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How PDGM Changes Can Help Home Health Agencies Deal with the Nursing Shortage


If you manage a home health agency (HHA), it may seem like the Patient-Driven Groupings Model (PDGM) has turned your world upside down. But as the saying goes, every cloud has a silver lining. Implementing process changes to adhere to PDGM requirements is helping some of our clients tackle one of their biggest business challenges: the home health nurse shortage and the high caregiver turnover in the industry.

Diagnosing the Problem

As with all health-related issues, before rendering a diagnosis and recommending treatment it’s important to understand the underlying issue. With regard to staffing, the average tenure for a home health nurse is only 19 months, according to the Bureau of Labor Statistics. That means you can only expect any given hire to remain on the job for a year and a half before they either burn out or leave for an employer that offers better working conditions.

The cost to recruit a replacement can be astronomical. The NSI National Health Care Retention and Staffing Survey found that the average cost of recruiting replacements is $52,000. Don’t expect to replace employees quickly, either. Recruitment periods last 86 days on average.

These are all symptoms of an underlying problem and aren’t all centered around PDGM changes. Being a home health nurse is a high-stress job. In a recent webinar, Axxess shared some of the feedback gathered from home health nurses. They said:

“I love my patients, but after six months of staying up till 10 PM every night, I finally had to leave.”

“[Management must provide] relief of stress for field staff.”

“Documentation requires too much time!”

“Workload is equivalent to two full-time jobs!”

Not only is turnover expensive, but a stressed-out nursing staff can also impact overall patient care. Yes, home health nurses do the best job they can, but we don’t need studies to inform us that employee burnout can lead to short tempers, lower-quality care, and an increase in errors.

How PDGM Changes Can Help Relieve Stress

It may seem counterintuitive that a change in billing and reimbursement protocols, especially one that requires 30-day billing increments instead of 60, could help reduce paperwork and solve the issue of home health nurse burnout.

And if you’re trying to solve the problem by simply implementing new processes, it probably won’t work. In fact, it may exacerbate the issue as nurses struggle to comply with the coding requirements and shortened reimbursement cycles. By the time they sort it all out, they may already be planning to head off to greener pastures.

On the other hand, updating both the systems and processes you use can have significant benefits. Recently, WorldView conducted a webinar with Axxess to show how having the right systems and a single source for documentation can significantly streamline processes, leading to less stress in your workforce and easier PDGM compliance.

Here are just six of the many ways that WorldView and Axxess work together to help make your home health nurses’ lives easier while improving your bottom line and ability to serve patients.

1. Eliminate Billing Delays and Rework

If a home health nurse or clinician enters an ungroupable diagnosis, Axxess’ home health software automatically alerts the user and prevents them from proceeding unless they’ve been assigned the appropriate access permissions. This can help eliminate the amount of rework that needs to be done and lessen the chance that an error will jeopardize reimbursement.

2. Tracking Comorbidity Resolution

Often a patient will have more than one condition that needs to be addressed. For example, they might have an acute illness as well as an underlying chronic condition. If the acute illness is resolved within the first 30-day period, that information needs to be shared with billing.

Unfortunately, manual and paper-based processes can be time-consuming and cumbersome. Axxess provides a change in focus form, which your home health nurses can use, from wherever they are, to capture everything your billing department needs to know.

3. Paperless Faxing

Perhaps no industry makes more use of fax machines than healthcare. With all that paper, it’s easy for a fax to get lost or attached to the wrong patient, which in turn increases paperwork, billing errors and delays. Working together, WorldView and Axxess enable you to eliminate a good deal of the manual faxing and automatically attach faxes to patient charts.

You can also fax documents directly from WorldView. Examples might be faxing lab results to a clinician or routing a document for a signature. This is especially helpful if a physician forgets to sign an order. The document can be routed right back to the physician through WorldView.

4. Less Data Entry

Your nurses didn’t enter their profession to spend time doing data entry. That isn’t why you hired them either. We can help your nurses find more time to spend with patients by automatically populating forms. If you receive a type of document frequently, e.g., signed orders, our application can create a scannable QR code that automatically pulls in all the necessary data.

We also offer a feature called a Virtual Print Driver that enables you to print documents from other sources into Axxess. In a recent training session, one attendee told us that, over the weekend, it took him four hours to pull documents for four separate patients from a portal and upload them. Using the Virtual Print Driver, we processed a 104-page patient document and sent it to Axxess in less than a minute. He was speechless.

5. Automated Order Tracking

Your nurses and other staff probably spend a significant amount of time tracking down orders. Though your team bears the brunt of these delays, they’re often not your team’s fault. With PDGM, delays can also derail reimbursement, so you’ll want to streamline order tracking as much as possible.

You can set up a schedule for how you want to handle orders that have not been signed and returned. With PDGM, many of our customers automatically resend unsigned orders after four days and again after seven days. You can also set up alerts for aging orders, so your team is aware of any delays. In addition to the ability to send orders directly from the system, WorldView can also use tracking functionality to track orders for physicians that still require physical copies.

6. Referral Management

Referrals are a constant in healthcare, but especially in-home healthcare. WorldView can automate the processing and tracking of incoming and outgoing referrals, saving your team time and helping to ensure your patients get the care they need.

Protocols are important. Every HHA has specific ways of doing things, and PDGM has requirements that must be met as well. Removing manual processes helps ensure these protocols are followed while providing much-needed stress relief for your staff.

If you’d like to learn more about Axxess and WorldView, you can watch the webinar or visit us online.

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