Home Health Articles and Information


Nov 13, 2019 1:20:00 PM / by Kristi Bajer, BSN, RN, COS-C

Free Range Nursing in PDGM and RCD

For years home health has been a practice area offering more personal freedom for clinicians.  This applied to self-scheduling of course, but also to assessment techniques and subjective OASIS interpretation.  Most agencies provided basic OASIS training before turning new employees out to become “Free Range Nurses” and hoping for the best.

The PDGM payment structure will dictate major changes in processes agencies use to manage and document patient care. The future of these agencies will depend on their ability to successfully change many long-standing behaviors and increase efficiency of care.

Those states that are in the review choice demonstration (RCD) have even more reason to consider process overhaul. Agenies who are unable to complete their OASIS and plan of care in under 72hrs may struggle with cash flow even before the RAP payment goes away in 2021.

People by nature find comfort in the old routines and usually find it difficult to accept “required” changes to well established routines.

Below are some of the reason’s nurses might be hesitant about change:

  • Lack of appreciation for the need to change, or considering it low priority –

                     The WHY.

  • Not connecting their own actions to part of the bigger operational change-

                      The WHAT.

  • Nurses might oppose the method of implementing the change-

                       The HOW.

  • Nurses might resist the pace of the change-

                      The WHEN.

  • Nurses might feel unable to learn and do things differently

                      The WHO.


If your Field staff has been the “Free Range” type with minimal supervision, maximum autonomy, acting as the primary decision makers in patient management and care planning, reining them in for the structure of the PDGM / RCD payment model may be tough.

As you continue your PDGM or RCD implementation look at your agency’s past track record with organizational change. Have you communicated and orchestrated those changes well? Does your agency have the tools, processes and strategies for success?

OperaCare's consulting is here to help guide your agency to successful change in PDGM and RCD.


Tags: PDGM, Compliance, Home Health, Quality assurance, Scribing, OASIS

Kristi Bajer, BSN, RN, COS-C

Written by Kristi Bajer, BSN, RN, COS-C

Kristi Bajer BSN, RN, COS-C, brings over 10 years of real world experience as a clinician, director, and administrator in home health. She is a firm believer in diagnosis driven evidence-based care in home health. Currently, she assists agencies with external chart audits and Medicare appeals, as well as providing training and coaching on OperaCare implementation and building QAPI programs using data to drive success and protect agencies from government audits.