Effective Disease Management Supports PPS

Abstract

Health Care Financing Administration’s Prospective Payment System (PPS) took home care from a visit-based to an episode-based payment system that closely monitors patient outcomes, primarily in functional improvement. It required that clinicians take a thorough look at whether patients are getting better: to examine not just their disease process but whether the patient’s overall status is improving. To succeed under PPS, home health agencies need to follow disease management principles that include having knowledgeable clinical staff skilled in assessment and documentation who can accurately identify the patient’s primary home care diagnosis and identify barriers to achieving goals. The challenge to reduce costs and still maintain a high level of quality will make it essential to establish a medical supply formulary, a method of monitoring outcomes, and new and creative ways to promote improvement both in patient health and the delivery of care.