OT PDGM (Patient-Driven Groupings Model) Home Health Update & Video

Thank you to LovelyyOT for producing a concise summary of the PDGM.

It has been a little over a month since PDGM has went live (1/1/2020) in the US. If you are in home health, you most-likely have heard about what this means.

Kaiser Health News just posted an article describing the story of a client who got discharged from OT services after PDGM. Whether it is a direct consequence of PDGM remains to be questioned.

The decision came out of the blue. “Your husband isn’t going to get any better, so we can’t continue services,” an occupational therapist told Deloise “Del” Holloway in early November. “Medicare isn’t going to pay for it.”

The therapist handed Del a notice explaining why the home health agency she represented was terminating care within 48 hours. “All teaching complete,” it concluded. “No further hands on skilled care. Wife states she knows how to perform exercises.”

Home health therapists, both OTs and COTAs have also been laid off or terminated. This should come as no surprise as the new PDGM model emphasizes quality in therapy instead of quantity.

Agencies are responding aggressively, according to multiple interviews. They are cutting physical, occupational and speech therapy for patients. They are firing therapists. And they are suggesting that Medicare no longer covers certain services and terminating services altogether for some longtime, severely ill patients.

Some pros under PDGM:

PDGM-chart

  • 432 (an increase compared to before) possible case-mix adjusted payment groups.
  • No threshold on visits. We will see if whether this will be good or bad.

Cons under PDGM:

  • No longer a demand to see a patient for a certain amount of visits within a timeframe.

Agencies now have a stronger financial incentive to serve patients who need short-term therapy after a stay in the hospital or a rehabilitation facility, said Kathleen Holt, associate director of the Center for Medicare Advocacy. Also attractive will be patients who need nursing care for complex conditions such as post-surgical wounds.

At the same time, there are fewer incentives to serve patients who need extensive physical, occupational and speech therapy.

Have you been directly affected by PDGM either as a patient, caregiver, or therapist? We would like to hear how this is going.

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