Maximizing Revenue and Growth: 3 Reasons your Home Health Agency needs SimiTree's PDGM Analysis

As we move further into 2023, it's becoming increasingly important for home health agencies to stay on top of changes in the Patient-Driven Groupings Model (PDGM) and adjust their practices accordingly. With competition increasing and margins getting thinner, agencies need to make sure they're capturing all possible revenue and optimizing their reimbursement rates.  

We created this post to let you know that it’s possible to stay ahead of the curve and maximize revenue and profitability in an increasingly challenging landscape. Don't wait until it's too late – contact us today by submitting our form below to learn more about how we can help your agency thrive. Keep reading to understand how SimiTree can help you through times just like these.


First, understand Medicare’s Patient-Driven Groupings Model (PDGM) changes

How are new case mix recalibrations under Medicare’s Patient-Driven Groupings Model (PDGM) and a marginal 0.7 percent payment increase (with behavioral adjustments factored in) impacting your home health organization? As the first quarter of the year ends, many home health agencies are still struggling to understand the full impact of this year’s changes to the underlying calculations that determine payment for home health services. Learn more about how data can pinpoint where OASIS training is most needed and how OASIS responses are used to drive PDGM payment in this blog post that explains common scoring issues.


Now ask yourself, ‘How will my home health agency adjust to these PDGM changes?’   

In addition to razor-thin reimbursement, the Centers for Medicare and Medicaid Services (CMS) applied multiple changes in the home health payment model for 2023. Changes were made in how certain diagnoses map to clinical groupings, new LUPA thresholds were set for some HHRGs, and some important tweaks were made to the point system used to determine functional impairment scores for patients. Figuring out the full impact of these changes has been a complicated financial endeavor for agencies juggling reimbursement uncertainties against inflationary costs and wage increases as well as changes in admission volume and patient characteristics.

A professional analysis from the experts at SimiTree can provide full-picture answers and help agencies determine the best course of action for ensuring profitability and growth.   

Here are 3 benefits you’ll get from a PDGM analysis by SimiTree’s data analytics and financial consulting experts


1. Understand the full impact of PDGM changes.   

As agencies drill down on revenue capture this year, looking at where to strengthen cash flow and optimize reimbursement, SimiTree’s experienced financial experts deliver a fully nuanced picture, pinpointing details such as the impact of both LUPA and non-LUPA payment changes.   
2. See individualized PDGM data.  

Specifics make the difference. SimiTree’s customized reports identify drivers of changes in reimbursement, offer comparisons of agency-specific patient mix and practices to state and national norms, and allow agencies to determine whether OASIS accuracy is lowering their reimbursement. Watch this short video to see how our coding and OASIS review dashboard shows OASIS response metrics to benchmark against the SimiTree data bank, showing how often each item is changed, and how often PDGM point increase. 
3. Recover the cost quickly.  

A professional assessment pays for itself in terms of increased revenue, accelerated cash flow, and stronger overall productivity. 


PDGM analysis by SimiTree: The tool you need to succeed 

SimiTree can provide a PDGM analysis on a percentage of your records to determine if your coding and OASIS are properly scored for maximum reimbursement that your agency deserves. 

SimiTree's PDGM Analysis provides agencies with the tools they need to do just that. By analyzing detailed data on patient mix, diagnosis coding, and OASIS accuracy, our experts can identify areas where agencies can improve and implement changes to maximize revenue. We also prepare your team with ongoing training. Trouble embracing OASIS E? Read this OASIS E early guide for clinicals with notes on Final Guidance changes.


How SimiTree Can Help  

With changes in reimbursement rates and clinical groupings, it's more important than ever for agencies to have a clear understanding of how PDGM impacts their bottom line. SimiTree's customized reports provide a nuanced picture of the impact of these changes on individual agencies, allowing them to make informed decisions about their operations and optimize their reimbursement rates. 

SimiTree has the resources and expertise your agency needs to ensure profitability and growth despite thinner margins and ongoing changes. Our experts help agencies determine where cost efficiencies, best practices, and revenue enhancements make a difference. Request a service or fill out a form below to be contacted by one of our experts today. Questions? Call us today at 1.800.949.0388. 

Contact Us

Let's work together to improve the health of your organization. At SimiTree, we balance financial expertise and clinical excellence to help our clients grow. How can we help you? Call us at 866.839.5471 or complete the form below.