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Game On: PDGM Encourages Home Health Agencies to “Game the System’

Posted on Friday, July 19, 2019 8:45 PM

CMS developed the new PDGM in part, to fix problems that exist with the current Prospective Payment System (PPS). One of the problems was that PPS is causing agencies to focus on quantity over quality since it leads to more money.  So, PDGM was created to eliminate therapy visit volume in calculating reimbursements.  Some industry experts are concerned that PDGM will do the exact opposite. 

“[CMS officials] talk about the agencies gaming the system in the past,” Mark Sharp, partner at national accounting and advisory firm BKD, said. “Well, with this, I suggest they say, ‘Game on.’ They basically are telling us they expect us to do it [and] we should do it.  I suggest, as providers, unless you can withstand a potential 6%, 7% or 8% cut in payment rates … you need to find strategies.”


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