How Telehealth Can Solve Home Health Agencies’ PDGM Therapy Problems

One of the most anxiously awaited aspects of the Patient-Driven Groupings Model (PDGM) is the elimination of therapy visit volume as a determining factor in calculating reimbursements.

Despite reassurance from industry leaders that PDGM isn’t a ‘death knell’ for therapy services, therapy-heavy agencies will have to become more cost effective to ensure they don’t take a hit when the new payment model takes effect.

One currently underutilized solution agencies can explore is supplementing therapy services with telehealth and telemonitoring when appropriate, Ellen Strunk — president of Rehab Resources and Consulting Inc., which provides consulting, training and audit services to post‐acute care providers — told Home Health Care News.


“Today, a lot of agencies may not take advantage of [telehealth] because they look at a therapy visit as a revenue driver,” she said. “But under PDGM — where visits don’t drive revenue, it’s just the skilled service that matters — [telehealth] is not going to be a strictly plus or minus to the bottom line, but the potential for the positive is there.”

Used appropriately, telehealth can eliminate the need for certain therapy visits without negatively impacting patient care, Melinda Gaboury, co-founder and CEO of Healthcare Provider Solutions Inc., a consulting firm serving the home health and hospice industries, told attendees recently at the 2019 Illinois HomeCare & Hospice Council (IHHC) leadership conference in Itasca, Illinois.

“If the patient has gotten to the point that they can do their own home exercise program, what better way to make sure that’s happening than a therapist watching them via remote monitoring?” Gaboury said. “I’m not saying you’re going to replace therapy with remote monitoring. I’m saying it is a possibility of supplementing having a registered therapist in the house.”


Thanks to technological advancements, telemonitoring no longer requires the advanced equipment necessary when the technology was first introduced. In fact, many systems allow for remote monitoring to be done via cell phone or iPad.

In general, telemonitoring is a subcategory of telehealth, defined as the use of information technology to monitor patients remotely.

But still, there hasn’t been a push to use telemonitoring to drive down therapy visit volume in the past, Strunk said, because therapy visits have been tied to reimbursement.

In recent years, therapy visits have actually increased.

From 1997 to 2016, therapy visits jumped from making up 10% of all home health visits to 39%, according to MedPAC. Additionally, agencies prone to providing a higher number of therapy episodes are usually more profitable, the commission also found.

“For a lot of agencies — but not all — therapy serves as a revenue driver and can be a source of revenue by the number of visits provided,” Strunk said. “Certainly when a patient needs therapy, an agency knows they will get revenue in return.”

PDGM changes that, with goal being to de-incentivize agencies from over-providing therapy and encouraging them to focus on quality outcomes.

“Agencies that are really going to suffer as far as reimbursement is concerned in the new model versus today’s model are agencies that are averaging today more than 10 or more therapy visits per episode overall,” Gaboury said.

But that doesn’t mean impacted agencies should automatically cut visits. Instead, they should prioritize meeting patients’ needs, while looking at creative ways — such as telehealth — to reduce costs.

“You can’t be providing all these therapy visits up to Dec. 31 and then all of a sudden turn it off,” Gaboury said, noting that doing so could raise red flags about the legitimacy of a home health agency’s operations. “If you think you’re not going to be on a big red blinking additional documentation request (ADR) radar by then, you’re dead wrong.”

While telemonitoring is a useful therapy resource under PDGM, it doesn’t solve all of agencies’ reimbursement problems, Kenneth Miller, chair of the practice committee for the home health section of the American Physical Therapy Association, told HHCN.

“If the state’s practice acts allow it … many clinicians would benefit from having telehealth as a way to touch down with the patients to see they’re doing it between visits, certainly the people that are rural [and] less likely to get visits,” Miller said. “The issue is getting it reimbursed on the therapy side. There’s more talk of it within the nursing model and the medical model, less talk of tele-rehab. But that certainly is an area I think that should be explored.”

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