{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T06:55:44Z","timestamp":1790924144735,"version":"4.1.0"},"reference-count":22,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["K01AG073538"],"award-info":[{"award-number":["K01AG073538"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Appl Gerontol"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The Patient-Driven Groupings Model (PDGM) assigns home health episodes to clinical groups using primary diagnosis codes. The implications of this approach for beneficiaries with ADRD, whose condition is rarely coded as primary, are unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare simulated PDGM clinical group assignment between ADRD-highly likely and ADRD-unlikely episodes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using national 2019 Medicare fee-for-service data, we simulated clinical group assignment and compared primary diagnosis profiles before and after 1:1 propensity score matching.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Nine in ten ADRD-highly likely episodes carried a non-ADRD primary diagnosis. After matching on demographics, comorbidity, and functional and cognitive status, clinical group assignment differences between cohorts attenuated but persisted. Most strikingly, ADRD-highly likely episodes were nearly 12 times as frequently assigned to Behavioral Health, the group with the lowest average payment weight, and comprised 92.1% of all matched Behavioral Health episodes. Within clinical groups, primary diagnosis profiles differed between cohorts, suggesting distinct care needs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/07334648261489746","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T11:56:17Z","timestamp":1790596577000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Group Assignment in Home Health Care for Medicare Beneficiaries With ADRD: A 2019 Pre-PDGM Simulation"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-3915-4939","authenticated-orcid":false,"given":"Maxwell","family":"Cutty","sequence":"first","affiliation":[{"name":"Medical University of South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4236-6225","authenticated-orcid":false,"given":"Lizmarie","family":"Maldonado","sequence":"additional","affiliation":[{"name":"Medical University of South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9661-0000","authenticated-orcid":false,"given":"Jada","family":"Johnson","sequence":"additional","affiliation":[{"name":"Medical University of South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5456-3019","authenticated-orcid":false,"given":"Carmen","family":"Pfeil","sequence":"additional","affiliation":[{"name":"Medical University of South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kit N.","family":"Simpson","sequence":"additional","affiliation":[{"name":"Medical University of South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5070-7117","authenticated-orcid":false,"given":"Sara","family":"Knox","sequence":"additional","affiliation":[{"name":"Medical University of South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"e_1_3_6_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-018-4377-y"},{"key":"e_1_3_6_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-022-07549-7"},{"key":"e_1_3_6_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.16654"},{"key":"e_1_3_6_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.19491"},{"issue":"2","key":"e_1_3_6_6_1","first-page":"igaf122","article-title":"Home health delivery for persons with dementia: Impacts of the new Medicare payment system","volume":"9","author":"Burgdorf J. G.","year":"2025","unstructured":"Burgdorf J. G., Mroz T. (2025b). Home health delivery for persons with dementia: Impacts of the new Medicare payment system. Innovation in Aging, 9(Suppl. 2), igaf122\u2013igaf283. https:\/\/doi.org\/10.1093\/geroni\/igaf122.283","journal-title":"Innovation in Aging"},{"key":"e_1_3_6_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/glad270"},{"key":"e_1_3_6_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.13928"},{"key":"e_1_3_6_9_1","volume-title":"Home health services","author":"Centers for Medicare & Medicaid Services","unstructured":"Centers for Medicare & Medicaid Services. (nd). Home health services. Medicare.gov. Retrieved February 27, 2026, from. https:\/\/www.medicare.gov\/coverage\/home-health-services"},{"issue":"217","key":"e_1_3_6_10_1","first-page":"60478","article-title":"Medicare and Medicaid programs; CY 2020 home health prospective payment system rate update [final rule]","volume":"84","author":"Centers for Medicare & Medicaid Services","year":"2019","unstructured":"Centers for Medicare & Medicaid Services. (2019). Medicare and Medicaid programs; CY 2020 home health prospective payment system rate update [final rule]. Federal Register, 84(217), 60478\u201360629. https:\/\/www.federalregister.gov\/documents\/2019\/11\/08\/2019-24026\/medicare-and-medicaid-programs-cy-2020-home-health-prospective-payment-system-rate-update-home","journal-title":"Federal Register"},{"key":"e_1_3_6_11_1","unstructured":"Centers for Medicare & Medicaid Services. (2026). Home health patient-driven groupings model. https:\/\/www.cms.gov\/medicare\/payment\/prospective-payment-systems\/home-health\/home-health-patient-driven-groupings-model"},{"key":"e_1_3_6_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-023-03780-x"},{"key":"e_1_3_6_13_1","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2023.0583"},{"key":"e_1_3_6_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/13872877261471874"},{"key":"e_1_3_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2019.09.012"},{"key":"e_1_3_6_16_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0902234"},{"key":"e_1_3_6_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.17183"},{"key":"e_1_3_6_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.17621"},{"key":"e_1_3_6_19_1","volume-title":"Medicare home health prospective payment system: Case-mix methodology [technical report]","author":"Plotzke M.","year":"2016","unstructured":"Plotzke M., Fout B., Hayashi B., Donnelly J. (2016). Medicare home health prospective payment system: Case-mix methodology [technical report]. RTI International for Centers for Medicare & Medicaid Services. https:\/\/downloads.cms.gov\/files\/hhgm_technical_report_120516_sxf.pdf"},{"key":"e_1_3_6_20_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2013.1159"},{"key":"e_1_3_6_21_1","article-title":"Medicare's home health payment model doesn't reflect the care many patients need","author":"Stein J.","year":"2026","unstructured":"Stein J. (2026). Medicare's home health payment model doesn't reflect the care many patients need. Center for Medicare Advocacy. https:\/\/medicareadvocacy.org\/home-health-payment-model-doesnt-reflect-patients-needs\/","journal-title":"Center for Medicare Advocacy"},{"key":"e_1_3_6_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/alz.70546"},{"key":"e_1_3_6_23_1","doi-asserted-by":"crossref","unstructured":"Werner R. M. Kim S. Konetzka R. T. (2025). Trends in home health care among traditional Medicare beneficiaries with or without dementia. JAMA Network Open 8(5) Article e2510933. https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.10933","DOI":"10.1001\/jamanetworkopen.2025.10933"}],"container-title":["Journal of Applied Gerontology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/07334648261489746","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/07334648261489746","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/07334648261489746","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T06:47:47Z","timestamp":1790923667000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/07334648261489746"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,28]]},"references-count":22,"alternative-id":["10.1177\/07334648261489746"],"URL":"https:\/\/doi.org\/10.1177\/07334648261489746","relation":{},"ISSN":["0733-4648","1552-4523"],"issn-type":[{"value":"0733-4648","type":"print"},{"value":"1552-4523","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,28]]},"article-number":"07334648261489746"}}