Patient-Driven Grouping Model and Medicare Financed Home Health Care Among Medicare Beneficiaries
A special issue of Healthcare (ISSN 2227-9032).
Deadline for manuscript submissions: 26 March 2026 | Viewed by 12
Special Issue Editor
Interests: long-term care delivery and financing; medicare payment innovation; medicare advantage; post-acute care; medicare payment policies; dual eligible
Special Issues, Collections and Topics in MDPI journals
Special Issue Information
Dear Colleagues,
Medicare's home health (HH) care provides benefits for nearly 10% of all beneficiaries at a cost of USD 18 billion annually. HH benefits cover physical therapy (PT), occupational therapy (OT), skilled nursing (SN), social work (SW), and personal aide (PA) services. HH offers functional and clinical benefits but service provision in the fee-for-service (FFS) Medicare program is highly sensitive to payment incentives, requiring careful study of the benefits and unintended consequences to inform policy. In 2000, HH reimbursement services adopted a prospective payment system (PPS) for a 60-day episode, which incentivized therapy, resulting in a 54% increase in therapy visits with a corresponding decrease in nursing and personal aide visits by 22% and 74%, respectively. In response to excessive therapy visits under the PPS, including inappropriate end-of-life use , the Center for Medicare and Medicaid Services (CMS) implemented the Patient-Driven Grouping Model (PDGM) in January 2020. The new PDGM payment model could disproportionately pose challenges to beneficiaries who have historically used higher-intensity HH services (e.g., people with dementia).
We are pleased to invite you to contribute to this Special Issue on the areas of Medicare home health care payment changes and service utilization, the effect of the new payment model among a sub-group of Medicare beneficiaries with dementia, and dual eligibles to better understand the potential effect of the HH payment changes on the health and functional outcomes of Medicare beneficiaries.
This Special Issue aims to explore the following topics:
- PDGM and source of HH admission and care use/intensity/subgroup population;
- PDGM and functional outcomes—differential impacts for high utilizers;
- PDGM and people with dementia.
Original research articles and reviews are welcome.
We look forward to receiving your contributions.
Dr. Rashmita Basu
Guest Editor
Manuscript Submission Information
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Keywords
- patient-driven grouping model
- home health care use
- Medicare payment model
- functional outcomes
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