PDPM Overview


Patient Driven Payment Model, or PDPM, is a Medicare Reimbursement Plan for a short stay (100 days or less) of post-hospital rehab care. Currently, Medicare rates are tied to the amount of therapy minutes a patient receives. Since facilities are paid less for patients not receiving therapy, it is often provided without clinical need or benefit.

How is PDPM Different?

Medicare Daily rate is now tied to the total amount of care provided by all professionals, meaning facilities will be paid more to care for clinically complex patients. Rates are based on Primary Diagnosis, Function, Cognition, and extensive nursing care.


PDPM daily rate is calculated from the 5-day admission MDS data, where the reason for stay is identified as a Primary Diagnosis (ICD-10). This determines their category for reimbursement.

PDPM Preparation

Engage all management to educate all professionals and appoint PDPM champions. Evaluate all facility resources and align as needed. Enhance all documentation and communication, and be a champion for continued education.

Patient Pattern will help you start navigating the Patient Driven Payment Model and optimizing reimbursements today.

Considering Compliance

We all know what happens on October 1, 2019, and each facility continues to prepare for that day. The Patient Drive Payment…

Therapy Contracts and PDPM

We are about to celebrate the last weekend of summer 2019 and for some in post-acute care this is the last moment…

The impact of frailty on PDPM

Residents who are frail are more clinically complex and have increased nursing care needs. Those whose frailty has increased as the result…

Ready to Roll? A PDPM Update

  Experts and advocates watching PDPM unfold believe that the minimal changes in the recently released CMS proposed rule (CMS-1718-P) for Fiscal…