Patient-Driven Grouping Model and Home Health Use Among Traditional Medicare Beneficiaries

Area of Science:

• Health Services Research
• Gerontology
• Health Economics

Background:

• The Centers for Medicare & Medicaid Services implemented the Patient-Driven Groupings Model (PDGM) in January 2020, significantly revising Medicare's home health (HH) prospective payment system.
• PDGM shortened the payment period from 60 to 30 days and removed therapy visit thresholds from payment calculations, potentially altering service utilization patterns.

Purpose of the Study:

• To examine the influence of PDGM on home health (HH) utilization among Medicare beneficiaries.
• Specifically, to assess the impact on beneficiaries with Alzheimer's disease and related dementias (ADRD).

Main Methods:

• A cross-sectional cohort study design was employed.
• Utilized a 20% random sample of traditional Medicare beneficiaries who received HH services in 2019 (pre-PDGM) and 2021 (post-PDGM).
• Compared total HH visits and length of stay (LOS) within a 60-day episode using generalized linear models, differentiating between beneficiaries with and without ADRD.

Main Results:

• Beneficiaries with ADRD experienced a greater reduction in total HH visits (22.4 to 17.9) compared to those without ADRD (18.2 to 15.4).
• Reductions were largely driven by therapy visits, which decreased significantly for both groups, particularly for those with ADRD.
• Average LOS within a 60-day episode also decreased post-PDGM, with beneficiaries with ADRD receiving fewer total and therapy visits.

Conclusions:

• PDGM reimbursement changes and shortened payment periods may disproportionately affect Medicare beneficiaries with ADRD.
• Further assessment is needed to understand the implications for patient outcomes and to inform future payment policy refinements.