Success Comes From Continuous Operational Improvements: Lessons Learned in PDGM 2020 Q1

The Patient-Driven Groupings Model (PDGM) represents the most significant change in the Medicare home health program in the 21st Century. It radically changes the Medicare payment methodology, including the unit of payment, the case mix adjuster, Low Utilization Payment Adjustment standards, and payment for Non-Routine Medical Supplies.

Program Topics:
  • Gain Gain a better understanding of what it takes to be a winner in PDGM.
  • Identify key steps that are proving successful in managing services under PDGM.
  • Recognize the actions that create unnecessary risks for your HHA.
  • Determine the early clinical and financial benchmarks that distinguish the successful HHA from others.
  • Attending one of these summits will fully prepare you to undertake any needed course corrections in your PDGM management, along with reinforcing the actions that you have already taken to ensure a positive outcome throughout 2020 and beyond.
Additional Workshop Details:
In 2019, the National Association for Home Care & Hospice (NAHC) provided thousands of home health leaders across the country with the knowledge they needed to ensure their agencies made a smooth transition to the Patient-Driven Groupings Model (PDGM), the biggest change to home health payment in the 21st century.

With PDGM now impacting agencies, NAHC is assembling a team of experts focus on lessons learned; what is working or not working and what some agencies are doing to thrive and how others can learn from them. For information on sponsoring at a national level, please contact Christopher Adams at cta@nahc.org.


PDGM has required HHAs to examine overall operations structure and day-to-day management. Changes were needed throughout HHAs to meet the demands of PDGM. HHAs must quickly determine what is working and what is falling short of their expectations. Any needed modifications in operations must be put in place sooner rather than later to thrive under PDGM. Operational areas most affected by PDGM include referral and sales management, intake, revenue cycle, operational reporting, and order and supply management. Change management must be handled throughout your organization. This session focuses on the operational practices that have demonstrated early success and long-term potential for fully positive outcomes.

  • Outline the operational changes that are showing reliable signs of early success and those that are not working as hoped.
  • Define key areas of operations that are showing the greatest need for additional changes and how to initiate that change.
  • Identify new skill sets needed in HHA management triggered by lessons learned in PDGM Q1.
PDGM has triggered a re-examination of clinical practices within HHAs nationwide. Documentation, diagnosis coding, care planning and care coordination are at the top of the list of best practice clinical strategies that have been employed. Are your changes resulting in the best outcomes? This session focuses on the lessons learned in Q1 in blending clinical practice and financial management to achieve the best patient and business outcomes in the new world created by PDGM. 

  • Describe how interdisciplinary care planning achieves cost effective and appropriate skill mix, including therapy utilization under the PDGM.
  • Evaluate the impact of how changing case mix affects resource and skill set needs in your organization.
  • Identify the best practice clinical strategies for managing LUPA thresholds and 30-day unit as defined by PDGM.
  • Recognize essential steps to success in documentation acquisition and management to support an accurate primary diagnosis and timely claim submission
  • Define the Clinical Manager role in the Clinical Teams success under PDGM, including the significance of effective case conferencing and case management.
Thriving (or even surviving) under the PDGM payment reform requires a clear understanding of how PDGM is affecting the financial outcomes of a home health agency. This session explores the fundamental steps necessary for home health agencies to assess whether the initiatives taken to prepare for PDGM are in place and working, the options for mid-course corrections in PDGM financial management, trends in the impact of PDGM, cash flow remedies, and planning for 2021.

  • Measure the early trends in PDGM financial impact on your organization including cash flow management under the new RAP model.
  • Recognize how to determine whether your revenue cycle management fits your agency under PDGM and what steps are needed to bring it to top performance.
  • Identify clinical and operational practices that lead to the most favorable financial outcome under PDGM.

Business Analytics
Increasingly, HHAs are recognizing the value of robust reliable business analytics in managing the change to PDGM. Real time data availability and early analysis of the key performance indicators in PDGM are important ingredients to early success in PDGM. This program is a deep dive into the early key data analytics that can help define whether your organization is on track for PDGM success or whether corrective action is needed. Through the assistance of IT and EMR partners across the country, this program will offer an intensely valuable first look at PDGM action and outcomes within the overall HHA community. That impact analysis and useful benchmark data can help guide your agency to success in CY 2020 and beyond.

  • Achieve meaningful insights on clinical categories, utilization and other characteristics using claims data from PDGM Q1.
  • Provide data drill downs on LUPA, lengths of stay and other operational metrics under PDGM Q1.
  • Obtain the insights needed to connect the data analytics tools to operational, clinical, and financial actions needed to ensure maximum value and PDGM success.

Session Schedule:
8:30 am – 9:00 am: Overview
9:00 am – 10:15 am: Operations
10:15 am – 10:30 am: Break
10:30 am – 12:00 pm: Clinical
12:00 pm – 12:30 pm: Lunch Break
12:30 pm – 1:45 pm: Financial
1:45 pm – 2:00 pm: Break
2:00 pm – 3:15 pm: Business Analytics
3:15 pm – 4:30 pm: Open Forum



Finance Speakers:
Mike Simione, Simione Healthcare Consultants / Nick Seabrook, Blacktree
Clincical Speakers:
Gina Mazza, WellSky / Kim Skehan, Simione Healthcare Consultants
Operations Speakers:
Raymond Belles, BKD, LLP / Todd Montigney, Blacktree
Data Analytics Speakers:
Raymond Belles, BKD, LLP / Nick Seabrook, Blacktree


Cancellations are subject to 20% handling fee. There will be NO REFUNDS issued for cancellations received within 10 business days prior to program. Cancellations must be in writing. Refunds will not be made for no-shows. However, substitutions will be allowed. Should CAHSAH® cancel the program, a full registration fee refund will be issued.


Six and one half (6.5) contact hours of continuing education provided by NAHC. You must be present for the entire workshop to earn Continuing Education Units. No partial credits can be given.