Change Is Coming to Medicare Home Health. Should I Be Worried?

A new Medicare home health payment system that takes effect Jan. 1, 2020, reimburses for care based on patient characteristics, rather than on the number of therapy minutes the patient needs. The new system, known as the Patient-Driven Grouping Model (PDGM), will likely affect the amount of speech-language treatment a beneficiary receives. It will also lead to changes in the ways speech-language pathologists demonstrate their value in this setting, their roles and responsibilities, and, in some cases, staffing levels. PDGM payment is based on: Source of admission (community or institutional). Lower payment for the second 30 days of a 60-day episode. The patient’s assigned clinical category, based on primary diagnosis. Only two of the 12 categories—musculoskeletal and neuro rehabilitation—specifically drive payment for therapy services. Comorbidities Patient’s level of function (low, medium, or high). Under the previous reimbursement system, the volume of services—such as speech-language treatment—triggered a separate payment. Under the new system, Medicare continues to expect that patients will still receive all the medically necessary services they need, regardless of whether the need triggers additional, therapy-specific payments. As the Center for Medicare and Medicaid Services stated in its proposed 2020 PDGM rule: “While these clinical groups represent the primary reason for home health services during a 30-day period of care, this does not mean that they...
Source: American Speech-Language-Hearing Association (ASHA) Press Releases - Category: Speech-Language Pathology Authors: Tags: Audiology Health Care Private Practice Slider Speech-Language Pathology Dysphagia Source Type: blogs