Abstract
Client-Driven Grouping Model and Home Healthcare Use among Traditional Medicare Beneficiaries With and Without Alzheimer's Disease and Related Dementias
Rashmita Basu, PhD, Assistant Professor, East Carolina University
Medicare's home health (HH) benefit costs $18 billion annually, accounting for nearly 10% of its beneficiaries. The new Patient-Driven Grouping Model (PDGM) shortens the HH payment period from 60 to 30 days and lowers reimbursements for therapy visits, the second 30-day period, and community-initiated episodes of care. This pilot aims to identify how PDGM changes the use of home health services among traditional Medicare (TM) beneficiaries with and without ADRD.
Specific aims:
Aim 1: Compare the change in annual number, length (in days) of HH episodes, and visit intensity (visits/week) for people with and without ADRD in the post- (2021) compared to the pre-(2017) policy period overall, then by admission source and episode timing.
H1. The average number of therapy visits will be lower in 2021 compared to 2017, and this reduction will be greater for people with ADRD than those without ADRD, controlling for all covariates.
H2: The average number of community-initiated episodes will be lower in the post-policy period (2021) compared to the pre-policy period (2017).
Aim 2: Assess the length (in days) of home health episodes and visit intensity among people with ADRD by dementia severity.
H1. The average length of an HH episode and visit intensity will be greater for those with greater severity.
This pilot study will help us understand the implications of PDGM and home health use for TM beneficiaries by offering critical information about the changes in therapy, skilled nursing, and aide visits in the post-policy compared to the pre-policy period. If the intensity of service use is linked to outcomes, there may indeed be an effect on outcomes from the PDGM model. To move towards outcomes analyses, we establish the implications of the new payment model for home health visit intensity for people with ADRD in this pilot.