“To survive, and flourish, it is critically important to understand the nature of the changes impacting the (SNF) sector today. Failure to do so, particularly with the major disruption that is now just beginning to take hold, will likely result in some operators going out of business.” Kramer, Provider, 2018

  1. Definition of PDPM: The Patient Driven Payment Model is a Medicare Reimbursement Plan for a short stay (100 days or less) of post acute nursing home care (PAC).
  2. Less Requirments: RUGS – IV goes away – Number of MDSs lowered
  3. Facts:   Current Medicare rate tied to minutes of rehab patient receives

Facilities now paid less for patients not receiving therapy

Facilities will be paid more to care for clinically complex patients

  1. Recommendations:

EDUCATE all professionals, including Medical Director

EXPAND all professionals’ communication and documentation practices

EVALUATE all facility resources and align as needed

ENGAGE all management + appoint PDPM champions


  • Dates to remember:

Today is the day to start to plan for PDPM – unless you started yesterday

Tomorrow is the day to check out the CMS site for information    https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/PDPM_Fact_Sheet_MDS_Changes_Final.pdf

October 1, 2019 is the day when reimbursement starts under PDPM

All current Medicare A patients must have PDPM MDS completed

October 7, 2019 is the last day to submit this required PDPM MDS