Home Health Providers: Beware of CMS’s PDGM Pendulum Swing

Home health providers looking to bet the farm that the Patient-Driven Groupings Model (PDGM) goes through in its current form should be warry, industry executives say. Although it’s important to adjust to the upcoming payment overhaul, the Centers for Medicare & Medicaid Services (CMS) has a history of changing its tune after regulatory actions trigger […]

Home Health Providers Skimping on Therapy Will Likely Pay Steep Price

As the Patient-Driven Groupings Model (PDGM) nears, providers are still trying to figure out how they will navigate 2020’s uncharted territory. For many, there’s a temptation to gain ground by sharply cutting therapy utilization. But that will likely hinder quality of care and cause some providers to pay a steep price. “The minute we saw […]

Trump Impeachment Investigation Stealing Spotlight From Home Health Industry’s PDGM Efforts

At first glance, it might be hard to spot a connection between the impeachment activity swirling around President Donald Trump and the home health industry. A deep dive into the current Washington, D.C.-landscape and national priorities, however, suggests the two are inevitably linked. With all eyes and ears tuned into impeachment talks on Capitol Hill, […]

Home Health Value-Based Purchasing Model Likely Headed to the Scrap Yard

The Home Health Value-Based Purchasing Model (HHVBPM) is likely headed for the scrap yard in the not-too-distant future. Implemented in 2016, HHVBPM was generally designed to pay home health providers in nine states based on outcomes and the value of services delivered. While many thought HHVBPM was fated for expansion, the initiative appears to be […]

NAHC’s Dombi: We’re Not Going To Be Bullied By Congress, CMS

There’s a flood of changes surging toward the U.S. home health care industry. But thanks to widespread recognition, improved quality and staunch advocacy efforts, providers have never been standing on higher ground. That was the key message delivered by the National Association for Home Care & Hospice (NAHC) leadership Sunday during the Washington, D.C.-based nonprofit […]

PDGM 101: Advice for Small-Scale Home Health Agencies

The Patient-Driven Groupings Model (PDGM) is less than three full months away. Among its biggest changes, PDGM halves the traditional 60-day billing period to 30 days and places greater emphasis on coding with a new 432-point case-mix mechanism. If those two changes weren’t enough, the overhaul also comes with a potential 8% behavioral adjustment cut […]

PDGM’s Lead Author Gets Candid About Pros, Cons of Revolutionary Model

Set to take effect on Jan. 1, the Patient-Driven Groupings Model (PDGM) is as controversial as it is revolutionary. The model’s therapy changes and behavioral assumptions are two reasons why. Home health operators worry their operations and patients will suffer as a result of those modifications, among others. Even PDGM’s lead author, Lisa Grabert, acknowledges […]

Bayada, Health Systems Back CMS’s Discharge Planning ‘Paradigm Shift’

In September, the Centers for Medicare & Medicaid Services (CMS) unveiled a new final rule regarding discharge planning requirements for hospitals and home health providers. The new rule, industry leaders say, will likely create a much needed paradigm shift in the discharge planning process. CMS’s discharge planning rule includes a number of changes that aim […]

New Trump Order Seeks Rate Equality Between Advantage Plans, Fee-for-Service Medicare

President Donald Trump signed a new executive order Thursday designed to bolster and expand Medicare Advantage (MA), the private Medicare insurance program for seniors that currently covers roughly 22 million individuals. While the executive order is relatively wide-ranging in scope, one major detail should immediately win the attention of home health providers. In the order, […]

CMS Pauses RCD in Two States Ahead of PDGM — But Moves Ahead in Texas

Good news for home health providers in North Carolina and Florida: The Centers for Medicare & Medicaid Services (CMS) will delay the implementation of Review Choice Demonstration (RCD) so agencies can adapt to the upcoming Patient-Driven Groupings Model (PDGM) first. Providers in Texas, however, won’t be as lucky. CMS announced Wednesday it is moving forward […]