Home Health Organizations Fall Short Under the Patient-Driven Groupings Model
Summary
In 2019, the Centers for Medicare and Medicaid Services (CMS) released the CY 2020 Home Health Final Rule, which introduced the new case-mix adjustment methodology, the Patient-Driven Groupings Model (PDGM). Home health organizations were actively against the automatic 4.36% behavioral adjustment that resulted in a reimbursement decrease, and these disappointing numbers don’t help CMS’s case. Learning a New Way to Operate For months preceding the PDGM transition, home health thought leaders worked hard to educate the healthcare industry on the new billing requirements. As the home health industry travels into the world of value-based purchasing, PDGM offers the opportunity for organizations to be paid for quality versus quantity. While the claims data presented has been offset by the COVID-19 pandemic, it still demonstrates the need for organizations to better educate their staff, helping to avoid a loss in reimbursement and, ultimately, a decrease in quality patient care.
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