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.
Call 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.
MoreMonday, September 18 | Thought Leadership,Human Services,Care Coordination,Cause Connected,Legislative/Policy,Value-based Care
The opioid crisis is one of the most serious healthcare issues in our nation today. But there is hope. We believe there are three strategies your organization can leverage to combat opioid addiction and overdose: integrated care, policy and technology. This blog outlines some examples of all three and lists helpful resources your organization can use.
MoreThursday, September 14 | Thought Leadership,Human Services,Netsmart in the Community
By understanding mental health and suicide go hand-in-hand we can take the first step in reducing suicide risk and help heal our families, friends and loved-ones heal and grow forward as a community.
More