On January 1, 2020, the Centers for Medicare and Medicaid Services (CMS) rolled out a new system for home health care referral reimbursement called PDGM. The main change for you is in the information required to refer patients for home health care.
Below we list new information requirements under PDGM.
Just as you’ve trusted VNSNY to deliver exceptional home health care for your most medically complex patients for over 125 years, you can count on us as your partner for guidance on PDGM. Our goal is to ensure that your patients receive the care they need, when they need it, for the best possible outcomes.
PDGM (Patient-Driven Groupings Model) is a new value-based payment model used by Medicare and other payers to reimburse certified home health care agencies. It took effect January 1, 2020.
A value-based system like PDGM places an emphasis on cost and quality of care: how much value will a patient get from a given service. This is why demonstrating a patient’s primary and secondary diagnoses, as well as comorbidities, is so important under PDGM.
PDGM places greater emphasis on clinical complexity and comorbidities—a core competency for VNSNY.
With PDGM, CMS has raised the bar on the information needed for home health care referrals. Better information equals better care. Evidence has shown that accurately capturing your patient’s clinical complexity under a system such as PDGM may help to reduce ED visits and rehospitalizations and increase patient satisfaction.
Starting on January 1, 2020, for referrals that do not meet PDGM requirements, VNSNY may have to contact your office to verify information.
Have a question about PDGM? Give us a call or schedule a consult with your VNSNY account representative. We’ll walk you and your staff through the steps for making successful referrals and avoid potential delays in referrals. We can also conduct team workshop trainings.
Your VNSNY account representative will provide you with a PDGM Referral Toolkit that includes: