With a full year of the Patient-Drive Groupings Model (PDGM) implementation and data collection now in the books, BlackTree Principal Nick Seabrook and SHP Vice President of Product Strategy Chris Attaya are taking another look at how the home care industry adapted to the myriad challenges of 2020. Using SHP’s robust, real-time provider data, they will examine how agencies actually performed under PDGM compared to expectations, plus explore the impact of the pandemic and trends throughout the year. Finally, they’ll delve into the story the data is telling regarding any behavior adjustments that occurred in PDGM’s year one.

Functional Impairment Level

  • CMS projected a High Functional Impairment level of 31.5%, SHP shows 44.1% for CY 2020, which is much higher than anticipated.
  • SHP shows Medium Functional Impairment at 32%, which is around what CMS predicted at 33.4%
  • SHP data for CY 2020 Low Functional Impairment 23.9%, compared to CMS prediction of 35.1%


  • Overall LUPA rate of 8.9% for CY 2020
    • CMS predicted LUPA rate of 7%
  • LUPA rate of 18% for patients that were only on service for one period.
  • Musculoskeletal Rehabilitation made up.

 Visit Utilization

  • Therapy visits consisted of 3.99 of the total average visit utilizations of 8.51, which equals 46% of all visits
  • Increase from prior year at around 45%

 Key Takeaways

  • LUPAs by HHRG and Sequence-
    • To get a better understanding of LUPA management it’s important to review volume of number of periods.
      • 19,952 MS Rehab and 13,790 Neuro Stroke Rehab
      • Opportunity to lower over LUPA rates by addressing clinical groupings with high volume periods.
    • COVID-19 Specific PDGM Benchmarks
      • End of March to the beginning of April showed a 30% drop in overall SOC volume.
      • Effective in April 2020 you could use a new diagnosis code for COVID-19.
        • COVID-19 diagnosis consisted of 1.8% of all PDGM period for Medicare and 1.9% for all payors.
        • Stats vary by region as Midwest consisted of 2.7% of period and 4.4% of 1st periods were a COVID-19 diagnosis.
        • % of 1st period COVID-19 patients drastically increasing towards the end of 2020
          • 2% in October compared to 4.9% in November and 9.1% in December
          • Slightly skewed by lower number of SOC in November and December due to holidays


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