management and pathway tools that help agencies manage outcomes with appropriate interventions and goals. At the point of care, we have tools that guide the clinician to assess and monitor for exacerbations of secondary diagnoses, and offer notifications regarding compliance with the care plan.“

Ross continued, “We are also looking at how to address industry issues. One topic of importance with PDGM is the nursing shortage. How does a home health agency staff and manage missed visits when there is a nursing shortage? We have developed an ‘Uber’ type experience for staffing. Agencies that use Axxess can post available visits to a portal that allows qualified nurses using Axxess to let them know they are interested in providing that needed care. Like Uber, the interested nurses are rated by the agency and the patient on a scale of one to five stars. We have launched this supplemental staffing solution in Illinois, Texas and Massachusetts with a 95% visit fulfillment rate reported. We will be launching in Florida within the next month and have recently opened this solution up for supplemental therapy visits as well.”

Michael McGowan, President, OperaCare added, “We all know how many hours our care team puts in each night documenting, only to get up and start the process all over again. Our focus at OperaCare is pushing the most relevant information regarding episode and risk management into dashboards with easy, drill-down capabilities. We have the capability to integrate with any home health EMR. Our tools help identify the most complex patients and then allow agencies to adopt our simple scribing workflow system so the home health QA and clinician team members can work together. We have found this increases thoroughness and accuracy, allowing for completion of both documentation and quality review at the point of care. Giving a nurse work-life balance is arguably the best recruitment and retention tool you will ever provide your RNs.”

After hearing from these three technology vendors, and the ones we interviewed last month, a conclusion becomes clear. Home health agencies and vendors are thinking through workflows, from beginning to end, to drive PDGM success. As this major regulatory change approaches, we are seeing innovative tools surfacing that support providers' need to comply with CMS’s push toward value-based care.


©2019 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. One copy may be printed for personal use; further reproduction by permission only.