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 […]

Encompass Health’s April Anthony: Unified PAC Payment Model ‘Could Happen Before PDGM Even Settles’

For home health providers and their policy advocates on Capitol Hill, the Patient-Driven Groupings Model (PDGM) is priority No. 1, 2 and 3. Lurking in the background, though, is possibly an even bigger, more drastic reimbursement overhaul — a unified payment system for the entire post-acute care landscape. Currently, post-acute care (PAC) providers include skilled […]

Schakowsky, Home Health Execs Tout Physician-Certification Bill’s Bottom-Line Impact

A bipartisan group of U.S. lawmakers has begun planting the seeds to eliminate Medicare’s physician-certification policy — which many home health industry insiders have critiqued as outdated. If successful, the move could potentially make it easier for older adults to gain access to home health care and have a major impact on providers’ bottom line. […]

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 […]

LHC Group CEO: MedPAC ‘Off on Some Island’

In its latest report to Congress, the Medicare Payment Advisory Commission (MedPAC) recommended cutting the home health reimbursement rate by 5% in 2020 while continuing its push for a unified, site-neutral payment system for all post-acute care providers. Those recommendations are short-sighted and fail to recognize the value that home health care providers have created […]

Refinement Bills Are Chance to ‘Get PDGM Right,’ Avoid Industry Destablization

Joanne E. Cunningham took over as The Partnership for Quality Home Healthcare’s executive director in August 2018. Since then, much of her focus has been spent educating policymakers on the Patient-Driven Groupings Model (PDGM) and its potentially industry-shaping impact. So far, those advocacy returns have been promising, recently contributing to PDGM-refinement legislation in the U.S. […]

Senate Lawmakers Introduce New Legislation Urging Evidence-Based PDGM Changes

Newly introduced bipartisan legislation in the U.S. Senate is targeting the widely opposed behavioral adjustments set to hit home health agencies next year under the Patient-Driven Groupings Model (PDGM). If passed, the legislation would require the Centers for Medicare & Medicaid Services (CMS) to base Medicare reimbursement rates on observed evidence and data, instead of […]