Patient Driven Groupings Model (PDGM)
This is the largest change home health has seen since the inception of PPS in 2000.
Presentation Date: August 8, 2018
TAHC&H Event: TAHC&H Annual Meeting | Frisco
Subscription Type: Individual
TX HCSSA Administrator/Alternate Continuing Education
1.25 Clock Hrs
Continuing Education for Nurses
1.25 Contact Hr(s)
This program awards CNE until 8.8.2020
CE Approval Statements:
· This program meets continuing education requirements
for Administrators and Alternates under Texas HCSSA licensing regulations.
· Texas Association for Home Care & Hospice is approved as a provider of nursing continuing professional development
by the Texas Nurses Association - Approver, an accredited approver by the American Nurses Credentialing Center’s Commission on
HCSSA Topic(s) Addressed:
§558.260[a]development and interpretation of agency policies
Program Description: Patient-Driven Groupings Model is the largest change that home health has
seen since the inception of PPS in 2000. PDGM was introduced in the 2019 Home Health Proposed Rule and while this rule has
not yet been finalized - as of the date of this presentation - it is in the works. Under PDGM, the 60-day episode of care
is replaced with a 30-day period of payment and patients are placed into one of 216 payment groups. The structure of
determining the payment grouping is as follows:
Admission Source & Timing (Claims) - (Community Early, Community Late, Institutional Early or Institutional Late)
Clinical Grouping (Primary Diagnosis) - (Medication Management Teaching & Assessment (MMTA), Neuro Rehab, Wounds,
Complex Nursing Interventions, Musculoskeletal (MS) Rehab, Behavioral Health)
Functional Level (OASIS Items) - Low, Medium, High
Comorbidity Adjustment (Secondary Diagnoses) - No or Yes
Low Utilization Payment Adjustments (LUPAs) will exist in the PDGM, but there will be multiple ways to calculate them
versus the current standard. All this and much more is addressed in this MUST VIEW session!
Program Learning Outcome:
Learners will actively engage in the learning activity and indicate an intent to change their practice by incorporating documentation practices that support the new Patient
Driven Groupings Model methodology.
TAHC&H Faculty/Presenter: Melinda A. Gaboury, COS-C Chief Executive Officer, Healthcare Provider Solutions
About the Presenter:
Melinda Gaboury, with more than 27 years in home care, has over 17 years of executive speaking and educating experience,
including extensive day to day interaction with home care and hospice professionals. She routinely conducts Home Care and Hospice Reimbursement Workshops and speaks at state association
meetings throughout the country. Melinda has profound experience in Medicare PPS training, billing, collections, case-mix calculations, chart reviews and due diligence. ZPIC, RA,
ADR & TPE appeals with all Medicare MACs have become the forefront of Melinda’s current impact on the industry. She is currently serving on the NAHC/HHFMA Advisory Board as
ex-officio and is Associate Director on the Home Care Association of Florida Board of Directors. Melinda is also the author of the Home Health Pocket Guide to OASIS-C2: A Reference for Field Staff.
 Patient Driven Groupings Model (PDGM)
- Gaboury, Melinda