We are now in week 4 of the PDPM implementation and many nursing facilities are beginning to grasp the impact the model imposes on every discipline. Established practices of the pre-admission assessment are not adequate for collecting all the medical information needed for a comprehensive picture of the patient’s conditions and subsequent nursing care needs. Hospitals are usually not providing all the needed information and perhaps have not been informed by the nursing facility that more information – very specific information – is needed. PDPM wants to pay facilities for the care provided but it must be identified and documented or it will not contribute to the optimal per diem reimbursement rate.

Many facilities are struggling to implement adequate communication structures so each discipline will know when there is a change, whether that change impacts their services, whether the changes combined add up to a “change in condition” appropriate for an Interim Payment Assessment (IPA) MDS. Other facilities are not requiring (or not having success requiring) increased medical provider involvement but are continuing in previous practices and guessing at the ICD-10 codes. Although the responsibility for accurate coding lies with the medical providers in some cases they are not readily available for verifying the diagnoses and so MDS nurses are filling the gap and likely leaving money on the table.

Patients too are likely to see a difference especially in the area of therapy and although their therapy needs may be adequately met, and recovery made, they may be surprised if the one-on-one therapy provided routinely in the past is now provided in a group setting. To avoid dissatisfaction it will be important to convey any changes in practice to patients and families prior to admission. Patient and family satisfaction is always important and, along with overall high-quality care and stellar outcomes, a facility will be on a fast track to becoming a facility where patients want to receive rehabilitation.

The preferred provider status is achievable and the requirements of PDPM can move a facility along to that status. For more information on this read:


Andrea Gele, October 7, 2019, McKnights News