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Are You Ready for PDGM?

By RehabCare

As of January 1, the home health (HH) industry will see the biggest change to its reimbursement model in more than 20 years. Under the Patient Driven Groupings Model (PDGM), reimbursement will move from being tied to the number of therapy visits to clinical characteristics and patient needs.

Are You Ready for PDGM?

How Does PDGM Work?
Patients will be placed into a case-mix group to determine an appropriate payment. There are five categories that will make up the case-mix groups:

  • Admission source
  • Timing
  • Clinical grouping
  • Functional level
  • Comorbidity adjustment

When all the categories are combined, a case-mix group will be assigned.

What Are the Highlights of PDGM?

  • Payments will go from 60-day periods to 30-day periods
  • Therapy visits will not be tied to reimbursement
  • Primary diagnosis, admission source and timing of the admission will have the biggest impact on reimbursement; functional impairment and comorbidity adjustments will also be factored into the payment.

Discussion Topic for You and Your Home Health Partner
How are your HH partners preparing for PDGM and the changes? Download the PDGM checklist to help further guide your conversations and preparation. 

The Value of a Rehab Partner Under PDGM

Providers cannot be short sighted when determining the value of their therapy resources. For some, this may require partnering with a contract rehabilitation partner, particularly one well-versed in PDGM. In order to succeed in this new model, senior living centers need therapy partners who understand the ins and outs of PDGM, and the risks that changing therapy services for patients may have in terms of additional future policy or reimbursement changes.

If you have questions not covered in this post, please contact RehabCare PLUS today at 502.596.7640.

By RehabCare