Whether your professional New Years’ resolution was to master the details of Patient Driven Payment Model or not today is a good day to start or reconsider. This model is complicated and requires significant changes in practice, communication, and documentation for every professional in your facility. If you can afford to leave money on the table do nothing, keep your head in the sand. If not start today to understand PDPM.

Step #1: PDPM Education is a must for every professional in your facility

  • Select a PDPM champion to coordinate educational material and opportunities
  • Form a PDPM Team with key administrative/management personnel involvement
  • Assign specific preparatory tasks, made clear with PDPM education – examples:


How comprehensive is your admissions screening process?

The 5-day Admissions MDS determines the PDPM per diem rate and will be improved with complete, timely data available from all professionals.

Do you have a process for evaluating MDS integrity?

MDS items have been modified for PDPM calculation and the 1st MDS drives the per diem rate for the the entire stay. Consider auditing current MDS accuracy.

Do you have the professional resources to care for clinically complex patients?

PDPM per diem rate is driven by the patient characteristics requiring increased complex care (delirium, depression, functional declines, ventilators, IV therapy, etc). Professional resources must match high acuity, as measured by Case Mix Index.

What is your approach for determining the Primary Diagnosis ICD-10 code?

Calculating the PDPM per diem rate starts with an accurate ICD-10 code. This requirement is new and not always easy for MDS nurses yet drives reimbursement categories. Clinician involved upon admission will be necessary for accuracy.

As your PDPM team proceeds with education even more areas for evaluation and alignment with, be obvious. Mastering the Model starts with education.