Industry Insiders: Too Early to Tell How Coronavirus Will Affect Admission Patterns, PDGM Reimbursement

During and after the COVID-19 public health emergency, U.S. home health providers will likely have to navigate sudden changes to both their patient volumes and admission sources.

When it comes to the latter, any drastic shifts in referrals and admissions could throw a huge wrench into the planning that went into Patient-Driven Groupings Model (PDGM) preparations. Under PDGM’s 432 case-mix groupings, reimbursement is typically higher when caring for patients discharged from institutional settings, including hospitals or skilled nursing facilities (SNFs), both COVID-19 hot spots.

“You certainly were trying to obtain those institutional referrals over community-based ones, mainly because they paid more,” J’non Griffin, owner and president of Home Health Solutions LLC, told Home Health Care News. “You could see the patient more and still be profitable.”


Carbon Hill, Alabama-based Home Health Solutions is a consulting company that works with post-acute care companies.

In theory, home health providers may soon see increases in institutional referrals due to coronavirus. So far, that hasn’t really played out, but some home health stakeholders describe early April as “the calm before the storm.”

In the present, institutional-sourced admissions have largely fallen, in part because most elective procedures, such as hip and knee replacements, have been postponed.


“People are just taking what they can get,” Griffin said.

For now, it’s difficult to tell whether the COVID-19 crisis will alter referral patterns on a long-term basis.

When looking at Q3 2019 data, 59.9% of home health referrals were from community sources, while 41.1% of referrals were from institutional sources, according to PlayMaker Health, a post-acute growth platform that serves hundreds of organizations.

Though home health saw more referrals from community sources for Q3 2019, the percentage of institutional sources had grown due to the implementation of PDGM, Holly Miller, chief revenue officer of PlayMaker, told HHCN.

“In Q3, what you are seeing is people being proactive in preparing for PDGM and starting to build out those alliances with [referral partners] who operate within institutional settings,” Miller said.

Over the past few weeks, home health providers have begun positioning themselves as the solution to decreasing the ever-growing burden on U.S. hospitals. Over-capacity issues remain a major concern.

Providers that have already formed these alliances ahead of PDGM’s launch may be first in line when it comes to receiving referrals from these institutions during the COVID-19 crisis, according to Miller.

“These agencies are really working closely with the institutional facilities to alleviate the burden by having patients who are less critical discharged to home health to make room for COVID-19 patients,” she said.

It’s tempting to assume that COVID-19 will automatically drive an increase in institutional referrals down the road, but this doesn’t tell the whole story, according to Griffin.

“We are seeing institutional referrals,” she said. “Providers are not getting a lot of community referrals when it comes to COVD-19, most patients that are COVID-19 positive are coming from the hospital. That said, there are a lot of community referrals that agencies are getting because the patient can’t go to the doctor’s office or outpatient therapy, because they may be immunocompromised.”

One question the COVID-19 pandemic raises: Would an uptick in institutional referrals change expectations for PDGM, a payment model that is supposed to be budget neutral?

That also may not necessarily be the case, according to Griffin.

“The uptick in community referral would still have a diluting effect,” she said. “Even if we get a surge of institutional referrals, I think it’s all going to even out from what I’ve seen.”

One thing that will certainly remain the same as before the pandemic is providers that want to attract referrals from institutional sources must have a strategy in place to accomplish as much.

“If [providers] want to go after those institutional referrals, they’ve got to have a plan in place,” Griffin said. “Just like they did before this.”

Companies featured in this article: