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PDGM’s Lead Author Gets Candid About Pros, Cons of Revolutionary Model

Posted on Monday, October 21, 2019 11:34 AM

Patient Driven Groupings Model is scheduled to being on January 1, 2020, and it’s a controversial game-changer.  Two of the main reasons why is the model’s therapy changes and behavioral assumptions.  Agencies are worried about the consequences to their patients due to these changes.

PDGM’s lead author Lisa Grabert, believes the model is well intentioned but the changes in therapy could be a bit extreme.  “It may go a little far on the therapy side,” Grabert, who is currently a research professor at Marquette and Georgetown universities, said. “I don’t think we know what the full effect of that is going to be.  We had total therapy reimbursement to no therapy reimbursement,” Grabert went on to say the right spot might be somewhere in the middle. We’re not going to know that until we actually monitor and study the system, so there may be a big swing afterwards to try to correct for that.”

In regard to behavioral assumptions, PDGM expects providers will choose the coding option associated with the highest reimbursement and try everything to avoid LUPAs. Insiders do not agree, they believe that assumption is wrong and will result in an 8.1% cut for providers.

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