Thursday, December 13 | Post-Acute Care, Care Coordination, Thought Leadership

Patient-Driven Payment Model (PDPM): A Primer For Skilled Nursing Success

As part of its 2019 Proposed Rule for Skilled Nursing Facility (SNF) Prospective Payment System (PPS), Centers for Medicare and Medicaid Services (CMS) published the Patient-Driven Payment Model (PDPM) which is scheduled to go into effect Oct. 1, 2019. As time ticks down to implementation, providers should become as familiar with the changes as possible to prepare for the upcoming overhaul of the current payment model.

What is Patient-Driven Payment Model, or PDPM?

PDPM is the latest Medicare proposed payment rule for skilled nursing facilities. Under this new budget-neutral rule, reimbursement will be determined by clinically relevant factors rather than the amount of therapy provided, impacting how care is managed and delivered.

From RUG to PDPM: What Changes to Expect

The model requires providers to make major shifts from the current RUG-IV model in a variety of areas:

RUG-IV

PDPM

2 case-mix components 5 case-mix components
Incentives higher for therapy utilization Incentives lower for therapy utilization
Rehab minutes primary driver for payment Rehab minutes do not impact reimbursement
Steady reimbursement throughout length of stay Declining reimbursement throughout length of stay
5 scheduled PPS clinical assessments One scheduled PPS clinical assessment
Group therapy discouraged Group therapy encouraged
More assessments required by MDS coordinators Fewer assessments required by MDS coordinators

What does it mean for my organization?

Organizations will get paid less for therapy-intensive patients and paid more for clinically complex patients. The change in payment suggests rehab providers will shift scheduling patient care delivery and focus on providing group therapies. Additionally, MDS coordinators will be required to complete fewer assessments. These changes will allow clinicians to focus more on delivering efficient and effective care.

What should we do to prepare for the shift to PDPM?

Consider the following as skilled nursing moves closer to the October 2019 PDPM implementation:

  • Get organized and educated. PDPM consists of quite a few changes and updates that require adjustment from many teams including nursing, therapy and Organize a committee or task force assigned to create a plan to help each group make the transition as smoothly as possible.
  • Ensure documentation of care is regularly and accurately recorded to determine the best care plan. As therapy will still be required for many patients, utilize information and data to support making clinical decisions to make sure care is coordinated and efficient as possible.
  • Brush your coders up on ICD-10. Since reimbursement will become focused on diagnoses, ICD-10 codes will be more important than before.

As SNFs shift from a payment model driven by therapy minutes to one based on clinical characteristics, organizations must take steps today to prepare for a successful transition. Stay tuned to CareThreads and NTST.com/pdpm as we continue to provide vital information to help your organization find success in the evolving reimbursement and payment landscape.

 

 

 

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Hannah Patterson · Director Project Management

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