The Patient-Driven Groupings Model (PDGM) changes how home healthcare fits into payment categories, eliminates the use of therapy service thresholds and changes home health payment from a 60- day episode to a 30-day episode. This new model goes into effect beginning January 1, 2020.
|CMS has passed a new Patient-Driven Groupings Model (PDGM) that goes into effect beginning January 1, 2020.|
|Under PDGM, an episode of care is now 30 days, versus the previous 60-day episode. Additionally, the number of therapy visits no longer counts toward home health payment.|
|PDGM categorizes each episode of care based on five factors:1
|These changes lead to several new payment categories, each with its own Low Utilization Payment Adjustment (LUPA) and a minimum threshold of two visits per category.1|
|PDGM also incentivizes innovation via remote patient monitoring (RPM). With RPM, the patient and/or caregiver digitally stores and/or transmits physiological data (i.e., blood pressure, glucose monitoring) to the HHA.1|
|This is the biggest change to Medicare Home Health in 20 years.2|
Who does PDGM affect?
Home health agencies and home healthcare providers
Key Dates for PDGM
January 1, 2020
PDGM goes into effect
The Patient-Driven Groupings Model is part of the continued effort to move from volume-based payment models to value-based payment models, and to help ultimately reduce the cost of healthcare.
How should you prepare for PDGM?
- Consider technology solutions to help address RPM
- Focus on saving staff time on administrative duties
- Allow more time for patient care
- Consider industry partners in telehealth
- Educate your staff on conducting thorough assessments