A revolutionary payment structure may radically change the way that home health agencies administer care.

HHGM – What you need to know


A revolutionary payment structure may radically change the way that home health agencies administer care. It’s called the home health groupings model, or HHGM, and if implemented could shake up the industry in some major ways.

Here’s what you need to know about HHGM, and what it means for your home health agency:

What is HHGM? 
If the Centers for Medicare & Medicaid Services moves forward with its proposal, HHGM would be required to be implemented in 2019.

According to CMS, HHGM was created to shift the focus from volume of care to value of care. Therapy visits would no longer be taken into account when calculating payments. Additionally, the model would aim to improve coverage of underserved patient populations.

“We’re redesigning the payment system to be more responsive to patients’ needs and to improve outcomes,” said CMS Administrator Seema Verma.

What’s changing?
HHGM brings some significant changes home health agencies should be aware of, including:

30-day periods of care
Under HHGM, the unit of payment would change from 60-day periods of care to 30-day periods of care, a move which would be made “to better account for the relationship between episode characteristics and episode cost.”

“CMS will evaluate patients based on five distinct classifying groups.”

Patient payment group classification
To determine which payment groups patients should be categorized in, CMS will evaluate them based on the following five distinct classifying groups, as ABT Associates, the firm that contracted with CMS to develop the model, explained:

  1. Timing (early or late).
  2. Referral source (community or institution).
  3. Clinical grouping (see below).
  4. Functional level (low, medium or high).
  5. Comorbidity adjustment (no or yes).

Point #3 above refers to six new clinical classifications that would drive agency reimbursement. These are, according to the proposed rule from CMS:

  • Musculoskeletal rehabilitation.
  • Neuro/stroke rehabilitation.
  • Wounds – Post-Op wound aftercare and skin/non-surgical wound care.
  • Complex nursing interventions.
  • Behavioral healthcare.
  • Medication management, teaching and assessment (MMTA).

Concerns about HHGM
Many home health providers are worried about possible negative implications of HHGM, with particular focus on its complexity, the speed with which it may be implemented and the potential that it may drastically reduce payments in the home health sector.

The proposed model is non-budget neutral, which could cause Medicare payments for home health providers to be slashed by $950 million in 2019, according to Home Health Care News. If rolled out to be partially budget-neutral, payments would still be cut by $480 million, CMS forecast.

HHGM has the potential to improve the quality of patient care for home health agencies, which is the ultimate goal of any provider. However, they will have to be vigilant about staying informed of any rapid developments in HHGM – and be ready to make the switch if necessary.

The team at Thornberry Ltd. has helped home health providers navigate the regulatory changes of the past 20 years, and is ready to support your agency to comply with HHGM through its EMR.