Home Health & Hospice Week

Number of high-comorbidity pairing groups more than doubles next year.

If you thought Medicare would leave PDGM case-mix categories alone because it did so last year, think again.

Medicare’s newly released home health payment proposed rule for 2022 “includes massive changes, primarily to rates,” stresses Melinda Gaboury with Healthcare Provider Solutions in Nashville in online analysis of the rule.

The Patient-Driven Groupings Model has 432 case-mix categories, the Centers for Medicare & Medicaid Services notes in a fact sheet about the proposed rule. “CMS is proposing to recalibrate the case-mix weights, functional levels, and comorbidity adjustment subgroups using CY 2020 data to more accurately pay for the types of patients HHAs are serving,” the fact sheet says.

“Determinants will change for both comorbidity adjustments and patient functional impairment levels,” notes Simione Healthcare Consultants in online analysis of the proposed rule. “The proposed rule indicates changes to the comorbidity subgroups that result in low comorbidity adjustments (both removals and additions), and there have also been modifications to the comorbidity subgroup pairings that result in high comorbidity adjustments (the number of pairings will more than double for 2022),” Simione details.

Specifically: “For comorbidity adjustments, the number of low comorbidity adjustments increases to 20 groups and [the rule] more than doubles the number of high interaction pairs to 85,” says advisory firm McBee in online analysis of the rule.

This expansion is “the most surprising thing to me,” shares consultant J’non Griffin, owner of Home Health Solutions in Carbon Hill, Alabama.

“Recalibration of 432 case mix weights adds some additional complexity to the one-year-old PDGM model,” judges consultant Angela Huff with BKD in Springfield, Missouri. “Agencies are still learning and evaluating data in a year that was also colored with the impactful pandemic that made it more challenging to understand and adjust to PDGM,” Huff assesses.

What to expect: “Changing case mix weights across the board will create another learning curve, although not as steep, that will require additional evaluation and monitoring in organizations,” Huff predicts.

Note: Links to the new case-mix weights and new comorbidity adjustment lists are at www.cms.gov/Center/Provider-Type/Home-Health-Agency-HHA-Center.