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Patient-Driven Grouping Model and Home Health Use Among Traditional Medicare Beneficiaries
Basu Rashmita, Polsky Daniel E, Van Houtven Courtney C. Journal of the American Medical Directors Association, 2026-07-04
Topic: Risk, prevention and care in population studies
In January 2020, the Centers for Medicare & Medicaid Services implemented the Patient-Driven Groupings Model (PDGM), the most substantial revision to Medicare's home health (HH) prospective payment system since its introduction in 2000. PDGM shortened the payment period from 60 to 30 days and eliminated therapy visit thresholds from payment calculations. Because Medicare's HH payment policies have historically shaped patterns of service use, payment changes under PDGM were expected to influence service intensity and episode length. The aim of this study is to examine whether PDGM influences HH utilization among Medicare beneficiaries, particularly those with Alzheimer's disease and related dementias (ADRD). Cross-sectional cohort study. A 20% random sample of traditional Medicare beneficiaries who used HH services in 2019 (pre-PDGM) and 2021 (post-PDGM). We compared total HH visits and length of stay (LOS) during a standardized 60-day episode in the pre- and post-PDGM periods. Generalized linear models were used to estimate changes in visit volume and LOS following PDGM implementation, comparing beneficiaries with ADRD and without ADRD. Beneficiaries with ADRD experienced a steeper decline in total visits (from 22.4 to 17.9) compared with those without ADRD (from 18.2 to 15.4), driven by reductions in therapy visits, which fell from 12.9 to 9.9 among beneficiaries with ADRD and from 9.8 to 8.3 among those without ADRD. The average LOS within a 60-day episode also decreased after PDGM implementation. Adjusting for patient-level characteristics, beneficiaries with ADRD in the post-PDGM period received 2.04 fewer total visits, including 1.4 fewer therapy visits, than those without ADRD. These patterns differed by the severity of ADRD. PDGM's reimbursement changes and the shortening of the payment period may disproportionately affect Medicare beneficiaries with ADRD, underscoring the need to assess the implications for patient outcomes and future refinements of the payment policy.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Rashmita, B., Polsky Daniel, E., & Van Houtven Courtney, C. (2026). Patient-Driven Grouping Model and Home Health Use Among Traditional Medicare Beneficiaries. Journal of the American Medical Directors Association. https://doi.org/10.1016/j.jamda.2026.106327
Vancouver
Rashmita B, Polsky Daniel E, Van Houtven Courtney C. Patient-Driven Grouping Model and Home Health Use Among Traditional Medicare Beneficiaries. Journal of the American Medical Directors Association. 2026. doi:10.1016/j.jamda.2026.106327. PMID: 42398284.
BibTeX
@article{rashmita2026-42398284,
author = {Rashmita, Basu and Polsky Daniel, E. and Van Houtven Courtney, C.},
title = {{Patient-Driven Grouping Model and Home Health Use Among Traditional Medicare Beneficiaries}},
journal = {Journal of the American Medical Directors Association},
year = {2026},
doi = {10.1016/j.jamda.2026.106327},
pmid = {42398284},
url = {https://doi.org/10.1016/j.jamda.2026.106327}
}
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Key findings
- Beneficiaries with ADRD experienced a steeper decline in total visits (from 22.4 to 17.9) compared with those without ADRD (from 18.2 to 15.4), driven by reductions in therapy visits, which fell from 12.9 to 9.9 among beneficiaries with ADRD and from 9.8 to 8.3 among those without ADRD.
Why it matters
After the Patient-Driven Groupings Model changed Medicare home health payment in 2020, beneficiaries with Alzheimer's disease and related dementias saw a steeper drop in total home health visits (22.4 to 17.9) than those without. This is a payment and service-use study and says nothing about treating, curing or preventing dementia.
Study details
- Study designcohort study
- Evidence strengthModerate
How this study scored 42/100
Published in a peer-reviewed journal, and it is a cohort study following people over time. Scored zero for sample size, effect reported, studied in people and randomized / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of the American Medical Directors Association) |
| Journal's citation record | 2 / 4 | Journal of the American Medical Directors Association: journal h-index 172 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomized / blinded | 0 / 2 | No randomization or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 0 / 7 | Cited 0 times (OpenAlex, 2026-10-17) |
| Citations per year | 0 / 5 | 0.0 citations a year over 2 year(s) since 2026 |
| Impact for its field and year | 0 / 6 | Cited 0.0× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 1 / 6 | Cited by 1 other studies in this library |
| Still being cited | 0 / 4 | Cited 0 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Courtney H. Van Houtven: h-index 43 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | Johns Hopkins University: institution h-index 2,309 (OpenAlex) |
| Multicenter collaboration | 1 / 3 | OpenAlex lists 3 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 42398284) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 42 / 100 | — |
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