The Finalized Medicare Home Health Payment Model

The CMS has finalized the new Home Health Payment Model, which already has people up in arms about the massive budget cuts that may soon be affecting American seniors.
Edward Neeman
Published on
November 28, 2018
Updated on
January 22, 2024

For Medicare beneficiaries, having access to high-quality healthcare is a necessity, which is why the federal senior health insurance program is so important. Not only does Medicare cover important medical costs and services, but it even offers a convenience factor with home healthcare. However, as the CMS just finalized their new Patient-Driven Groupings Model, many are screaming that Medicare is under attack. Here’s what you should know.

What Is PDGM And How Does It Affect Individuals

PDGM, otherwise known as the Patient-Driven Groupings Model, is the latest introduction of Medicare changes that could affect the Medicare recipients the most. This program reduces the amount of funding that facilities, home health care agencies, and companies utilize in order to provide services to their customers. The concept behind this change is to determine funding for companies and agencies based upon pre-disposed suggestions of a company’s billing practices per client rather than key facts and factors of the companies clients.

This finalized Medicare home health payment model will contain a drastic cut in money in certain areas where home health companies and agencies provide in-home services for individuals on Medicare who are elderly or may have other kinds of conditions that Medicare covers. The argument that home health workers in companies are presenting is that with the PDGM changes in the budget, that could average out to be at least $1 billion from the healthcare market industry. That kind of dramatic reduction in budget cuts will cause the companies to have a major deficit in services being rendered to those that are on Medicare and are receiving care within their homes.

Patient-Driven Groupings Model is simply a plan devised by the government to reduce funding for facilities, companies, and agencies that cover Medicare services that are being offered to individuals. The idea behind this policy is to make payments based upon behavioral changes within the companies. It will also reduce reimbursement rates, and traditional 2-month billing cycles will be cut down to 1-month for the same amount of services rendered.

The Patient-Driven Groupings Model will also force facilities and agencies to work more with hospitals rather than doctors offices. This is because this plan also includes a clumping factor, meaning individuals may be grouped together in groups and therefore have a required set of treatment. However, this clumping of individuals into groups does not take into account what the underlying symptoms are that may be causing the outward problems, and therefore they would need a different type of service.

Additionally, placing individuals into groups means that facilities and agencies will receive a set amount of payment for the group and nothing more. With that being said, a lot of customers will lose that one on one preventive care because of being grouped together. Patients will not be able to receive care specifically designed for them which is going to be a problem because the overall group assessment may not be what they necessarily need.

The finalized Medicare home health payment model is different from the Patient-Driven Groupings Model. Both models were designed to streamline the funding and services for Medicare recipients but they do not have the same desired effects and outcomes.

The finalized Medicare home health payment model is designed to give increases of funding for companies, healthcare facilities and agencies that provide home healthcare services. It also going to utilize data-driven information about clients in hopes of having Medicare clients to continue receiving services without any interruptions.

The overall concept of the finalized Medicare home health payment model is completely opposite of the Patient-Driven Groupings Model. The only problem that yet remains is the fact that the finalized Medicare home health payment model still not 100% established. This model is still being adjusted and is not expected to be in effect until 2020.

The discussion about the previous Medicare changes has been going on for quite some time. Although Medicare laws, rules and regulations can be confusing the adjustments or proposals that are supposed to be for the better of services and Medicare recipients must be reviewed from time to time.

As our world continues to evolve and change so must the laws and policies of all that we do and are governed by. Hopefully, a Medicare plan can be devised that will be beneficial for the company, facilities, and agencies as well as the Medicare recipients who receive and rely on its services.

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