It’s been a few months since the CMS Patient-Driven Groupings Model (PDGM) began to dramatically change your reimbursement scenario. You’ve had to re-evaluate everything, from staffing to workflows. There’s no denying that your relationships with physicians are foundational to your success under PDGM; if those relationships lack the proper focus, communication and clarity, your care reputation and financial success are already in jeopardy.
You don’t have time to wait for providers to give you the details you need or sign the orders you’re anticipating. You must be proactive, ensuring that your agency’s contact with providers is focused on quality and not just quantity. So how do you improve relationships and work around bottlenecks in this first year of PDGM? Thankfully, in most cases, you don’t need to throw out everything and start from scratch.
Best Practices are All About People, Process and Technology
You may already be leveraging your people, process and technology to achieve better patient care and business success. But take the time now to consider how to make your agency even more efficient and effective, particularly with more changes coming in 2021. Let’s explore some best practices that will enhance your provider relationships going forward.
Everything Starts with People
Your ultimate success is contingent on people! Three groups are critical to developing and implementing best practices when it comes to provider relationships:
- Business office personnel (intake, order management and business development)
- Clinicians in the field
- Physicians with whom you have – or wish to have – an association
Train your intake staff to thoroughly gather all necessary referral information, starting with complete diagnosis codes. By consistently requesting the necessary patient details up front, they’re educating physicians about your agency’s PDGM requirements…and accurately initiating the entire episode for that patient.
Be sure that your order management team understands the direct correlation between their follow-up and your agency’s revenue. When each person knows what part of the process he or she owns, there will be less overlap of physician contact. With the right interpersonal skills, they’ll build relationships with people in the ordering physician’s offices or practices who can facilitate provider signatures. Those contacts offer insight into a doctor’s preferences and behaviors, so your staff will better connect with the physicians when necessary.
Adequately prepare your practitioners to go into patients’ homes. Be certain they understand and master the point-of-care documentation potential that they have. Get your supervisors out in the field, to mentor and coach field clinicians. When your practitioners understand and trust the available processes and tools, as well as their manager’s expectations, they’ll be more accurate, better manage their time and coordinate care, and have greater job satisfaction.
Institute some new practices relating to your referral network. Remind your providers that accuracy, timeliness and interoperability are more important than ever for the patients you share as a team. Tell your providers about the National Association for Home Care and Hospice (NAHC) PDGM toolkit. Doctors need to know why you’re contacting them more often, particularly for increased coding detail and consistent, high-quality documentation.
The Right Processes Enable People and Technology to Succeed
Review your current processes – if you haven’t already – to see what still works and what doesn’t. To build and maintain smarter, healthier relationships with the right providers, revise your workflows and add new ones as necessary, such as:
- Systematize every step, from referral to closing of the claim
- Make every touchpoint with your providers count
- Implement the appropriate supportive technologies
Tech Should Improve Transparency, Visibility, Efficiency
Even if you’ve already deployed systems and software in your agency, PDGM makes it vitally important that you understand and act upon the data you’re collecting with that technology. Aligning your entire business process with the right technology will allow you to serve your patients more effectively and run your business more precisely…basically mandatory for survival under the new model. You need technology that supports:
- Greater transparency into the current status of all patients
- Better visibility into your current and future business operations
- Increased efficiency for your back-office and field staffs
Employing state-of-the-art technology best practices, you’ll maximize relationships with your providers and get your order turnaround time where it should be. Here are some features that will make that happen:
- A provider dashboard with easily accessible information for follow-up callers
- The ability to track follow-ups and add notes in bulk
- A list of contacts already made, reducing duplicate efforts
- The ability to add more alerts and prompts
- Earlier, categorized views into outstanding orders, including hyperlinks to providers
- Views showing reasons for delays
- Thoroughly documented escalation processes
- More detailed data for manager oversight
If you’re a Forcura Workflow user, you already have those features at your fingertips! Our recently enhanced orders management functionality enables you to see everything you need in one holistic view to make that next provider contact streamlined, efficient and productive.
Further, with insights provided by Forcura Analytics, you can quickly determine the health of operations across your enterprise. From managing referrals to tracking outstanding orders and driving faster A/R, know what's working and what needs attention - fast. Forcura Analytics gives you data you need to manage your teams, too. Our staff reports help you identify anomalies, drill-down to the employee level, and take action.
The bottom line? If your agency appropriately employs and supports people, process and technology, and incorporates data into your best practices, you’ll benefit from rewarding provider relationships – and a thriving business!
Today's Best Practices for Provider Relationship Management
Our white paper dives deep into the best practices for managing your provider relationships. Access it today!
Deb Buenaflor is responsible for the strategic growth of the Forcura platform, while focusing on meeting the ever-changing workflows and regulatory requirements for the post-acute healthcare industry. She works closely with Forcura’s Engineering team to guide products from conception to launch, and with industry-leading EHR partners to build technology workflows that will fulfill regulatory requirements, drive productivity, and enable better patient care.