“P” Is for Patient in PDGM

PDGM (Patient-Driven Groupings Model) will have an impact on every single function in the agency and planning for PDGM must begin now. Agencies that fail to plan for PDGM, can plan to fail. The new Patient-Driven Groupings Model for home care begins on January 1, 2020. Is your agency ready?

PDGM marks the first time the word “patient” has been used in a reimbursement model. Certainly, every patient in PDGM is unique and the reason they need home care services and a plan of care must be uniquely created for that patient. Agencies must accurately code and describe in the documentation the reason for admission to the agency, the co-morbidities that affect that patient, and impact on the plan of care.

This payment model is all about the patient & their outcomes after receiving care from the agency, not about the number of therapy visits. All agency staff must be competent, productive, and accurate in data collection and documentation. Importantly, they must keep the patient in the forefront at all times. Here are some important topics to keep in mind.

Do Not Underestimate This PDGM Change

The impact of accurate diagnosis coding supported by documentation cannot be underestimated by an agency in PDGM. Accurate coding and OASIS data will comprise 60% of the HHRG in PDGM. Agencies must make huge changes to address workflows and processes. Change takes time. Therefore, now is the time to implement a culture change in your agency to minimize the effects of the new model.

Rise to the Challenge

Certainly, PDGM poses significant challenges to the home healthcare industry. However, agencies and the industry as a whole can establish models in which we can thrive.

  • Intake Diagnosis Query Tool. Mandated checklists will be invaluable as you aim to streamline workflows and ensure intake staff members have completed all necessary documentation.
  • Remember the patient in PDGM. Since the diagnosis is patient-centered for that individual patient, establish a strict policy of no cut-and-paste.
  • Document in the home. The most accurate patient data will only happen if collected at the time of the assessment in the home.
    • We are the only industry that allows health care providers to document after they leave the care site.
    • Accurate documentation hours after seeing a patient is an implausible task and has been documented to show inaccurate data after a short period of time.

Outcomes – Not Tasks – Become Important

As your agency prepares for PDGM, develop a culture of patient engagement in the plan of care for ownership in managing conditions.
Communication is the name of the game, so be sure to share and discuss what the patient identifies as their goal. For instance, you can positively influence outcomes for at-risk patients before they occur by discussing the roles of each person on the patient care team and what role they have in reducing hospitalization risks. Similarly, streamlined workflows and communication can reduce the number of visits per discipline per patient and make those visits count: utilize other types of “visits” to connect with the patient/caregiver. Importantly, collaborate with your team on accurate data and accurate coding.


The new payment model supports patient-centric care. This is a step in the right direction. Information-sharing between team members can lead to an improvement in patient outcomes through optimal service delivery. Above all, keep the patient in mind. Can’t handle the new workflows and processes while managing the patient? We recommend you outsource coding and billing processes. Remove the excess headaches and keep your energies where PDGM focuses them … and where your energies belong… with your patients.

Prepare with QIRT

Expert Hands-On Help

To help you prepare for PDGM, QIRT will review your agency’s coding and OASIS and provide an assessment of what reimbursement will look like when PDGM begins in January 2020. QIRT will offer guidance and recommend changes to ensure your agency is ready. 

Contact our PDGM expert team today.

Or Do-It-Yourself:

  • PDGM Readiness Tool Kit– an agency’s step-by-step guide to successful implementation through proper planning, preparation, communication, and training.
    • INCLUDES: PDGM Agency Guide to Success, PDGM Questionnaire, Intake Tool, Functional Impairment Chart Tool, PDGM Primary Diagnosis QIRT Tool, Top 75 Home Health Non-Valid Diagnoses Tool, PDGM Comorbidity Adjustment, PPS/PDGM Crosswalk and the Function Impairment Chart tool 

PDGM Tools

Our QIRT experts have created these tools to assist with your home care agency’s preparations. Be sure to make good use of this QIRT advantage…on us! Head to QIRT.com to access the tools.

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