{"id":95003,"date":"2026-08-20T15:05:38","date_gmt":"2026-08-20T19:05:38","guid":{"rendered":"https:\/\/livingstonepartners.com\/?post_type=insights&p=95003"},"modified":"2026-08-20T15:05:38","modified_gmt":"2026-08-20T19:05:38","slug":"how-will-pdgm-affect-home-health-ma","status":"publish","type":"insights","link":"https:\/\/livingstonepartners.com\/fr\/insights\/how-will-pdgm-affect-home-health-ma\/","title":{"rendered":"Quel sera l’impact du PDGM sur les M&A dans les soins de sant\u00e9 \u00e0 domicile ?"},"content":{"rendered":"\n

Jim Moskal<\/a>, associ\u00e9 et co-responsable de la pratique Sant\u00e9 chez Livingstone, a partag\u00e9 son analyse de l’impact du PDGM sur les M&A dans un article initialement publi\u00e9 dans HomeCare Magazine<\/a>.<\/strong>

Lorsque les Centers for Medicare & Medicaid Services (CMS) ont finalis\u00e9 le Patient Driven Groupings Model (PDGM) en octobre 2018, cette mesure a \u00e9t\u00e9 consid\u00e9r\u00e9e comme la plus importante refonte du remboursement des soins de sant\u00e9 \u00e0 domicile depuis deux d\u00e9cennies. Con\u00e7u pour \u00e9liminer les incitations \u00e0 la sur-prestation de services th\u00e9rapeutiques en pond\u00e9rant les caract\u00e9ristiques cliniques (ainsi que d’autres informations sur le patient), ce mod\u00e8le r\u00e9duit \u00e9galement de moiti\u00e9 l’unit\u00e9 de paiement traditionnelle par \u00e9pisode de soins, la faisant passer de 60 \u00e0 30 jours.

Ce changement implique que les agences doivent planifier, prodiguer, documenter et facturer les soins deux fois plus souvent. Une autre pr\u00e9occupation li\u00e9e \u00e0 ce mod\u00e8le de paiement concerne ses ajustements comportementaux controvers\u00e9s, \u00e0 savoir des r\u00e9ductions de tarifs con\u00e7ues pour compenser la possibilit\u00e9 anticip\u00e9e que les agences de soins \u00e0 domicile modifient leurs pratiques afin de maximiser leurs paiements sous le PDGM. Initialement, le CMS proposait un ajustement comportemental r\u00e9duisant les paiements de 6,42 % ; celui-ci est pass\u00e9 \u00e0 8,01 %, avant d’\u00eatre ult\u00e9rieurement ramen\u00e9 \u00e0 4,36 %, chiffre sur lequel il a \u00e9t\u00e9 finalis\u00e9.

Historiquement, l’impact moyen des ajustements comportementaux au cours d’une ann\u00e9e donn\u00e9e se situait entre 2 % et 3 %, loin de l’ajustement de r\u00e9f\u00e9rence maximal de 8,01 % pr\u00e9conis\u00e9 par le CMS pour le PDGM. Les prestataires ont soutenu que ce niveau de r\u00e9f\u00e9rence \u00e9tait irr\u00e9aliste et potentiellement d\u00e9vastateur pour les petites et moyennes agences.

Depuis l’annonce du plan fin 2018, les experts ont tir\u00e9 la sonnette d’alarme quant \u00e0 des sc\u00e9narios sombres, allant de r\u00e9ductions tarifaires \u00e0 l’\u00e9chelle du secteur jusqu’\u00e0 des estimations sugg\u00e9rant que jusqu’\u00e0 30 % des agences de soins de sant\u00e9 \u00e0 domicile pourraient d\u00e9poser le bilan.

Sans surprise, l’activit\u00e9 de fusions-acquisitions (M&A) s’est ralentie au cours du second semestre 2019, les prestataires \u2014 et les acqu\u00e9reurs \u2014 attendant l’entr\u00e9e en vigueur du nouveau mod\u00e8le de remboursement le 1er janvier de cette ann\u00e9e. Le volume de transactions dans le secteur des soins de sant\u00e9 \u00e0 domicile et des soins palliatifs a fl\u00e9chi au troisi\u00e8me trimestre 2019 ; il a chut\u00e9 de 23 % avec 20 transactions annonc\u00e9es publiquement, contre 26 acquisitions au deuxi\u00e8me trimestre.

Par rapport au troisi\u00e8me trimestre 2018, o\u00f9 25 acquisitions avaient \u00e9t\u00e9 annonc\u00e9es, l’activit\u00e9 M&A dans les soins \u00e0 domicile et les soins palliatifs a diminu\u00e9 de 20 %. Le PDGM se profilant \u00e0 l’horizon, les acheteurs se sont montr\u00e9s plus optimistes en 2019 \u00e0 l’\u00e9gard des entreprises de soins palliatifs en raison de l’environnement r\u00e9glementaire relativement stable de ce secteur.

