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- Title
Home Health Agencies: Empirical Evidence on the Patient-Driven Groupings Model's Expected Effects on Agency Reimbursements.
- Authors
Plummer, Elizabeth; Wempe, William F.
- Abstract
Beginning January 1, 2020, Medicare's Patient-Driven Groupings Model (PDGM) eliminated therapy as a direct determinant of Home Health Agencies' (HHAs') reimbursements. Instead, PDGM advances Medicare's shift toward value-based payment models by directly linking HHAs' reimbursements to patients' medical conditions. We use 3 publicly-available datasets and ordered logistic regression to examine the associations between HHAs' pre-PDGM provision of therapy and their other agency, patient, and quality characteristics. Our study therefore provides evidence on PDGM's likely effects on HHA reimbursements assuming current patient populations and service levels do not change. We find that PDGM will likely increase payments to rural and facility-based HHAs, as well as HHAs serving greater proportions of non-white, dual-eligible, and seriously ill patients. Payments will also increase for HHAs scoring higher on quality surveys, but decrease for HHAs with higher outcome and process quality scores. We also use ordinary least squares regression to examine residual variation in HHAs' expected reimbursement changes under PDGM, after accounting for any expected changes related to their pre-PDGM levels of therapy provision. We find that larger and rural HHAs will likely experience residual payment increases under PDGM, as will HHAs with greater numbers of seriously ill, younger, and non-white patients. HHAs with higher process quality, but lower outcome quality, will similarly benefit from PDGM. Understanding how PDGM affects HHAs is crucial as policymakers seek ways to increase equitable access to safe and affordable non-facility-provided healthcare that provides appropriate levels of therapy, nursing, and other care.
- Subjects
STATISTICS; PROPRIETARY health facilities; HEALTH services accessibility; CENSUS; NONPROFIT organizations; HOME care services; RURAL conditions; CRITICALLY ill; PATIENTS; COST control; HEALTH insurance reimbursement; CENTERS for Medicare &; Medicaid Services (U.S.); VALUE-based healthcare; DATABASE management; QUALITY assurance; DESCRIPTIVE statistics; PROSPECTIVE payment systems; POLICY sciences; LOGISTIC regression analysis
- Publication
Home Health Care Management & Practice, 2021, Vol 33, Issue 3, p183
- ISSN
1084-8223
- Publication type
Article
- DOI
10.1177/1084822321990382