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Home Health Care colleagues excitedly discussing KPIs and how they will help them succeed under the PDGM regulation

Key Performance Indicators: How they Help you to Succeed with PDGM

As previously mentioned in our last blog, Benchmarking for the Future of Home Health Care, at the recent 2020 Financial Management Conference, NAHC hosted a session on New PDGM Benchmarks and Trends, discussing how the new payment model has impacted the home health industry since its implementation. Our first blog post summarizing this session detailed the discussion around the importance of benchmarks. As a follow up to that, we will now focus on the value of Key Performance Indicators (KPIs). While they are similar, benchmarks and KPIs are not the same thing and agencies need to ensure they have both in place to ensure their success — especially for PDGM.

Key Performance Indicators

KPIs are the critical indicators of progress towards an intended result. They offer valuable insight into agency performance, provide focus for strategic and operational improvement, create an analytical basis for decision making, and help focus attention on what matters most. Basically, KPIs are meant to help your organization understand where you are in relation to your goals.

How Benchmarks and KPIs Work Together

While benchmarks are about looking externally to see where you measure up, KPIs are your internal goals. Often, they work together, as benchmarks help you to see the industry standards, successes, and goals of your industry and KPIs help you to achieve success for your own agency. For example, your benchmarks might show that your Case Mix is below the national average. Your goal would then be to improve your Case Mix score and that’s when you start developing your internal KPIs detailing what you are going to do to improve your score. Maybe that’s by looking at your OASIS improvement, or educating your nurses or therapists, or maybe by looking at the documents coming in from your referral source. All of these are a great start to establishing your goal and how you plan to measure the success of that goal.

Common KPIs in Home Health Care

Two common KPIs in Home Health Care are Case Mix and Payor Mix, and currently there is also a big focus around outstanding orders — especially in regard to PDGM. For example, with the impact of PDGM, agencies need to get their claims out the door much quicker than they did under the prospective payment system (PPS). The outstanding orders delay the claims process and then your claims that could be billed are put on hold until all documents are completed. In this scenario, with KPIs in place you could be measuring how long it takes to get an order out or how many outstanding orders you currently have, and the reasons for those items. These measurements will then help you to improve the claims process for the future. When looking at KPIs for Payor Mix, it’s important to know your agency and what benchmarks you are measuring against. For example, there are different parts of the world where care penetration is in the 50-60% range, so if you have 40% Medicare and want to improve that, you might be able to but it is unlikely that you will be at 70% in the future. Bottom line — your KPIs need to be a realistic goal for your specific agency.

How PointClickCare Can Help

As part of our ongoing commitment to education, PointClickCare created a Key Performance Indicator dashboard for our home health care solution. This dashboard gives agencies real-time insights to ensure they always know where they stand in achieving their goals. These dashboards serve as a way to surface information to employees in those roles that will be helpful in their day-to-day processes. Some items may be actionable information and some may be performance based. There are also dashboards that can help you track efficiency metrics like the Days to RAP and Days to Final, episode timing, referral sources, LUPA percentages, clinical grouping, etc. These help to identify areas that could benefit from process improvement to help you stay on track with your goals.

See how PointClickCare helps agencies thrive under PDGM.


September 28, 2020