Thursday, December 13 | Post-Acute Care, Care Coordination, Thought Leadership
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:
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.
Thursday, November 30 | Thought Leadership,Human Services,Netsmart in the Community,Revenue Cycle/Billing
Erica Gregory and Deanna Cerwin, CFO of Resources for Human Development, explore growth strategies highlighting the crucial balance between technology and human resources in expanding behavioral health services. From building a strong foundation to mastering project management, the insights offer a practical roadmap for scaling operations efficiently and meeting the increasing demand for behavioral health services.
MoreTuesday, October 03 | Thought Leadership,Human Services,Partnerships and Collaboration
We are living in an extremely competitive time for human services. So, how can we go into "competition mode" by becoming disruptors and innovators? In this webinar, Neal Tilgman, MPA, Director and General Manager of Integrated Care, interviews two clients who have succeeded by balancing growth and innovation with profitability and sustainability. Learn their secrets to grabbing market share using technology, strategic planning, and automation.
MoreCall to Action: Proposed Cuts Could Deprive Home Health of Necessary Funds
Wednesday, September 20 | Post-Acute Care,Value-based Care
Millions of older Americans could be greatly impacted if the Centers for Medicare & Medicaid Services goes through with its proposed rate cut to the Home Health Prospective Payment system for Calendar Year 2024. One of the most concerning aspects of the proposed rule revolves around its potential impact on home health reimbursement.
More