Why Home Health Therapy Contractor Aegis Isn’t Stressing About PDGM

Among its many changes, the Patient-Driven Groupings Model (PDGM) aims to completely refocus how home health providers are paid for the therapy services they deliver, mainly by moving away from visit volume as the determining factor in calculating reimbursement. When the Centers for Medicare & Medicaid Services (CMS) first proposed PDGM in July 2018, some […]

CMS: No ‘Secret List’ of Troubled Home Health Agencies

Earlier this week, a bipartisan pair of U.S. senators released a “secret list” of nursing homes under consideration for placement on the federal government’s roster of properties with serious quality issues. Maintained by the Centers for Medicare & Medicaid Services (CMS), the list features more than 400 nursing homes that are “candidates” for the Special […]

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. […]

Current Health CEO: Readmissions, PDGM to Drive Expansion of Remote Patient Monitoring Tech

Current Health — makers of an artificial intelligence-powered wearable remote patient monitoring platform — cleared a major regulatory hurdle last month in securing FDA approval. The U.K.-based technology startup now has its sights set on expanding throughout the U.S. market, largely by helping home health agencies adapt to the Patient-Driven Groupings Model (PDGM) and by […]

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 […]

Home Health Industry Reacts to CMS Value-Based Primary Care Initiative

Health care policymakers on Monday unveiled a new voluntary risk-based initiative designed to reward physicians who keep patients at home and away from hospitals. Based upon the work of previous administrations, the new initiative marks a major inflection point for the value-based transformation of the U.S. health care system, according to Department of Health and […]

CMS: 80% of Home Health Agencies May Have Negative Margins by 2040

Medicare’s Hospital Insurance Trust Fund — which helps pay for Medicare Part A services, including in-patient hospital, skilled nursing facility, hospice and home health care services — is set to go broke by 2026, Trump administration officials reported Monday. What’s more, if current utilization and financial projections prove accurate, the vast majority of home health […]

What Anthem Wants from Its Medicare Advantage Home Care Partners

Geographic alignment and outside-of-the-box thinking are among the qualities Anthem Inc. (NYSE: ANTM) values from its prospective home care partners in Medicare Advantage (MA) plans. An ability to demonstrate the value of in-home care services through data and evidence is also important, Martin Esquivel, vice president of Medicare product development for Indianapolis-based Anthem, told Home […]