The complexities introduced by the Patient-Driven Groupings Model (PDGM) require home health agencies to revisit and refine their strategies for LUPA management. Strategic foresight becomes essential in a landscape where every visit counts and margins are tight. Here are key strategies that can guide agencies toward success in this challenging environment:

Precision in Clinical Assessment:

Ensure comprehensive and accurate clinical assessments from the start. A well-defined understanding of the patient’s needs will lay the groundwork for an effective care plan, minimizing the risk of unexpected LUPAs.

Data-Driven Approach:

Harness the power of analytics to gain insights into patterns and trends related to LUPAs. Use this data to proactively identify high-risk patients or care periods and adjust care plans accordingly.

Continuous Staff Education:

Equip your team with the latest PDGM and LUPA nuances knowledge. Regular training sessions can ensure that staff members understand the importance of each visit and its potential implications for LUPA adjustments.

Collaborative Care Planning:

Promote an interdisciplinary approach to care planning. When nurses, therapists, and aides collaborate and communicate seamlessly, care delivery becomes more cohesive, and the chances of LUPAs decrease.

Embrace Technology:

Invest in technological tools like Electronic Health Records (EHR) and remote patient monitoring systems. These tools can offer real-time insights into patient progress and potential LUPA risks.

Robust Communication Channels:

Establish strong communication pathways between care teams, patients, and their families. Addressing concerns, rescheduling missed visits, or adapting to changes becomes efficient with clear communication.

Periodic LUPA Risk Assessment:

Incorporate regular LUPA risk assessments into your agency’s routine. Agencies can make timely interventions and minimize LUPA occurrences by periodically evaluating LUPA risks.

Optimize Visit Scheduling:

Ensure visits are strategically spaced throughout the 30-day care period, reducing the risk of clustering visits and inadvertently triggering a LUPA.

Engage in Peer Benchmarking:

Compare your LUPA rates and practices with similar agencies. Peer benchmarking can provide valuable insights and highlight areas of improvement.

Foster a Culture of Quality:

Prioritize quality over quantity. By delivering exceptional care during each visit, agencies can achieve better patient outcomes, reducing the chances of unexpected LUPAs due to readmissions or complications.

LUPA management under PDGM necessitates proactive planning, agile decision-making, and continuous improvement. With the right strategies, agencies can ensure clinical excellence and financial stability in PDGM.


The Patient-Driven Groupings Model (PDGM) has indisputably transformed the home healthcare landscape. Within this new paradigm, managing Low-Utilization Payment Adjustments (LUPAs) has emerged as a pivotal challenge. Navigating this intricate terrain demands adaptability and a proactive approach rooted in knowledge, collaboration, and technology. 

Home health agencies, equipped with strategic insights and a commitment to continuous improvement, can achieve a harmonious balance of optimal patient care and financial sustainability. The journey through PDGM, with its LUPA intricacies, is a testament to the evolving nature of healthcare, emphasizing the importance of agility, innovation, and patient-centricity.

Key Takeaways

  • The Introduction of PDGM and LUPA
    • PDGM represents a significant change in home healthcare.
    • LUPA, integral to home health care, impacts clinical outcomes and billing practices.
    • Understanding and adapting to these changes is crucial for agencies.
  • LUPA Background
    • LUPAs adjust payment for episodes with minimal service utilization.
    • They influence clinical outcomes and the financial well-being of home health agencies (HHAs).
    • The Triple Aim policy by CMS impacts the payment models and intertwines with LUPAs.
  • Decoding LUPA Under PDGM
    • PDGM introduces complexities, especially regarding LUPA thresholds based on clinical grouping and episode timing.
    • The shift includes transitioning from a 60-day episode to two 30-day payment periods.
    • Agencies must understand and manage 432 LUPA home health resource groups (HHRGs).
  • Key Diagnoses Leading to LUPA
    • Some diagnoses, like heart failure and COPD, historically have higher chances of leading to LUPAs.
    • PDGM introduces a broader range of diagnoses that can lead to LUPAs, requiring agencies to adapt and plan accordingly.
  • Impacting Factors of PDGM on LUPA Management
    • PDGM emphasizes the importance of 30-day billing periods, clinical groupings, comorbidities, and the shift to value over volume.
    • Efficient resource allocation, continuous monitoring, and leveraging technology are crucial for LUPA management under PDGM.
  • Conducting a Thorough LUPA Review
    • Agencies should conduct regular LUPA reviews, analyze patterns, implement feedback loops, and educate their team.
    • The review process involves understanding patient needs, strategic visit planning, leveraging technology, and efficient resource allocation.
  • Effective Management of 30-Day LUPA Periods
    • Emphasizes the importance of in-depth patient assessment, strategic visit planning, continuous monitoring, and proactive address of issues.
    • Agencies should harness technology and adopt a collaborative care approach.
  • Optimizing Practices for PDGM and LUPA Success
    • Key focus areas include proactive patient onboarding, collaborative care planning, robust communication channels, and a focus on quality.
  • Critical Strategies for LUPA Management in PDGM
    • Highlights the importance of precision in clinical assessment, data-driven approaches, robust communication channels, and a quality culture.

LUPA Under PGDM: Everything You Need to Know

This comprehensive exploration of Low-Utilization Payment Adjustments (LUPAs) within the Patient-Driven Groupings Model (PDGM) offers critical insights into the evolving landscape of home health care. LUPAs, integral to both clinical outcomes and the financial health of home health agencies (HHAs), present challenges that require strategic navigation. The guide emphasizes the impact of PDGM in reshaping LUPA management, highlighting the shift to a more complex system where LUPA thresholds are determined by varied factors such as clinical grouping and episode timing.

Key to this transformation is the understanding of diagnoses that commonly lead to LUPAs and how the PDGM model expands this range, demanding a deeper, more nuanced approach from agencies. The guide outlines the importance of conducting thorough LUPA reviews, focusing on patient needs, strategic visit planning, and the effective use of technology. Agencies are encouraged to embrace new strategies for managing the 30-day LUPA periods introduced by PDGM, including detailed patient assessments and continuous monitoring to ensure optimal patient care and minimize financial risks.

More Information

This post is the first in our five-part series exploring the transition to PDGM for home health providers. If you’ve found this information to be helpful, you may want to check out Part 2: PDGM Factors, Part 3: LUPA Periods, Part 4: Optimizing Practices, and Part 5: Strategies for LUPA Management.