‘It’s Different for Everybody’: Inside Recover Health’s PDGM Strategy

Since the implementation of the Patient-Driven Groupings Model (PDGM), home health providers have taken a number of measures to ensure success amid the payment shakeup.

Two of PDGM’s biggest changes are the model’s new 30-day billing periods and how it handles therapy reimbursement.

One provider — Recover Health — has chosen to extend plans of care and how it utilizes therapy visits as a core part of its transition strategy.

“For whatever reason, we were doing a lot of visits early. I think there was a little bit of human behavior involved in that,” Greg Von Arx, CEO of Recover Health, told Home Health Care News. “After 30 days, the therapist has to do another assessment. Most of the time, it was in the therapist’s best interest to just discharge at 30 days and move on to the next client, as long as they were busy enough.”

Broadly, that trend meant “a lot of times” Recover Health wasn’t getting to the second 30-day payment period under PDGM, Von Arx noted.

Minnetonka, Minnesota-based Recover Health is a Medicare-certified home health agency with 31 locations across six states. As a provider, its service mix includes core nursing services and therapy services.

The organization served roughly 11,000 unique patients in 2019, employing about 1,300 staff members.

Prior to making a change to how it handles therapy visits change, Recover Health was only reaching the second 30-day payment period 35% of the time. Now, after mindfully extending therapy visits, the company is reaching the second 30-day payment period 70% of the time.

Speaking of therapy utilization, some providers have chosen to alter their therapy strategies by making cuts to their therapy roster. While it has become smarter in how and when it uses therapy, wholesale cuts were never part of the plan for Recover Health, Von Arx said.

Instead, the company focused on creating a frequency tool to manage therapy protocols.

Additionally, the company set up an authorization process. With that process in place, if someone wanted to deviate from the established therapy protocols, that person would have to collaborate with the therapist to decide on the best clinical conclusion for the client.

So how have Recover Health’s PDGM maneuvers played out? So far, Recover Health’s episode value went up to $3,274, compared to $2,996 under the old Prospective Payment System (PPS).

Additionally, the company’s average length of stay went from 36 days under the PPS model to 48 days under PDGM.

Of course, Recover Health’s PDGM response has included more than therapy changes and extending plans of care. On the staffing side, Recover Health’s coders have also played an instrumental role in avoiding questionable encounters, according to Von Arx.

“We have excellent people who really know what they’re doing,” he said. “We like having our own coding. I think that’s important. I know a lot of companies don’t. Our coders made sure we were picking up co-morbidities when we needed to.”

While Recover Health focused on extending plans of care and reaching the second 30-day payment period, Von Arx points out that each company’s plans surrounding PDGM should be based on their own unique, internal data.

“It really is about making sure you understand your data and where the breakdown is in the conversion from PPS to PDGM for your particular organization,” Von Arx said. “I think it’s different for everybody. I’m certain there were people that were staying in [the home] longer than we were pre-PDGM. When we looked at it, we understood that it might have been a shortfall of what we were doing and we corrected that.”

Outside of PDGM, Von Arx believes that the COVID-19 emergency has forced Recover Health to make much needed operational improvements.

“I’ve seen [industry leaders] suggest this has made us better,” Von Arx said. “I think that’s true. We did things like implementing a company-wide texting capability to keep people informed. Prior to COVID, our home health aides and paraprofessionals didn’t have a company email. We gave them this during [the public health emergency]. We were able to communicate more easily.”

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