The leader of a home healthcare coalition said her organization will push back aggressively after the Centers for Medicare and Medicaid Service on Monday proposed keeping a 4.3% cut related to the Patient-Driven Groupings Model (PDGM). 

Partnership for Quality Home Healthcare (PQHH) Executive Director Joanne Cunningham said the reduction, which began last year, should end because the new payment system actually has saved CMS money. An analysis her organization commissioned found home health care spending has been lower than expected since CMS adopted PDGM in 2020.

Joanne Cunningham

“In the rule they actually make a comment that they understand that if stakeholders have experienced something different than they have, then they invite comment on the methodology. They seem to be inviting some discussion on the issue,” Cunningham told McKnight’s Home Care Daily.

PDGM was intended to be a budget-neutral payment model — meaning it would hold the line on home healthcare spending. When it went into effect, CMS slashed the home health payment rate based on the assumption that home health agencies would upcode and increase the number of patient visits under the new model. But an analysis of 2020 Medicare claims by healthcare economists hired by PQHH found home health spending was 1.3% lower.  

The National Association for Home Care & Hospice (NAHC) also has advocated rolling back the so-called behavioral adjustment of 2020. A spokesman told McKnight’s Home Care Daily NAHC will provide formal comments to CMS during the rulemaking period.

Cunningham said the coalition has had ongoing discussions with CMS about rescinding the cut and planned to continue those discussions in the months ahead. CMS is expected to make a final decision on the proposed rule in November.

While she is concerned about the rate cut, Cunningham voiced approval about the proposed expansion of the Home Health Value-Based Purchasing Model outlined in Monday’s rule