PDPM (Patient Driven Payment Model)

WHAT IS PDPM?

On July 31, CMS announced the final rule for the skilled nursing facility future prospective payment system: PDPM (Patient Driven Payment Model).

CMS will reimburse facilities based on characteristics of the resident, versus volume of care delivered. This will be a shift from current system where payment is primarily driven from therapy minutes delivered and ADL scores.

The new system of payment will be effective October 1, 2019. There will be no transition or overlap of payment systems.

KEY COMPONENTS

• Still requires Medicare three-day qualified hospital stay.
• SNF skilled payment established by five-day MDS for entire stay.
• Five case-mix adjusted components: PT, OT, SLP, NTA (non-therapy ancillaries) and skilled nursing classifications.
• Section GG scoring will be used to determine a patient’s functional level and associated CMI contribution for payment.

CMS goals: decreased the complexity of the system and administrative burden on facilities by reducing the number of payment categories and required number of MDS’s . The PDPM payment model will more accurately compensate facilities based on the complexity of each patient.  Another CMS goal is budget neutrality and estimates based on 2017 MDS data is that PDPM does not cost CMS overall any more or any less – but the difference varies by facility.

Key Rehab’s Approach TO PDPM

Be Prepared!

The key to success during this change is to acquire knowledge of the new program and regulations, identify clinical and operational opportunity for success, and gain your confidence that we will not only succeed, but thrive TOGETHER in the new structure.

KNOWLEDGE

At Key Rehab we are working hard to understand the changes and nuances of PDPM. We can assist your facilities in navigating through the new coding process and functional scoring. We have recorded webinars available.

We will have online trainings available for your staff. Throughout 2019, we will be offering our customers webinars on what PDPM is all about. All trainings will be recorded for later viewing. We will also be offering some regional, in-person seminars, in addition to meeting with you and your staff to plan for the transition.

CLINCIAL and OPERATIONAL OPPORTUNITY

Key Rehab will help you understand the key clinical components of PDPM in order to assist with achieving necessary functional outcomes, reductions in hospital readmissions, and achieving financial success.

^{Check out the PDPM provider specific impact analyzer on CMS website using your facility specific MDS data at the following link: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/the...}

^{We are currently rolling out extensive trainings in complex medical care for our therapists as well as providing monthly continuing education events on various clinical, philosophical, and ethical topics, so that our therapists have the clinical skills, regulatory knowledge, and integrity to unlock your patient’s highest potential.}