Nurse with senior

November 18, 2019


The Patient-Driven Groupings Model is coming January 2020, bringing major changes to the home health industry. Here is some basic information to help you understand PDGM and how it will impact your home health partner.

The patient benefits

Just as the name says, the Patient-Driven Groupings Model puts the patient at the center of the care plan by:

  • Aligning with patient needs
  • Using patient characteristics (including diagnosis and functional impairment) to determine payment
  • Increased access to home health for vulnerable patients associated with lower margins

What’s changing

PDGM replaces the home health Prospective Payment System. Here are a few of the major changes with the new model.

Home Health (HH) PPS PDGM
Clinical score (low, medium, high) Assigned to one of six clinical groups
Functional scores Combine OASIS responses (low, medium, and high)
153 payment HHRGs 216 payment HHRGs
NRS Non-routine supply utilization cost already determined in CMW
LUPA LUPA thresholds will vary dependent upon assigned payment group

Let’s use our relationships within the Avamere Family of Companies to provide a continuum of care to meet our patients wherever they are in their care journey. Together, we can embrace PDGM.

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