Therapy’s Future Under Patient-Driven Groupings Model Unclear Due to COVID-19 Chaos

The Patient-Driven Groupings Model (PDGM) was described as home health care’s “boogeyman” before it was implemented.

One of the chief concerns, especially for therapists, was that therapy utilization would significantly decrease in 2020 — and beyond — because of what PDGM incentivizes. 

But preliminary data suggests that therapy did not decrease overall in 2020. It’s not that those who predicted a dramatic decrease in therapy were wrong, however. Instead, the answer is more nuanced. For a variety of reasons, therapy increased in some places — and decreased in others.


From January to October, in fact, the percentage of therapy visits compared to overall visits actually increased, from 45.9% to 46.8%, according to data from BlackTree Healthcare Consulting. Therapy visits per episode also increased slightly. 

“From my perspective, I think there [are] just so many variables that have figured into therapy utilization during the pandemic,” Mission Healthcare CEO Paul VerHoeve told Home Health Care News last week during HHCN’s PDGM Summit. 

San Diego-based Mission Healthcare is a home health and hospice services provider with 600 employees who serve 10 locations across Southern California.


Mission Healthcare’s therapy utilization decreased, but VerHoeve said he believed that to be more due to COVID-19 than PDGM.

“COVID hit, and we pretty quickly found that missed visits and canceled visits were happening quite significantly,” VerHoeve said, noting that many patients considered therapy visits non-critical and chose to forgo them. “The other piece of this too was that facilities went into lockdown. So when you think about the assisted living environment, where a lot of therapy tends to be driven from, there just wasn’t as much access or patient referrals coming out of that particular arena. Then you throw in less elective surgeries on top of that.”

Still, VerHoeve acknowledged that the therapy decline — even if it was mostly tied to COVID-19 — helped Mission Healthcare align its services with the new payment model.

“That aligned us with where PDGM was pushing,” VerHoeve said. “They wanted us to do better chronic care management and deal with higher levels of acuity. And we absolutely saw that in great abundance.”

Until there’s a wider range of data, it’ll be hard to determine COVID-19’s true effect on the first year of PDGM.

And even a bevy of data analyses may not be enough.

“I’m not really sure we’re ever going to have clean data to be able to figure out what the direct effect of PDGM on therapy utilization was,” Cindy Krafft, the owner and founder of Kornetti & Krafft Health Care Solutions, said during an HHCN webinar in January.

The results have been different for every agency. Whereas Mission Healthcare saw COVID-19 decrease its therapy utilization, for instance, Dearborn, Michigan-based American Advantage Home Care saw the opposite.

“Maintenance therapy has become a greater trend for us,” American Advantage Home Care CEO Cleamon Moorer Jr. said at the PDGM Virtual Summit. “We’ve seen that with patients who were on ventilators, and even the patients who were homebound on ventilators, and family and doctors getting the loved ones off of it. So we’ve seen a big increase in respiratory therapy, as well as speech. So we’ve still seen an uptick.”

American Advantage Home Care provides skilled nursing, rehab and specialty care services to nearly a dozen Michigan counties.

Until the industry has a greater swath of non-COVID-19 utilization data, it’ll be hard to tell what the future looks like for therapy under PDGM.

But curious providers shouldn’t hold their breath.

“This could just be COVID-driven, right?” Visiting Nurse Service of New York (VNSNY) CEO Dan Savitt said during the PDGM Virtual Summit. “And the question will be: Will it bounce back? And we won’t know till mid- to late-2021.”

Founded in 1893, VNSNY is the largest not-for-profit home- and community-based health care organization in the United States.

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