Dombi, Myers: Dangerous Assumptions in PDGM Could Disrupt Home Health

Two prominent home health leaders are trying to keep pressure on federal lawmakers to eliminate components of the forthcoming Patient Driven Groupings Model (PDGM).

Bill Dombi, president of the National Association for Home Care & Hospice (NAHC), and Keith Myers, CEO of LHC Group (Nasdaq: LHCG) and chairman of the Partnership for Quality Home Healthcare, penned an op-ed on PDGM that was published Monday in The Hill, a Washington, D.C.-based newspaper that describes itself as “for and about Congress.”

“A newly finalized home health payment model from the Centers for Medicare & Medicaid Services (CMS) moves away from evidence-based decision making toward dangerous assumptions that could disrupt care for some of our nation’s most vulnerable seniors,” Dombi and Myers wrote.

Specifically, the two men take issue with PDGM’s behavioral adjustments. These are Medicare reimbursement changes that CMS baked into PDGM to account for how home health providers will adjust billing practices in response to the new payment framework.

But the behavioral adjustments are based on CMS’ assumptions, not on any observed evidence, Dombi and Myers emphasized in their op-ed. And if CMS’ assumptions don’t pan out, home health providers face a potential Medicare cut of 6.42%, or more than $1 billion across the industry, when PDGM takes effect in 2020. Such a reduction in payments would jeopardize seniors’ access to home health care, Dombi and Myers warned.

Myers expressed similar concerns in a recent interview with Home Health Care News.

Three bills — two in the Senate and one in the House of Representatives — have been introduced that would eliminate the behavioral adjustments. The bills require CMS to base reimbursement changes on observed changes in providers’ billing patterns.

Myers and Dombi are urging lawmakers to support these pieces of legislation “while they still have time,” before the current Congressional session ends in early January.

Written by Tim Mullaney

Photo Credit:

  • Washington, DC Capitol Building: Pixabay
Tim Mullaney on Email
Tim Mullaney
If he’s not in the newsroom, Tim likes to be on the tennis court or traveling to a new destination. Recent highlights include Sri Lanka and Iceland.

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