Home Health PDGM Winners and Losers: State Level Data

With just over 6 months until the new Patient Driven Grouping Model (PDGM) goes into effect, the home health industry is awash in a sea of comparative data. State-level comparisons of 2017 CMS, and HHGM PPS data project overall reimbursement for home health services to fall under PDGM in some states and rise incrementally in others.

For example, states expected to experience the most significant payment reductions under PDGM in 2020 if 2017 case mix trends hold true include: Colorado (-11.3%), Idaho (-11.4%), South Dakota (- 11.2%), Utah (- 9.2%), Florida (-8.4%), Nevada (-8%), and Wyoming (-6.4%). Potential winners, those states whose data indicates the projected highest increased overall home health revenue based on 2017 data, include Mississippi (+ 7.8%), New York (+ 5.2%), Oklahoma (+6.5%), California (+ 4.7%), and Louisiana (+ 6.7%). With respect to regional impact, New England States data shows more consistency: Connecticut (+ 1.2%), Massachusetts (+ 3.1%), Maine (-0.9%), New Hampshire (+ 0.8%), Vermont (+ 4.8%), and Rhode Island (- 1.5%)