Why MCHs Should Know About PDGM


For durable medical equipment (EMR) suppliers looking for new benchmarks, the most common call points are Qualified Nursing Facilities (SNFs), Respirologists, Cardiologists, Internists, and Management Services hospital cases. However, one go-to source is often missing from their sales and marketing strategies: Home Health Agencies (HHAs).

This article will help EMR providers build HHA credentials, better distinguish their brand, create new growth opportunities, and increase revenue. Understanding the Patient-Oriented Groups (PDGM) model will help HHA sales calls resonate in knowledge and ideas, rather than just product and price. This understanding should, in turn, allow you to focus on the positive impact the EMR can have and why an HHA should partner with you.

PDGM primer

In January 2020, the Centers for Medicare & Medicaid Services (CMS) finalized a new home healthcare payment model, the Patient Driven Groupings Model. It draws on clinical characteristics and other patient information to create a case classification, placing periods of home care into meaningful payment categories.

PDGM transformed payment for home care by removing the incentive to overproduce therapy in favor of a value-based payment system that prioritizes patient needs. HHAs receive higher reimbursement for patients from institutional settings compared to community referrals. Hospitals and NFCs are penalized for higher than expected readmission rates under their value-based programs; therefore, HHAs need strong, verifiable data demonstrating better patient outcomes and reduced readmission rates to target and increase their referral sources.

An EMR provider who can demonstrate how the right equipment can prevent hospital readmissions is a valuable resource for the HHA.

Marketing to HHAs

Start by differentiating yourself from your competition. Anyone can advertise a service, selection, or door-to-door delivery, which makes it hard to stand out if you offer more of the same. The key is that customers want to choose you, and then keep coming back for your review and service.

When it comes to working with home health agencies, you don’t just take orders. You create a story, and the storyline is the opportunity. You must speak their language to make them order from you. If you understand their needs, you can approach them with a plan. Saying, “Let’s go through these models of clinical clustering, and I’ll show you which EMR products will help your patients in these clusters,” is a powerful message.

The home health field is very competitive. They are all competing for the same patients and facing staff shortages. When you help your HHA partners better order the EMR, more patients can stay home, which keeps agencies on top of their game.

Patients want to be at home, a trend that will continue in the future. Keep in mind that HHAs have rarely been in the driver’s seat when it comes to ordering EMRs, so they need your expertise, guidance, and training. As more and more patients ignore short-term rehabilitation or skilled nursing care, the acuity of patients directly admitted to home health care is increasing dramatically. Answer questions they may not know how to ask, such as: What is the place of the MDG in keeping these sickest patients healthy at home rather than in the hospital? Talk about patient safety and how the EMR helps with rehabilitation and overall health and wellness. Know the specific health benefits of the products you recommend, including how the EMR may improve function for certain diagnoses.

Find out how HHAs get referrals and help them get more. There are benefits to the HHA in knowing which EMR to order and what to document so Medicare or insurance covers the equipment. If your home health partners can share the correct documentation for an oxygen prescription, this is a marketing tool the HHA can use to help the doctor, versus a competitor who repeatedly calls with documentation questions. . Once an HHA is competent to order and document the EMR, they can partner with local physicians and medical groups.

Endowment assistance

Focus on long-term results rather than readmissions within 30 days. HHA nurses and orderlies play an important role in EMR orders, but often they are unaware of equipment options. Offer to provide in-house training for home health workers on the equipment you have that can facilitate their work.

Staff turnover is among the highest operational costs for HHAs, and labor shortages are always a major concern. EMR providers can help with agency staffing by focusing on specific items and equipment that simplify and expedite nursing care. For example, train your delivery staff to perform home assessments that include fall prevention and bath safety, and share that information with the HHA. Educate your delivery staff on basic manual wheelchair positioning, such as adjusting the front rig and armrests, which helps HHAs as they cannot bill for hours if they have to send a therapist.

Examining diagnostic trouble codes

Let’s take a look at a PDGM clinical group as an example of how an EMR and HHA can team up for referrals. Under PDGM, a patient with stage 3 pressure ulcer or sacral pressure injury belongs to the wound care clinical group. Wound care is one of the highest paying clinical diagnoses under PDGM, so if you provide dressings and support surfaces, you can help HHAs acquire injured patients and improve their condition. This increases the home health agency’s value in the wound care market, resulting in more referrals and increasing the bottom line for HHA and yours.

Review the major diagnostic codes the HHA will see and create an EMR suite by condition or disease state to meet unique care needs. Highlight skills in areas like congestive heart failure, COPD, pressure injuries, etc. Help the HHA understand key products such as beds, bath safety, lifts and transfers, wheelchairs, mattresses and cushions, or pressure prevention. HHAs may not be familiar with specialty products with clinical benefits that can also be used at home. Be specific and build your brand to help them build theirs.


Have you looked at the “Choose Home” bill that is currently before Congress? It will most likely pass, and if it does, divert $ 247 million from skilled nursing care to home care. This means HHAs will have sicker customers and might not know how to order materials for these higher level patients. They may not even know what is available and will need more support; work with your local HHAs to show how you can help. This is how you stay competitive and enhance your differentiating strengths.

Take your EMR business to the next level by becoming an HHA and / or PDGM clinical cluster diagnostic specialist and using that expertise to market yourself. Seek to have your staff certified as a Post Acute Care Specialist, Memory Care Specialist (dementia is one of the main diagnoses), or other condition-specific specialist to become a better patient advocate and clinical expert. This is a substantial opportunity for you to help patients and partners and augment your current business plan.


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