“The redesign of the home health payment system encourages value over volume and removes incentives to provide unnecessary care.” -CMS Administrator, Seema Verma
If you have been paying attention, you know that PDGM maintains the 60-day episode of care but splits it into two 30-day units of payment and eliminates the Request for Anticipated Payment (RAP). Many industry experts have expressed concerns that it will create cash flow complications compounded further by reduced payments due to Medicare’s anticipated “behavioral” adjustments by agencies to maximize payments.
"Order management inefficiency is an industry problem - not an agency problem- and requires an industry solution. PDGM will accelerate the industry's need to put an infrastructure in place BEFORE 2020 that respects the physician's workflow to reliably get orders signed in a timely manner. If agencies wait until PDGM hits, it will be too late and they will likely succumb to the cash flow crunch."
However, one consequence of PDGM that seems to be overlooked is the high level of efficiency that will be required of the industry’s order management process to bill Medicare timely and combat the cash flow crunch. PDGM’s 30-day unit of payment is expected to intensify the need for agencies to get physician orders signed within days to enable billing at the end of each 30-day period. Gone will be the days when agencies can sit on orders for 45-60 days.
James DeVriendt, Chief Development Officer of Doctor’s Choice Home Care, reveals, “We are actively taking steps to improve and operationalize our orders management process now so that we are ready when PDGM takes effect.”
Michael Blackstone, MD, CEO of Suture Health, Inc., the maker of SutureSign, which is the industry-leading electronic signature network, warns the industry that waiting to implement a real solution could have dire consequences. Blackstone warns, “As I have said since our inception, order management inefficiency is an industry problem - not an agency problem - and requires an industry solution. PDGM will accelerate the industry’s need to put an infrastructure in place BEFORE 2020 that respects the physician’s workflow to reliably get orders signed in a timely manner. If agencies wait until PDGM hits, it will be too late and they will likely succumb to the cash flow crunch.”
Is CMS’ Seema Verma trying to tell the industry something? Maybe this is why she is calling for an end to the fax machine by 2020?
