52% of Surveyed Home Health Agencies Say PDGM Is Forcing a Therapy Decrease

Over the past few months, there have been dozens of anecdotal examples of home health agencies cutting back on therapy, whether that’s in the form of layoffs, visit reductions or converting full-time therapists to PRN status. In these examples, the Patient-Driven Groupings Model (PDGM) and Medicare reimbursement changes are often cited as the trigger.

Home Health Care News and Kaiser Health News were among the first outlets to highlight the shifting therapy strategies. Over the past week, Forbes and The Washington Post both entered the discussion as well.

For now, though, the true extent of PDGM’s impact on therapy services within home health care remains largely unknown. The anecdotal examples continue to roll into HHCN’s inbox — and therapy professionals continue to voice their concerns on Facebook, Twitter and even Reddit.


Findings from a recent survey conducted by HHCN in collaboration with Homecare Homebase begin to paint a clearer picture. The survey — compiled from December 2019 through January 2020 — includes responses from more than 500 professionals working in or alongside the in-home care space.

Of the providers who completed the survey, 52% said they saw PDGM forcing a decrease in therapy utilization.

Specifically, when asked how they expected PDGM to impact therapy utilization at their agency, 38% of respondents said they anticipated therapy utilization to decrease by more than 10% compared to historic baselines. Another 14% said they expected utilization to drop by less than 10%.


On the flipside, 5% of providers surveyed said they expected therapy utilization to increase at their agency under PDGM. Additionally, 14% said they expected it to remain the same.

Overall, 28% of surveyed providers said they still weren’t sure how their agency would ultimately handle the delivery of home health therapy services under PDGM.

The American Occupational Therapy Association (AOTA) and the American Physical Therapy Association (APTA) have both launched surveys of their own, with AOTA already receiving nearly 530 responses as of Feb. 3. So far, the AOTA survey has found that roughly one-third of respondents reported being laid off or seeing their hours reduced in some capacity.

“The majority of responses that we’re getting from occupational therapy practitioners is that their home health agencies are reducing the number of OT visits, and that those reductions appear to be mandated by the agencies,” Sharmila Sandhu, AOTA’s vice president of regulatory affairs, previously told HHCN. “Some of the responses are extremely concerning. For example, some have said their home health agency is not fulfilling physician orders to OT [services].”

Generally, the recent surveys reflect a similar one that the National Association for Home Care & Hospice (NAHC) released in June 2019.

Additional findings from the HHCN and Homecare Homebase survey are available here. HHCN plans to conduct a separate follow-up survey focused on therapy changes in coming months.