Skilled nursing is saying goodbye to therapy minutes and welcoming a new payment model. The Patient-Driven Payment Model makes patients the focus of the care plan. This is a major shift away from volume-based services to value-based services designed to depend on the patient’s clinical classification.

This change will take effect October 2019. Here is what you need to know and how you can prepare.

What is PDPM?

PDPM is a new Medicare payment model for skilled nursing facilities (SNF). This replaces the current Resource Utilization Groups IV (RUG-IV) system, creating a different way of calculating reimbursement.
This change is intended to enhance payment accuracy for therapy, nursing, and non-therapy ancillary services by relying on patient characteristics as the payment dependent rather than therapy minutes.
PDPM creates a case mix based on all factors related to the patient and assigning a score based on that case mix.

The six components used to calculate scores are: nursing, physical therapy (PT), occupational therapy (OT), speech-language pathology (SLP), non-therapy ancillary (NTA), and non-case-mix.

These components add up to a total rate.

Here are other major changes with PDPM:

  • Focus on patient characteristics (including diagnosis and function)
  • Therapy minutes are no longer a factor in determining the PDPM level
  • Combined limit of 25 percent on group and concurrent therapy services
  • Two required (and one optional) unscheduled Minimum Data Set (MDS) assessments
  • Over 28,800 payment categories, up from 66 under RUG-IV

How to Prepare

PDPM is a major change and can seem overwhelming at first. Take action now to prepare for these important changes by educating yourself about the new system.
Infinity Rehab is here to help.

Our approach is to provide reassurance so you will be prepared for the new payment model. We will partner with you to develop an individualized strategy to your specific market. Lastly, we will identify clinical and operational opportunity for your business to thrive during this industry change.
At the core of this approach is our commitment to quality outcomes for everyone we serve.

Reach out to Infinity Rehab Director of Compliance & Strategy Michelle Jabczynski with any questions you have regarding these changes and their implementation plans.
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