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It's A Whole New World of PDPM


Unless you have been living in a bubble, you have heard that CMS has proposed a new SNF Medicare payment model. This proposed payment model is entitled ‘Patient-Driven Payment Model’ or ‘PDPM’ for short.  It is the first all-new SNF Medicare reimbursement system in 20 years and it is proposed to go into effect October 1, 2019.

The new model is designed to meet the needs of the whole patient instead of focusing on the volume of services provided. Although the goal for PDPM is to be budget-neutral, one can expect significant changes in how resident care drives revenue. The new model will base payments upon an array of patient characteristics and the complexity of the patient. As a result, therapy minutes will no longer drive payment as in the RUG-IV model.  

PDPM is still a per diem payment system and is the sum of five independent case mix payment components plus a non-case mix component. These six components combine to create a daily rate and include:   

•    PT component   

•    OT component   

•    SLP component   

•    Nursing component   

•    Non-therapy ancillary component   

•    Non-case mix component

There is also a variable payment element to the new model. The PT, OT and NTAS components of the daily rate will decline over the length of stay. Being a contract therapy provider, Stein Ancillary Services is most interested in how the three therapy components are calculated. All three begin with first identifying the patient’s overall clinical category. PT and OT rely heavily on the responses of the required Section GG while SLP relies on a patient’s cognitive abilities and the presence of any swallowing disorder. By identifying these key data points, a daily rate can be calculated for each of the therapy components following CMS provided formulas.

Over the next few months SAS will continue to study and review the new changes. This study will result in changes to both clinical care and software to best serve our clients and their residents. Through these changes Stein Ancillary Services is committed to providing outstanding customer services and quality clinical outcomes for our patients.

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