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.
Mar 1, 2020 / Article
Dec 20, 2019 / News
Dec 1, 2020
Medicare does indeed cover services to maintain or manage a beneficiary's current condition when no functional improvement is possible.
Additional Patient-Driven Groupings Model Content
Jun 30, 2021 / Review
CMS uncovered some surprising data but can't tell the extent of the pandemic's influence on the numbers.
Jun 3, 2020 / News
APTA is taking concerns about PDPM and PDGM misapplication directly to physician and consumer groups.
May 21, 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 22, 2019 / Perspective
It's important to understand two questions: Who assesses the functional impairments? Who collects the data for the functional score?
Jun 11, 2020 / 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?