Home Health & Hospice Week

The Patient Driven Groupings Model is unfairly pushing the Medicare home health benefit to be more and more short term, says a beneficiary advocacy organization.

PDGM includes a “sharp payment decline to agencies after 30 days of home health care,” the Center for Medicare Advocacy says on its website. “After the first 60 days of home health care, payments decline even further.”

The drop-off is worst for the Medication, Management, Teaching and Assessment — Surgical Aftercare clinical group, under which PDGM payment decreases 40 percent from the first 30-day period to the second, CMA shows.

The “discriminatory” new payment model, aggressive audits, quality measure structure, and more “cumulatively limit Medicare home health care to only a short-term, post-acute care benefit,” the group charges. “Beneficiaries who legally qualify for longer-term coverage are unable to find agencies to provide services.”

“PDGM is a significant factor in reducing, and often eliminating, access to ongoing home health care for beneficiaries with longer-term and chronic conditions” like diabetes, stroke, paralysis, multiple sclerosis, Parkinson’s, ALS, heart disease, pulmonary disorders and more, CMA maintains. “CMS should develop payments, policies and practices that support home health care for all individuals who qualify for coverage under the law,” the group urges.

More data and the group’s call to get in contact about premature discharges or inabilities in obtaining home health services are at https://medicareadvocacy.org/cma-alert-march-4-2021.