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The PDGM is a shift away from volume-driven home health payment to a model that focuses on the unique characteristics, needs, and goals of each patient.
Medicare’s Patient-Driven Groupings Model is a patient-centered payment system that places home health periods of care into more meaningful payment categories while eliminating the use of therapy service thresholds for adjusting payment for home health episodes. The system also moves payment from a single 60-day episode to 30- day periods of care, still retaining the 60-day certification and plan of care requirements.
There are several myths about the PDGM. Claims that the need for therapy will be diminished, that only patients discharged from an institutional setting will receive therapy, that the PDGM doesn’t support maintenance therapy, and that services cannot be delivered after the first 30 days are false.
Similarly, rumors that therapy will be covered only when a patient is assigned a clinical grouping of musculoskeletal rehabilitation or neurological/stroke rehabilitation, that Medicare will dictate which providers are qualified to provide certain types of therapy, and that home health visits will be dictated by the Low Utilization Payment Adjustment (LUPA) claims system are all untrue.
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Mar 1, 2020 / Article
The PDGM is not intended to be used to make treatment or staffing decisions that reduce or compromise patient care.
Dec 20, 2019 / News
APTA and two other organizations are urging HHAs to keep patient access front-and-center and avoid "unnecessary staffing changes."
Dec 1, 2020
Medicare does indeed cover services to maintain or manage a beneficiary's current condition when no functional improvement is possible if the services are medically necessary and meet the skilled care requirements.
Additional Patient-Driven Groupings Model Content
Nov 7, 2023 / Review
Market basket adjustments set the stage for a slight increase in 2024, and Medicare will cover compression treatment items.
Jul 14, 2023 / Review
After narrowly escaping reductions in 2023, home health could see a $375 million drop in 2024 as CMS adjusts to PDGM realities.
Jun 30, 2021 / Review
CMS uncovered some surprising data but can't tell the extent of the pandemic's influence on the numbers.
May 15, 2020 / News
APTA is taking concerns about PDPM and PDGM misapplication directly to physician and consumer groups.
May 1, 2020 / Summary
Review the survey that assesses the effects that the SNF PDPM and home health PDGM models may have had on care delivery in the SNF and home health settings
Dec 11, 2019 / Analysis
PDPM and PDGM are here, and PTs and PTAs must now learn how to navigate the changed landscapes.
Nov 21, 2019 / Perspective
It's important to understand two questions: Who assesses the functional impairments? Who collects the data for the functional score?
Nov 15, 2019 / Perspective
It's time to move forward. We can't change the past, but we can learn from it.
Nov 1, 2019 / News
What's in the final 2020 home health payment rule from CMS?