More than two years after the implementation of the Patient-Driven Groupings Model (PDGM), home health operators are still trying to make sense of its bottom-line impact.
Initial deep dives into PDGM have suggested the overhaul contributed to home health spending being down as much as 21.6%. New data from consulting firm SimiTree further confirms that total home health reimbursement has gone down since the implementation of PDGM, according to Director of Data Christine Lang.
“The … data [we have] will show you, statewide, what we’re seeing in terms of change and number of providers and change in total reimbursement,” Lang told Home Health Care News. “A little bit of a spoiler alert – home health total reimbursement has actually gone down since the implementation of PDGM.”
At this point, Lang can only tease the change in reimbursement and is unable to share specific numbers. She has been looking at that data as part of the rollout of SimiTree’s new Market Analysis Platform (MAP).
The Connecticut-based SimiTree is a consulting firm for post-acute care providers. Its roots are in financial consulting, but the company has since expanded to outsource coding, documentation, revenue-cycle management and much more.
“We think that we’ve come up with a collection of information and a way of presenting it that just makes it really easy for folks to quickly look at and assess what’s going on,” Lang said. “And make some data-driven decisions.”
Despite the general reimbursement downturn, home health providers that are looking to grow in new and existing markets should still feel good about opportunities to do so, she noted.
And while every provider will have a slightly different approach to how it wants to grow, the new MAP tool will allow users to customize their plan of attack based on a wide variety of goals and variables.
“Some organizations may be focused on building a census in a particular area, whether it’s a particular patient condition or a particular type of referral source that they want to work with,” Lang said. “Some organizations are all about building the use of home health and hospice, and they target areas where they feel like home health and hospice are underutilized. There is no blueprint for what’s going to work for every organization.”
Specifically, MAP was born from a marriage between SimiTree’s data analytics and its growth-solutions organization. Among its capabilities, Lang said, MAP data can show providers trends such as hospitals in certain areas underutilizing home health and hospice.
“Some hospitals are referring 8% or 9% of patients to home health versus 25%, 26%, 27%,” she said. “The rate of referrals to hospice ranges from 2% to 6% – and that’s at a state level. With individual hospitals, it can be even more varied.”
That kind of information can create market potential, which then could create competition.
“[If that’s the case], let’s talk about why that is, and are there patients who could really benefit from home health and hospice services,” Lang said. “Then you could funnel more patients into that service line and hopefully to your organization in the process. On top of that, you could start understanding exactly who the competition is and what strengths [a provider] brings to the table.”
Lang said one of the most important factors she’s noticed after combing through some of the MAP data is that home health providers should be aware that some referral organizations have tight networks of post-acute providers.
“Even in hospitals that do use post-acute care a lot, some of them have no more than 30% of their patients going to a single home health or hospice provider,” Lang said. “In some communities, no hospital has fewer than 70% of their patients going to one provider. So in some areas, we just have these really tight — it appears — referral networks. And in other markets, it’s just very diluted.”
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