La transaction la plus notable dans les soins \u00e0 domicile en 2019 a \u00e9t\u00e9 finalis\u00e9e en mai, lorsque AccentCare a \u00e9t\u00e9 acquise par la soci\u00e9t\u00e9 de private equity Advent International. Aucune transaction de taille significative n’a \u00e9t\u00e9 conclue au second semestre 2019, o\u00f9 les op\u00e9rations plus petites et les acquisitions compl\u00e9mentaires (\u00ab tuck-in \u00bb) sont rest\u00e9es pr\u00e9dominantes.

\u00c0 bien des \u00e9gards, l’ann\u00e9e 2019 a pos\u00e9 les jalons de nombreuses transformations majeures attendues pour 2020. Ce nouvel environnement d’affaires dictera la mani\u00e8re dont les prestataires op\u00e9reront au cours de l’ann\u00e9e \u00e0 venir, les agences de petite, moyenne et grande taille \u00e9tant confront\u00e9es \u00e0 leurs propres s\u00e9ries de d\u00e9fis et d’opportunit\u00e9s. La consolidation et l’adaptation pr\u00e9vaudront tout au long de l’ann\u00e9e.

Livingstone Partners anticipe un premier trimestre 2020 calme en termes d’activit\u00e9 M&A, suivi d’un accroissement du deal flow d\u00e8s le deuxi\u00e8me trimestre et tout au long de l’ann\u00e9e, \u00e0 mesure que les agences de soins \u00e0 domicile confront\u00e9es \u00e0 la baisse des remboursements sous le PDGM chercheront \u00e0 c\u00e9der leur entreprise pour pr\u00e9server leur viabilit\u00e9 financi\u00e8re. Cela cr\u00e9era des opportunit\u00e9s pour les acteurs les plus solides du secteur, qui pourront acqu\u00e9rir des parts de march\u00e9 \u00e0 bon compte, ce qui stimulera le volume des transactions tout en pesant probablement sur les multiples de valorisation.

Encore consid\u00e9r\u00e9 comme un secteur tr\u00e8s fragment\u00e9, les soins de sant\u00e9 \u00e0 domicile pourraient conna\u00eetre une consolidation \u00e0 des niveaux in\u00e9dits depuis la mise en \u0153uvre du Prospective Payment System il y a 20 ans. En plus des acqu\u00e9reurs strat\u00e9giques qui \u00e9tendent leurs parts de march\u00e9 via des acquisitions, le private equity va tr\u00e8s probablement s’investir encore davantage dans les soins \u00e0 domicile cette ann\u00e9e. Les fonds de private equity disposent d’un tr\u00e9sor de guerre de 1 500 milliards de dollars de capital non investi \u2014 des liquidit\u00e9s plus abondantes que jamais.

En fin de compte, le secteur survivra au PDGM mais affichera un visage radicalement diff\u00e9rent une fois la temp\u00eate pass\u00e9e, en particulier en ce qui concerne le nombre d’agences. Les agences priv\u00e9es qui survivront et prosp\u00e9reront apr\u00e8s le PDGM seront parfaitement positionn\u00e9es pour se pr\u00e9senter comme des opportunit\u00e9s de plateforme aupr\u00e8s de la communaut\u00e9 du private equity.<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":3,"featured_media":100059,"template":"","meta":{"_acf_changed":false,"footnotes":"","_links_to":"","_links_to_target":""},"categories":[3398,3395],"tags":[],"sector":[],"service":[],"class_list":["post-95003","insights","type-insights","status-publish","has-post-thumbnail","hentry","category-thought-leadership","category-in-the-press"],"acf":[],"yoast_head":"\nQuel sera l'impact du PDGM sur les M&A dans les soins de sant\u00e9 \u00e0 domicile ? - Livingstone Partners<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/livingstonepartners.com\/fr\/insights\/how-will-pdgm-affect-home-health-ma\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Quel sera l'impact du PDGM sur les M&A dans les soins de sant\u00e9 \u00e0 domicile ?\" \/>\n<meta property=\"og:url\" content=\"https:\/\/livingstonepartners.com\/fr\/insights\/how-will-pdgm-affect-home-health-ma\/\" \/>\n<meta property=\"og:site_name\" content=\"Livingstone Partners\" \/>\n<meta property=\"og:image\" content=\"https:\/\/livingstonepartners.com\/wp-content\/uploads\/2026\/05\/iStock-1061370190.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"2448\" \/>\n\t<meta property=\"og:image:height\" content=\"1224\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/livingstonepartners.com\\\/fr\\\/insights\\\/how-will-pdgm-affect-home-health-ma\\\/\",\"url\":\"https:\\\/\\\/livingstonepartners.com\\\/fr\\\/insights\\\/how-will-pdgm-affect-home-health-ma\\\/\",\"name\":\"Quel sera l'impact du PDGM sur les M&A dans les soins de sant\u00e9 \u00e0 domicile ? 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