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Navigating the Impact of PDGM on Therapists in Home Health

The Patient-Driven Groupings Model (PDGM) has brought significant changes to the landscape of home health care since its implementation. While its primary focus is on reimbursement structures, its impact extends beyond financial considerations to affect various aspects of care delivery. One group that has felt the reverberations of PDGM is therapists working in home health settings. In this blog, we'll explore how PDGM is reshaping the roles and responsibilities of therapists and discuss strategies for navigating these changes effectively.


A brief introduction to PDGM:


PDGM is a payment model introduced by the Centers for Medicare & Medicaid Services (CMS) for the Medicare home health benefit. It classifies patients into payment categories based on various factors, including diagnoses, functional status, and comorbidities. PDGM aims to align reimbursement more closely with patient characteristics and care needs, incentivizing providers to deliver efficient, high-quality care.


Impact on Therapists:


  • Referral Patterns: Under PDGM, therapy services are no longer a determinant factor in reimbursement. Consequently, some agencies have experienced changes in referral patterns, with fewer patients being referred for therapy services or shorter durations of therapy being authorized.

  • Care Planning: Therapists play a crucial role in assessing patients' functional status and developing personalized care plans. With PDGM emphasizing patient characteristics in reimbursement, therapists must ensure thorough documentation of functional impairments and treatment goals to justify the necessity and intensity of therapy services.

  • Documentation Requirements: PDGM places increased emphasis on accurate and detailed documentation to support the level of care provided. Therapists must document the rationale for therapy services, including assessments, interventions, progress notes, and discharge planning, in alignment with PDGM requirements.

  • Time Management: With potential changes in caseloads and therapy visits, therapists must prioritize time management and efficiency without compromising the quality of care. Optimizing scheduling, minimizing administrative tasks, and leveraging technology can help therapists adapt to evolving workloads under PDGM.

  • Interdisciplinary Collaboration: PDGM encourages interdisciplinary collaboration among healthcare professionals to achieve optimal patient outcomes. Therapists must effectively communicate with other members of the care team, including nurses, physicians, and social workers, to coordinate care plans and ensure holistic patient care.

How we can help navigate PDGM Challenges:


  • Education and Training: Continuous education and training are essential for therapists to stay informed about PDGM regulations, documentation requirements, and best practices. Agencies should invest in comprehensive training programs to equip therapists with the knowledge and skills needed to thrive under PDGM.

  • Advocacy and Communication: Therapists can advocate for the importance of therapy services in home health care by effectively communicating the value they bring to patient outcomes and overall quality of care, especially in facility settings! Open dialogue with agency leadership and collaboration with industry associations can help address concerns and advocate for supportive policies.

  • Embracing Innovation: Embracing technology and innovative solutions can streamline workflows, enhance communication, and improve efficiency for therapists in home health settings. Electronic health record (EHR) systems, telehealth platforms, and mobile applications offer opportunities to optimize care delivery and documentation processes.


PDGM has reshaped the landscape of home health care, impacting therapists' roles, responsibilities, and workflows. By understanding the implications of PDGM and adopting proactive strategies, therapists can navigate these changes effectively while continuing to deliver high-quality, patient-centered care. Collaboration, education, advocacy, and innovation are key to thriving in the evolving healthcare landscape shaped by PDGM.


Contact C&C Strategic Consulting for more information on how we can further assist navigating these challenges.



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