Travel Therapy: PDGM

Beginning on January 1st, 2020, the new Home Healthcare Patient-Driven Groupings Model (PDGM) will be going into effect. Many travel therapists are interested in learning not only the changes that will be going into action, but also how this will change the market. With the Patient-Driven Payment Model (PDPM) shaking up the market in recent months, it’s fair for travelers to want to learn how this may impact their careers.

What is the PDGM?

The Patient-Driven Groupings Model is a revamped version of the Home Health Groupings Model that was first introduced in 2017, and then discontinued. This will be taking the volume out of the equation when determining home health agency payments. It is described by the CMS as a way to shift payment to be more based on value. This is hoping to decrease the cost of home health delivery.  It will be focusing on patient-needs.

This is expected to impact how agencies treat referrals as well as develop plans when it comes to patient care. The exact impact will be determined by home health agency size and design.

What will change

Timing: The most significant change in the PDGM is the change of the unit of payment episodes. The unit of payment episodes will be changing from 60-day to now 30-day. This was enacted due to the fact that 28% of patients were out of service in 30 days or less. This means for agencies that they will be planning, documenting, and billing for care twice as often.

Volume Requirements: With billing being every 30 days under PDGM, this means that the Request for Anticipated Payment and final claim will happen in a much shorter time span. However, the 60 day certification period will be remaining the same as well as the Outcome and Assessment Data Set. When it comes to volume, this will no longer be a factor for payments in HHA’s. This is placed to remove financial incentive to over-provide therapy services and focus more on the value.

Admission Classification: Each 30 day period will be either a community admission or an institutional admission. If a patient has had an acute care stay or post-acute care stay within a nursing home in the past 14 days, it they will be classified as an institutional admission. If the patient has had no acute or post-acute stay within the past 14 days, they will be a community admission. Almost all second and subsequent 30-day periods will be a community admission.

When it comes to timing, the 30-day period will be classified as ‘early’ and the subsequent 30 will be classified as ‘late.’ However, if there was a gap of 60 days between 30-day periods, the subsequent 30 days will be classified as ‘early.’

There will now be 12 clinical groupings for classification which are designed to capture the most common types of care in home health. When it comes to LUPA, a four-visit threshold will now be the minimum. Agencies can expect up to 20 visits over 60 days for some HHRGS.

How this will impact the market

Much like the PDPM, it’s tough to determine early-on how this will impact the travel therapy market. Some facilities may take this as an opportunity to limit travel therapists, while others may continue as business as usual for contract employees. Be sure to stay in contact with your recruiters in order to stay up-to-date on the Home Health market changes.

How to prepare

As expressed during the PDPM changes, it is always best to be flexible if travel is passion of yours. Be sure to gain experience in other settings to improve your marketability to facilities. Also if home health is your ‘bread and butter’, becoming flexible on location for that next assignment will increase your chances of finding the position you are looking for. For those therapists just entering the travel world, both flexibility and experience are key in your career.

Brady Garza is a Social Media Recruiter for the Therapy division at Aureus Medical Group.

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