Why Home Health Agencies Should Gear Up for PDGM’s Wound Care Opportunity

Home health providers across the country are fine-tuning their back-office and clinical operations for the intricacies of the Patient-Driven Groupings Model (PDGM). Wound care, in particular, can’t be neglected.

Currently, wound care is one of the most frequent clinical groupings and the one utilizing the most in terms of home health resources, according to statistics from wound care management technology company Swift Medical. The average associated reimbursement with the clinical grouping: $2,090.82.

Due to patient characteristics and the way PDGM is structured, wound care is projected to become even more important come Jan. 1, 2020, industry experts say.


“The biggest steps that people are going through right now are understanding revenue cycle and operational processes — and how PDGM is going to impact them,” Don Spiers, post-acute and long-term care product manager for Relias, told Home Health Care News. “What we’re looking at is potentially more people providing care that is tied to wound care, which will be one of the highest areas of reimbursement under PDGM. Providers are looking for patients and opportunities to expand their scope of practice in that area.”

Morrisville, North Carolina-based Relias is an analytics, assessments and education firm that serves providers across the continuum of care.

In general, wound care will become an essential service because wound care patients are often discharged to home health agencies from institutional settings with higher levels of co-morbidities — traits that lead to bigger payouts under PDGM.


PDGM has 432 possible Home Health Resource Groups (HHRGs), reached via five main categories related to admissions source, timing, clinical groupings, functional impairment and co-morbidities.

Patients who come from an instuitional setting — an in-patient hospital, skilled nursing facility (SNF), in-patient-rehabilitation facility (IRF), long-term care hospital (LTCH) or in-patient psychiatric facility (IPF) — will have an average reimbursement level that’s up to $551 more than those from the community.

“What you may start seeing is [home health] providers looking to partner with SNFs more,” Spiers said. “Getting people moving out of the hospital, out of skilled nursing facilities — but doing that a little quicker.”

In some instances, reimbursement tied to the wound clinical grouping is projected to be 24.8% higher than under the existing Prospective Payment System (PPS), according to a data analysis conducted by BlackTree Healthcare Consulting.

To prepare for the wound care opportunity, home health providers should begin training staff and making sure the proper specializations are in place, Jan Wilson, director of learning design and outcomes for Relias, told HHCN.

“On the change management front, there’s the operational side and then there’s the human side,” Wilson said. “Certifications will definitely become more important — like the wound care certification.”

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