The PDGM Center displays targeted insights into the Patient-Driven Groupings Model with real-time aggregate data. Using the information in the PDGM Center, organizations can analyze critical components of PDGM, develop data-driven business decisions, review the impact of patient care, and assess the impact of PDGM on revenue.

To access the PDGM Center, hover over the PDGM tab in the Home Health solution and select PDGM Center from the drop-down menu.

At the top of the PDGM Center, users can navigate directly to the PDGM Billing Center, Revenue Impact Analysis, PDGM Modeling Tool, and PDGM Resources screens.

PDGM data will begin populating in the following PDGM Center feature tiles as OASIS-D1 assessment documentation is collected, and scheduling and billing are completed. As this data accumulates, metrics will populate in the appropriate sections of the PDGM Center.

LUPA Risk Alert

LUPA risk alerts occur when scheduled visits fall outside the specified visit threshold for the 30-day payment period. Users can select the numbers under Low, High, and LUPA to view patients that fall into that category.

• Low risk indicates that the number of scheduled visits is greater than the LUPA threshold.
• High risk indicates that the number of scheduled visits is equal to the LUPA threshold. (This alerts users to monitor missed visits to avoid LUPAs.)
• LUPA indicates that the number of scheduled visits is under the LUPA threshold. (As an example of potential impact, moving a visit just one day past the end of the 30-day payment period could result in a loss of $800).

Avg. Length of Stay

Displays the average number of days from the Start of Care date to the current date for all patients under PDGM in real time.

• An average length of stay that is 30 days or shorter appears in red to alert agencies to potential revenue loss.
• An average length of stay that is 31 to 120 days appears in blue.
• An average length of stay that is 121 days or longer appears in orange to alert users to the heightened risk of claim review.

Upcoming 30-Day Review

Displays the total number of patients in the last seven days of the first 30-day payment period. This metric enables agencies to review the focus of care and verify completion of all orders, visits, and documentation to submit final claims in a timely manner. Users can click the number under Upcoming 30-Day Review to view patients that fall into this category.

Upcoming Recerts

Displays the the total number of patients in the last seven days of the second 30-day payment period. This metric enables agencies to review the focus of care to determine if patients should be recertified or discharged, and verify completion of all orders, visits, and documentation to submit final claims in a timely manner. Users can click the number under Upcoming Recerts to view patients that fall into this category.

% of Outliers

Displays the percentage of patients identified as outliers.

• If the percent of outliers is 0%, the percentage appears in blue.
• If the percent of outliers is 1-10%, the percentage appears in green.
• If the percent of outliers is greater than 10%, the percentage appears in red to alert users to the potential threat to revenue.

Users can click the percentage to view patients identified as outliers.

Avg. Gross Margin

First 30-Day Payment Period

Displays the average gross margin for the first 30 days, which is calculated by subtracting the total cost for all patients with completed episodes for the first 30-day period from the average expected payment.

Second 30-Day Payment Period

Displays the average gross margin for the second 30 days, which is calculated by subtracting the total cost for all patients with completed episodes for the second 30-day period from the average expected payment.

Average Revenue per Billing Period

Displays the average revenue for all patients under PDGM for each 30-day billing period.

Number of Patients per Clinical Grouping

Displays the number of patients under PDGM per clinical grouping. The top five clinical groupings with the highest volume of patients appear in green.

Admission Source and Timing

Displays the percentage of early vs. late and institutional vs. community patients.

Functional Status

Displays the percentage of patients at each functional status (high, medium, low) at Start of Care and Recertification.

Comorbidity Adjustment

Displays the percentage of comorbidity adjustments (high, low, none) at Start of Care and Recertification.

Average Estimated Margin per Billing Period

Displays the average expected revenue for all patients under PDGM for each 30-day billing period.

Average Visits per Episode

Displays displays the average number of visits completed per 60-day episode for each clinical grouping, once the care episode has ended.