PDGM’s Impact on the Home Health Care Market


To remain competitive in the increasingly evolving healthcare industry, post-acute care executives must transform their organizations into client/patient-focused, value-driven providers capable of providing high-quality care in today’s quickly changing healthcare environment and beyond.

Agency leaders must use their envisioning, planning, and execution muscles to execute the Patient-Driven Groupings Model (PDGM) effectively. It all comes down to leadership and the capacity of leaders to handle change. The firms that succeed in the transition to PDGM will rely heavily on effective change management. In the same way as PPS, the consolidation of providers under PDGM will occur via agency closures and mergers and acquisitions.

We are witnessing a fundamental change in how home health companies operate — they need to transition from providing volume to creating value. Value-based care is becoming more prevalent in all areas of healthcare. We may anticipate many more changes in the future due to this transformation. As home health care continues to embrace PDGM, its impact will increase.

30-Day Payment Period

New payment model features include eliminating the present payment model’s treatment threshold, reducing the 30-day payment term, and customizing the criteria for obtaining the Low-Utilization Payment Adjustment (LUPA).

It has been over 20 years since the National Association for Home Care, and Hospice deemed the patient-driven groupings model the most remarkable significant improvement to the home care sector.

Classifying the need for care

Rehabilitation for musculoskeletal, neurological, and stroke-related conditions, wound care (both surgical and non-surgical), behavioral health (including drug use disorder), complicated nursing interventions, medication management, education, and evaluation are all part of the new standard.

A patient will be assigned to one of these six groups upon referral and before admission to better explain the terminology. One won’t make a payment if an ICD-10 code provided as the primary reason for delivering care does not correspond to one of these clinical groups. Thus, doctors will need to be aware that the primary diagnosis for a home health care episode of treatment must be allocated to one of the clinical categories for home health care providers to get reimbursed correctly.

Reviewing patient care protocols

Home care organizations must examine their patient care practices to guarantee correct treatment and payment. To achieve this, clinicians and coders must understand OASIS requirements and conduct more thorough patient assessments, including collecting complete health histories and recording comorbidities. They must also work together in cross-functional teams to provide coordinated care.

Eliminating therapy-visit volume

Another change brought about by the PDGM is eliminating the volume of treatment visits as a consideration in determining payment amounts. Therapists won’t be a guaranteed source of income for home health businesses anymore. To ensure that patients receive the treatment they need, home health organizations should communicate with therapists before making any modifications to the services they offer due to PDGM.

According to Home Health Care News, PDGM will modify providers’ income streams, but it won’t improve the diseases and illnesses of their patients. Notably, compensation under the PDGM is based more on value than volume, making it more critical to improving results.

Increased demand for healthcare services

Post-acute care providers will see a rise in demand for their services as the change to value-based care takes hold and becomes more widely accepted. The number of adults 65 and older is expected to increase by 36 million in the coming decade. About 65% of seniors will have two or more chronic illnesses by 2050, increasing the medical complexity of the elderly population. While demand for medical services continues to rise, the supply of professional and paraprofessional caregivers will not keep up with the rising need for their assistance. Leaders in the post-acute care industry must adapt and innovate to stay relevant.

Home health organization executives must plan for and manage the transition to PDGM to ensure a successful implementation. Post-acute care executives need to transform their companies into value-driven, client/patient-centered providers capable of providing world-class care in today’s fast-changing healthcare environment and beyond.

Due to the patient-driven groupings model, organizations must have data and evidence to back up any operational adjustments they make because of PDGM because of this new reality. Organizations can examine their healthcare data recording to guarantee their systems are secure and reliable.

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