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|CMS has passed a new Patient-Driven Groupings Model (PDGM) that goes into effect beginning January 1, 2020.|
|Under PDGM, an episode of care is now 30 days, versus the previous 60-day episode. Additionally, the number of therapy visits no longer counts toward home health payment.|
|PDGM categorizes each episode of care based on five factors:1
|These changes lead to several new payment categories, each with its own Low Utilization Payment Adjustment (LUPA) and a minimum threshold of two visits per category.1|
|PDGM also incentivizes innovation via remote patient monitoring (RPM). With RPM, the patient and/or caregiver digitally stores and/or transmits physiological data (i.e., blood pressure, glucose monitoring) to the HHA.1|
|This is the biggest change to Medicare Home Health in 20 years.2|
Home health agencies and home healthcare providers
January 1, 2020
PDGM goes into effect
The Patient-Driven Groupings Model is part of the continued effort to move from volume-based payment models to value-based payment models, and to help ultimately reduce the cost of healthcare.
Talk to your McKesson Medical-Surgical Account Manager about these resources to help you prepare for PDGM.
Clinician trunk bin program | Clinician trunk bins put the essentials right in your clinical staff’s trunk for late or weekend admits, which means no turning patients away.
Formulary management | Control what products you’re ordering and when you’re ordering them. Our formulary management tool helps your agency stay compliant and on budget.
McKesson Patient Care Solutions | The supplies patients need, with none of the hassle. MPCS bills the insurance payer automatically for seamless processing.
Homecare Homebase | Features like automatic routing to insurance payers and smart search capabilities help keep you focused on patients, not paperwork.
Be advised that information contained herein is intended to serve as a useful reference for informational purposes only and is not complete clinical information. This information is intended for use only by competent healthcare professionals exercising judgment in providing care. McKesson cannot be held responsible for the continued currency of or for any errors or omissions in the information.