Patient-Driven Payment Model (PDPM)

Master PDPM. Improve your financial operations. Ensure top-rate care for your residents. 

Patient Driven Payment Model (PDPM) Overview

Effective October 1, 2019, the Centers for Medicare and Medicaid Services (CMS) replaced the RUG-IV Medicare reimbursement system for Skilled Nursing Facilities with the Patient Driven Payment Model (PDPM) for traditional Medicare A residents. The system is designed to ensure residents receive therapy based on need, rather than meeting a minimum therapy requirement. While this reimbursement method may help to improve patient outcomes in some cases, it can present a challenge for Skilled Nursing Facilities that are receiving Medicare reimbursement based on therapy hours. In order to ensure the financial stability of your facility, and ultimately, provide the best care possible to your residents, it is critical that your staff fully understands and utilizes the PDPM system. 

How Will Your Organization Be Impacted?

Under PDPM, your organization will feel financial and operational impacts. One major impact is that reimbursement will reduce over the length of the Medicare stay. These reimbursement changes will affect staffing and therapy costs. It will be critical for your organization to accurately report ICD-10 codes in section I and the hospital surgical procedure in section J of the MDS. Staff members will need education at the very least, but it may be necessary to have someone ICD-10 certified, which can take up to 9 months. 


LeaderStat Consultants Know the Ins and Outs of the New System

Our expert consultants can help your team master the new model. They will help you understand how the clinical characteristics of the patient will determine reimbursement rather than therapy minutes. Changes to the MDS assessments may mean additional training for your team. Our consultants can educate your staff on the new assessments and help determine how to best redistribute staff hours under the new system. LeaderStat can help evaluate and retool your clinical staff so you are able to increase patient satisfaction and positive outcomes.