Nonprofit, Health System-Based Agencies Likeliest to Weather PDGM’s Therapy Storm

A huge portion of existing home health agencies will have to rethink how they delivery therapy services in 2020 in response to the Patient-Driven Groupings Model (PDGM) and its sweeping changes. But nonprofit and health system-affiliated home health agencies appear well-positioned to weather the PDGM therapy storm.

That’s according to recent findings from a survey of more than 680 home health providers compiled by the National Association for Home Care & Hospice (NAHC), a Washington, D.C.-based advocacy organization.

“We do see the stability that I believe hospital- and instuitional-based providers feel that they have with their case-mix,” NAHC President William A. Dombi said during a Tuesday webinar highlighting the findings.


Overall, nearly half of the home health providers that participated in NAHC’s survey said they plan to decrease their levels of therapy utilization in 2020 because of PDGM, which eliminates the use of therapy thresholds and broadly shifts reimbursement more toward nursing.

Yet less than 36% of health system-based home health agencies plan to decrease therapy utilization in response to PDGM, according to the NAHC survey. Similarly, less than 30% of nonprofit agencies plan to make that move.

Also of note: nearly 40% of larger home health agencies — or those between $10 million and $20 million in revenues — plan to keep their levels of therapy utilization the same from this year to next.


“Agencies that are larger expect a little more stability,” Dombi said. “With their large size, they probably have a balance of patients in terms of their case-mix, so they’re able to buffer some of the reductions of payment for therapy-type patients under PDGM.”

Of the more than 680 providers that participated in NAHC’s therapy survey, more than 36% identified themselves as for-profit organizations, with about 40% falling under the nonprofit category. The bulk of respondents were free-standing home health agencies, with more than one-quarter affiliated with health systems.

Separately from therapy utilization, about 28% of all home health agencies that participated in the survey said they planned to decrease their employed therapy staff in 2020. That figure was also substantially lower for nonprofit and health system-based home health agencies.

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