Are patients sicker when they leave a hospital?

Since Covid and the introduction of PDGM, some agencies are seeing referrals increasing with sicker and more complicated patients.

does this mean for your agency?

PDGM divides Home Health care into episodes for timely payment and initiation of care delivery. Timing of care is critical to ensure payment. However, discharge planning by the hospitals can be delayed or even duplicated with patient referrals being sent out via Al-driven programs to multiple agencies who then can cherry-pick the referrals. If your agency doesn’t purchase one of these programs then you are relying on less timely referral methods which can often result in smaller agencies getting the bulk of the more care- intensive patients and with them comes the increased risk of rehospitalization and a potential LUPA!

Timely admission is critical -scheduling this around the patient’s discharge can be challenging as they arrange for equipment, receive medications, await family, etc., and the agency triages the referral documents.

Having a focused review process and an educated intake team can dramatically aid the admission process. Intake can ensure the admission is timely and smooth obtaining labs, results, orders, immunization records, comorbidities, and medication lists. Obtaining pre-authorization from commercial insurance can be a challenge again delaying timely access to care, increasing the risk of rehospitalization or the patient’s decision to even seek Home Health care.

The “Improving Seniors‘ Timely Access to Care Act of 2023″ https://www.congress.gov/bill/117th-congress/house-bill/3173 is designed to reduce some of the burdens in the authorization process by mandating a move to electronic prior authorization for Medicare Advantage Plans. This still requires a comprehensive review by the Agency to ensure care is delivered to the skill and progress notes from the physician’s orders and documents.

staffing challenges continue to mount outsourcing your document review process is an excellent way to manage costs and ensure documentation meets the skill defined in the physician’s order and the clinician’s documentation is clear in defining the skill and plan of care to meet the goals for maximum improvement.