Complete Story
07/02/2019
NAHC’s PDGM Workgroup Submits Recommendations to CMS
The Patient Driven Grouping Model (PDGM) Workgroup, convened by the National Association for Home Care & Hospice (NAHC), sent a letter to the Centers for Medicare & Medicaid Services (CMS) to address concerns with the diagnoses selection and assignment used to implement the PDGM for home health agencies.
The PDGM is a new home health prospective payment model CMS developed that goes into effect January 1, 2020. In the PDGM, the primary diagnosis and co-morbidity diagnoses are the sole determinants for the clinical and co-morbidity groupings that contribute to the model’s case mix. Therefore, it is critical that the diagnoses used in the model are appropriate for home health services and assigned into the correct diagnosis groups.
The workgroup reviewed the top 200 diagnoses used on home health claims to ensure the diagnosis group assigned to each diagnosis accurately reflected the patient’s clinical condition.
The work group recommended that several of the diagnoses be assigned into different diagnosis groups, along with recommendations to include in the PDGM several diagnoses that are currently not part of the model.
CMS officials who expressed appreciation for the work the group had done and to ensure that the recommendations will be reviewed for consideration.
For questions on PDGM, please contact Anne Shelley at ashelley@leadingageohio.org.