Healthcare Landscape

Changes Coming to the Payment Driven Payment Model (PDPM)

I was a therapist that treated residents in Skilled Nursing Facilities (SNFs) prior to 1998. At that time, therapy rooms typically consisted of a vacated resident room with a small stack of cones, a few wrist/ankle weights, and a therapy mat if you were lucky. Documentation was limited to a few carbon copies and quick notes in a hard chart.

In 1998, we were introduced to CMS Prospective Payment System (PPS) / Resource Utilizations Groups III (RUG III). The Medicare program reimbursed SNFs based on their costs with per-diem limits on routine expenses (room, board and routine nursing) but with no limits on ancillary services, including therapy services and medications.  Our world changed and we had to adjust.

PPS/RUG III limited costs to the predetermined payment level or less and introduced us to a case-mix adjustment. Because of the projected reduction of reimbursement to SNFs, there was the concern about lower quality of care, declining outcomes and resident discharge patterns.

Over time we have seen RUG refinements including, increased focus on outcomes, increased documentation expectations and continued updates to CMS PPS. The residents that have received SNF/PPS services are now discharged from hospitals sooner and admitted to SNFs with acute conditions and increased comorbidities. As therapists, we have continued to provide quality rehabilitative services, improved our documentation skills, focused on positive outcomes and have watched our residents achieve goals in often shorter periods of time.

The industry rode the wave and adapted to what seemed like constant change, and we continually exceeded the expectations of those we served.

In July 2018, CMS finalized a new case-mix classification model, the Patient Driven Payment Model (PDPM), that will be used under the SNF PPS to classify SNF patients in a covered Part A stay.

Effective October 1, PDPM will classify patients into payment groups based on specific, data-driven patient characteristics that considers clinical categories, function, comorbidities and other relevant factors. We will no longer classify patients into payment groups based on the volume of therapy services provided.

We will ride the wave of change again, and we will continue to provide outstanding therapy services that improve outcomes and provide clinical pathways to help our patients achieve their goals.

-Mindy Lankenau, Senior Vice President of Clinical Services

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