Patient-Driven Grouping Model and Home Health Use Among Traditional Medicare Beneficiaries.
Rashmita Basu, Daniel E Polsky, Courtney C Van Houtven
PMID 42398284WHAT IT FOUND
Home health visits and episode length fell after PDGM, especially for beneficiaries with dementia.
Therapy visits drove much of the decline, and the largest reductions appeared in advanced dementia. This is service use, not proof of harm.
Key findings
01Between 2019 and 2021, mean total visits per 60-day episode fell from 22.4 to 17.9 for beneficiaries with ADRD and from 18.2 to 15.4 for those without ADRD.
02Therapy visits decreased from 12.9 to 9.9 for beneficiaries with ADRD and from 9.8 to 8.3 for those without ADRD. Length of stay decreased from 55.6 to 47.1 days for beneficiaries with ADRD and from 44.1 to 39.9 days for those without ADRD.
03Compared with the lowest ADRD severity group, the highest severity group had 2.9 fewer total visits, 1.8 fewer therapy visits, 0.67 fewer skilled nursing visits, and 9.07 fewer days of length of stay after PDGM.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPsWhat it means for RNs
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What it does not show
The study compared 2019 with 2021 without a separate control group, so it cannot prove PDGM caused the changes. The 2021 post-PDGM period overlapped with pandemic-related changes in referrals, staffing, and service delivery, and the authors could not fully separate these from PDGM. ADRD status came from claims, and pandemic disruptions may have reduced diagnosis or documentation. The supplied text does not report separate PT, OT, or SLP visit counts. It measured visits and length of stay, not patient outcomes such as hospitalization or function.
Declared interests
The authors declared no conflicts of interest. The supplied metadata lists NIH extramural research support.
The easy way to misread this
Do not read the declines as proof that PDGM alone caused them. The study compared 2019 with 2021 without a separate control group and could not fully separate PDGM from pandemic-related changes in referrals, staffing, and service delivery.