Home Health Articles and Information


Jun 1, 2019 3:36:00 PM / by Kristi Bajer, BSN, RN, COS-C

Preparing to Manage Therapy Under PDGM Starts Now

When Diagnosis Related Groups (DRGs) started in hospitals in the late 80s it was a huge adjustment for acute care providers.  The group hardest hit may have been the physicians managing patient care.

Before DRGs, physicians determined the patient’s length of stay in the hospital and the facility was reimbursed accordingly.  After DRGs the patients admitting diagnosis determined payment and physicians had to learn how to practice within the payment model.

Under the Patient Driven Groupings Model (PDGM) we are going to see something similar, but for home health it’s the physical and occupational therapists who will have to learn how to practice within the payment model.

Consider the following to prepare your agency for this change;

  • Determine your agency’s therapy utilization compared with the rest of the nation by pulling your “agency patient related characteristics report”- aim to be at or below the national average
  • Pull a FIT report…how many patients are receiving therapy from your agency with only a functional 1 score under PPS? There will very little therapy money in your HHRG for these patients in PDGM
  • Start having meaningful conversations with therapists now about how the change in reimbursement might affect therapy utilization management under PDGM

Remember, home health will continue to provide therapy in PDGM.  Since the additional therapy payment will be gone, accurate OASIS documentation will be more important than ever to provide the revenue needed to care for your patient needs.

Tags: PDGM, Therapy, Home Health

Kristi Bajer, BSN, RN, COS-C

Written by Kristi Bajer, BSN, RN, COS-C

Kristi Bajer BSN, RN, COS-C, brings over 10 years of real world experience as a clinician, director, and administrator in home health. She is a firm believer in diagnosis driven evidence-based care in home health. Currently, she assists agencies with external chart audits and Medicare appeals, as well as providing training and coaching on OperaCare implementation and building QAPI programs using data to drive success and protect agencies from government audits.