PDGM’s Co-Morbidity Changes May Trigger Substantial Payment Bump

To fine-tune operations ahead of the Patient-Driven Groupings Model (PDGM) with the hopes of maximizing reimbursement, many home health providers have shifted their referral focus to institutional settings. But there are also substantial dollars tied to patients’ co-morbidities, an idea that has largely fallen by the wayside when it comes to PDGM preparation. “It’s somewhat […]

Encompass Health’s April Anthony: PDGM Is an ‘Overcorrection’ to Therapy

As currently structured, the Patient-Driven Groupings Model (PDGM) will completely change how and when home health providers deliver therapy services. It will do so in multiple ways, most notably by eliminating the use of therapy service thresholds as a factor in payment determinations. It’s a move the Medicare Payment Advisory Commission (MedPAC) has long recommended. […]

Home Health Clinicians Face PDGM Knowledge Gap

The vast majority of home health clinicians currently face a steep uphill climb when it comes to operationalizing the Patient-Driven Groupings Model (PDGM), with slightly less than eight months to go before the payment overhaul goes live, a new survey suggests. Among its changes, PDGM uses 30-day periods as a basis for payment, with each […]

House Lawmakers Move to Scrap PDGM’s Widely Opposed Behavioral Assumptions

The home health industry won a major victory in its battle to scrap widely opposed provisions of the Patient-Driven Groupings Model (PDGM) Wednesday, as a group of bipartisan House lawmakers introduced a new bill targeting the payment overhaul’s behavioral assumptions. Introduced by Reps. Terri Sewell (D-Ala.), Vern Buchanan (R-Fla.) and Ralph Abraham (R-La.) — along […]

Home Health Audits Expected to Spike in PDGM Aftermath

Home health providers from coast to coast are scrambling to prepare their operations ahead of the Patient-Driven Groupings Model (PDGM) — but what comes after the new model’s implementation could cause agencies an even bigger headache. In the months after PDGM goes into effect, home health audits — much like bankruptcies — are expected to […]

Why Home Health Agencies Should Gear Up for PDGM’s Wound Care Opportunity

Home health providers across the country are fine-tuning their back-office and clinical operations for the intricacies of the Patient-Driven Groupings Model (PDGM). Wound care, in particular, can’t be neglected. Currently, wound care is one of the most frequent clinical groupings and the one utilizing the most in terms of home health resources, according to statistics […]

Amedisys CEO Paul Kusserow: ‘I Don’t Believe PDGM Has Settled Yet’

Amedisys Inc. (Nasdaq: AMED) has long been a home health powerhouse. Under the leadership of CEO Paul Kusserow, however, the Baton Rouge, Louisiana-based provider is steadily building expansive hospice and personal care footprints as well. For proof, look no further than the industry-shaping Compassionate Care Hospice deal for $340 million. Part of Amedisys’s hospice-centric strategy […]

Humana Executives Get Candid About PDGM, Medicare Advantage

Top executives from Humana Inc. (NYSE: HUM) on Wednesday got candid about their home health operations and the expected impact of the Patient-Driven Groupings Model (PDGM). In addition to its long-standing Humana At Home business, the Louisville, Kentucky-based insurance company owns a 40% stake in Kindred at Home, one of the largest home health providers […]

Addus Exec: CMS’s Dual-Eligibles Move Encouraging for In-Home Care Providers

The Centers for Medicare & Medicaid Services (CMS) announced plans Wednesday to expand coverage options for Americans who qualify for both Medicare and Medicaid, giving states the freedom to develop their own programs for dual-eligible beneficiaries. While the directive doesn’t outline specific opportunities for home-based care providers, the move is still encouraging for the industry, […]