08/13/2019

What is PDGM?



The Patient-Driven Groupings Model (PDGM) is one of the most significant changes to Home Health agencies in years. It's no wonder why a lot of agencies are worried about what this is going to mean for their revenue.


But before we jump too far ahead of ourselves, let's take a look at what PDGM is and what are the changes it brings.


PDGM or The Patient-Driven Groupings Model is a re-worked version of the Home Health Groupings Model that CMS submitted and withdrew in 2017. It takes therapy volume out of consideration in determining Home Health agency (HHA) payments and cuts the payment periods to 30 days from 60 days.


In itself, this a significant change for HHA's. Before these Home Health Agencies were able to bill over a 60-day episode and now they only have 30-days. RAP (Request for Anticipated Payment) and the final claim will also be accelerated and occur in a much shorter time. It is forcing Home Health agencies to re-evaluate their Plan of Care.


Of course, the 60-day certification remains the same, HHA will just now need to bill twice as often.


PDGM will be removing therapy volume as a factor of payments for HHAs. According to data from MedPac, there has been an increase of 29% in therapy visits over a 19 year period. This "Therapy threshold" is encouraging volume over value in the Home Health industry. What CMS hopes with PDGM is that any monetary incentive to over provide therapy services will be eliminated.


What you can do


Patient-Driven Grouping Model (PDGM) is a significant change to the Home Health landscape. However, there are some tips we recommended.

1. If your seeing a dip revenue due to PDGM make sure you are looking over where you are losing money. This will be a perfect time to re-evaluate what coding and the use of best practices. Make sure everyone is up to date with those best practices and make sure you coders are ready for this change. Look at who on staff who may struggle with one aspect but shines at another and vice versa.

2. Make sure not to over-utilize care, do you have too many recertifications? What about LUPAs?

3. And finally, the big one. Physical Therapy Assistants (PTAs) often cost less than a Therapist and provide much of the same services. The bonus is having a sound system step up where your PTA's are taking on more freeing up your Therapist to tackle the significant issues.


There are some positives to PDGM; for instance, it gives Home Health agencies the chance to try out Telehealth and Telemonitoring. Telehealth can eliminate the need for some therapy sessions without impacting care. Telemonitors allows for a patient who can perform their therapy at home.


Unforentley Big changes are coming to the Home Health industry. The best thing you can do is meet them head-on. Make sure you are ready, and you have done all of the preparations you can. Check the PDGM grouper tool and keep yourself up to date on what is happening. Also, check out everything about the PDGM here

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