Payment moved from 60-day episodes to 30-day periods, grouped by clinical need instead of therapy visits. Every calculation in the old system assumed the old model.
Home health financial system for PDGM
We rebuilt a home health and hospice provider’s financial system to meet new CMS payment rules, on a fixed deadline, while the requirements were still changing.
Services
- Custom software development
- Event-driven architecture
- Offshore development teams
- Test automation
The challenge
Our client runs home health and hospice services from multiple locations in the United States and abroad. In its 2019 Home Health final rule, CMS introduced the Patient-Driven Groupings Model, a new way of paying for home health care that took effect in January 2020.
PDGM changed the basic unit of payment, so the client’s financial system had to be rewritten to comply. The deadline was fixed, and requirements kept arriving as the rule was clarified. We were designing for a target that kept moving.
Technology
- .NET Core
- Angular 7
- AWS and Aurora
- Kafka
- Kubernetes
- Postgres and SQL Server
- CircleCI and Jenkins
- New Relic and Sumo Logic
The solution
We built the new system in .NET and Angular and deployed it to AWS. We worked in short sprints with automated testing, which kept bugs and regressions down while the requirements changed underneath us.
The core is event driven. Financial events from the client’s legacy system arrive over Kafka and are written to a journal. On top of that we built reporting, period close and general ledger services, plus a new interface that shows those events to the finance team.
Everything runs as microservices on AWS, managed with Kubernetes, so the system scales with message volume and the number of users. If you are facing a similar rewrite, our guide to legacy system modernization covers the options.
Event-driven architecture
Every financial event lands in one journal first, so reporting, period close and the general ledger all work from the same record.
The team
Three development teams of three developers and two test automation engineers, led by two delivery managers and an architect in the USA. Offshore developers never had access to patient health information.
What PDGM changed
