PDGM Series 5/5: Use Cases by Clinicians for PDGM

In our final article we offer use cases and pointers for PDGM gleaned by our survey of clinicians on working in the field. We’ve taken anecdotes from our peers in the field to present a quick rundown of how you can start incorporating this understanding into your daily practice while providing value for your patient, teams and agency.

The main takeaway from PDGM, for clinicians, is the importance of documentation. Proper documentation of a case helps to assess proper duration of treatment and visits so the patient gets adequate care and the agency is properly compensated. 

As a general rule of thumb, community based referrals are expected to use fewer resources and thus receive less reimbursed. But when you’re matched with a complex patient, it helps to understand why they are homebound for many reasons. One of these reasons is justifying the frequency and set duration for the patient’s plan of care. An example of this might be: A patient who’s complaining of cervical pains and headaches with a medical history of COPD and CHF.  Due to these comorbidities, the patient might have to be in a more upright position all the time resulting in a forward head posture which causes pain. If the patient isn’t in an upright position, they can’t breathe. The clinician would need to spend more time with adapted treatments to help with pain management, with the possibility to allow improvement in functional ability.   

Another example may be: a patient requiring postoperative care.  A patient with a total knee replacement may heal more slowly because they have diabetes. Complex comorbidities have an effect on patient progress and needs to be properly documented so the patient can be properly treated.

You might be wondering if PDGM is changing the way clinicians practice. The answer is, it depends how they were practicing prior.  If a clinician was thorough in documentation, had proper justification of homebound status and set plans of care that fit the needs of the patient, then their practice will not change much.  With PDGM, accurate documentation is an important tool in the clinician’s arsenal as a means to secure the patient the care they need. 

To conclude this PDGM series, each home health clinician should start looking at the appropriateness of their visits and make each visit count. Comparing notes with functional objective data and relating it to the patient’s functional needs at home will be vital in today’s PDGM overhaul.