Patient-Driven Groupings Model (PDGM), is essentially a billing model for Home Health Agencies (HHAs) who work with patients through Medicare or Medicaid. The main goal of PDGM in 2020 is to move away from a quantity, or volume focused billing model and shift towards one that’s based on quality, or value, for patients. Essentially, the shift to PDGM should ultimately lead to reduced the overall cost of home health care delivery. At least, that’s what they hope will happen.
The primary way CMS is hoping to accomplish this more patient-driven model is by no longer determining home health payments through the total number of therapy visits. Under the previous model, HHAs were often able to game the reimbursement system by over-visiting patients (and over-charging them). Now, patient visits are designed to be handled in a budget-neutral manner.