Let’s connect

PDGM in everyday life

It’s been nearly a year since the Patient-Driven Groupings Model (PDGM) went into effect, changing the way home health organizations are reimbursed. Although mandated in the 2016 Cures Act, PDGM wasn’t implemented until January 1, 2020. However, with more changes slated for January 2021, it’s important to look at how organizations are responding to PDGM today, and what they should look to implement to prepare for the changes in the future. Read on as we take a deeper look into some of these changes and examine how life is today with PDGM.


Organizations have had to step up their documentation processes and ensure all their t’s are crossed and their i’s dotted. After all, incorrect documentation or the wrong diagnosis codes could impact a patient’s treatment and how you’re reimbursed. So, ensuring accurate charting and documentation could help prevent your organization from being in a financial frenzy. One challenge that makes it hard to ensure accuracy is tracking down patient health information. Having to hunt down information from a hospital or another provider can be time-consuming and tedious.

With staff consumed with administrative work, productivity can take a plunge. Not only that, but the focus on paperwork can leave patients paying the price. So, having a software solution that can integrate with other systems to access patient health information while still being compliant is key. Even better, look for a home health EHR that’s part of the CommonWell Health Alliance. CommonWell was started to enable providers to collaborate in an effort to improve care coordination and make patient health information more accessible. Learn more about MatrixCare’s interoperability with CommonWell here.


Referrals are another area that has been impacted greatly due to PDGM and COVID-19. When you look at where organizations were receiving the bulk of their reimbursements pre-COVID, it was from institutional discharges. These are typically discharged from the hospital and/or skilled nursing facilities. The industry has seen shifts in referral patterns, as well as changes in patient-driven care setting choices. While CMS did come through with some reimbursement for those affected organizations, truth be told, most organizations still had to lay employees off. Plus, with higher costs for personal protective equipment (PPE), organizations should look to maximize their investments – including their EHR. With the pending January 2021 PDGM changes, there will be an increased focus on the intake and admission process. Organizations will need to ensure timely workflows to avoid penalties.

Data and analytics

Since PDGM and COVID, organizations need to take a closer look at making the most out of their investments. And the only way to effectively know which investments are worth the expense is to look at your data and analytics. Being that you serve customers wherever they need you, it can be hard to monitor efficiency and operational trends that impact financial performance. Certain tools, like MyAnalytics, have dashboards that help you identify which offices are driving the most revenue and monitor overtime by a caregiver, client location, and service code, to name just a few. This comprehensive insight can help you realize lost revenue and provide better care.

2021 Preparation tips

In preparation for the new PDGM changes on January 1, home health organizations should focus on the intake process to ensure their patients have diagnosis codes and are admitted quickly. CMS is implementing a penalty for any RAP claims submitted later than 5 days from the start of care (SOC). Organizations should confirm that their EHR is simplifying workflows to support these changes, as opposed to hindering the timeliness of the admissions and clinical engagements.

To summarize

To conclude, PDGM and COVID-19 have changed how healthcare is being delivered. We’ve uncovered that the best way to navigate these changes is through software solutions that support your staff’s workflow. In doing so, you can enable your staff to be efficient, proactive, and prepared for the unexpected. By leveraging these tools, staff can spend less time on paperwork and more time with the people they serve. At the end of the day, that’s what really matters.

Explore how our solutions can help you navigate PDGM.

Want to learn more? Let’s connect!

The content in this presentation is for informational purposes only and is provided “as-is.” Information and views expressed herein may change without notice. Given the fluidity of the current regulatory environment due to the pandemic, we encourage you to seek as appropriate, regulatory, and legal advice on any of the matters covered in this presentation.

Back to blog

Learn more about how our services can help you succeed.