Healthcare Landscape

Changes to Home Health

As Paragon prepares for the Patient-Driven Payment Model (PDPM) changes, we’re also getting ready for another change within our industry. On January 1, 2020, the Patient-Driven Groupings Model (PDGM) will be the new payment model for the Home Health Perspective Payment System.  As part of the Bipartisan Budget Act of 2018, home health periods of care will move to 30-day periods versus 60-day periods. Payment will not include number of therapy visits as a driving factor, and will be structured around over 200 case-mix groups. The 30-day periods will be classified according to a combination of five major factors to determine the Home Health Resource Group (HHRG):

Admission Timing

  • Only the first 30-day episode would qualify as early with all other subsequent episodes qualifying as late.

Admission Source

  • The 30-day period would be classified as institutional if the patient had an acute or post-acute stay within 14 days of the start of care with all other referrals classified as community.

Clinical Grouping

  • Depending on principal diagnosis, patients will be assigned to one of 12 clinical groups.

Functional Impairment Level

  • Relies on the OASIS codes to designate a patient’s level into either: low impairment, medium impairment, or high impairment.

Comorbidity Adjustment

  • Based on the presence of secondary diagnosis may receive either: no adjustment, low adjustment, or high adjustment. 

Paragon’s therapy programming in the home health setting will continue to emphasize the value of Physical, Occupational and Speech Therapy services with a focus on improving function, fall prevention, and reducing the risk of re-hospitalization to support our customers through this time of change. For more information, visit this link. 

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