Connecting PDGM with Medicare’s Value-Based Spending | Axxess
Summary
Under the current fee-for-service payment system, there is not always a clear correlation between good quality ratings and the amount of money Medicare spends on home healthcare reimbursement. PDGM creates a landscape for home health agencies to promote patient-centered detailed care plans, and improve quality patient outcomes with optimal resource utilization. As an industry, our relative value – the amount spent per level of quality achieved – should fall in line with the national average of 1.0. In turn, Agency A holds high quality ratings, but at a very steep Medicare spend, signaling questions regarding sustainability and operations. PDGM aims to better align payment to quality outcomes with increased patient classification, more focused consideration of acute severity (Admission Source), increased specificity of coding leading to a more comprehensive picture of the patient (Clinical Groupings and Comorbidity), and functional impairment tied to any underlying condition.
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