HHVBP and PDGM mimic the restructuring hospitals went through in the acute care reforms when “fill the beds” turned into “empty the beds” almost overnight. This practice continues without fail almost twenty years later. Home health is now seeing high volume, large census, low value care models being replaced with high Acuity, outcomes driven, rapid cycle care.
CMS payment reforms in acute care, changed the clinical behavior of Physicians, Nurses, and Paraprofessionals, and the focus of hospitals administrators and CFO’s.
The primary change, and easiest to see, was the care model hospitals had embraced for several decades changed overnight. Volume of care… Beds Full vs Value of care … Beds empty- Hence The change from Procedure Recovery Discharge to Procedure Discharge Recovery.
CMS watched this develop, examined the innovations that were born of it, and considered it a success in meeting their agenda. CMS understands and has proof that placing quality before cost and quantity does succeed in producing better outcomes and reduced cost of care.
As a nurse experiencing this change, and not liking it, I joined my peers on the picket line marching up and down the sidewalk protesting. And here we are today; DRG’s are what define the content of the patient episode, not the clinicians providing the care.
Agencies who understand and embrace the new metrics of success will not only survive this change but thrive in it. Maybe it’s time to stop protesting HHVBP and PDGM and learn to provide the value our patient’s and Medicare dollars deserve.
