PDPM: Everything Skilled Nursing Facilities Need to Know | Netchex
April 12, 2019

The Centers for Medicare and Medicaid Services (CMS) finalized the Patient-Driven Payment Model (PDPM) in July of 2018. The guidelines will become effective on October 1, 2019. This blog post will explain PDPM in a nutshell.

PDPM in a Nutshell:

The PDPM is a new classification system. The rules will directly affect Skilled Nursing Facilities (SNFs). They involve a revamped method of calculating reimbursements. Under PDPM every resident is provided a case-mix classification. This classification drives the daily reimbursement rate for that patient.

How PDPM Could Affect You:

PDPM poses a unique challenge for care providers. Special attention must be paid to offering the right level of care to residents. Providing more care than necessary could result in a reimbursement deficit. Inadequate care could result in decreased patient satisfaction or even a Medicare audit.

Analysts don’t expect PDPM to have much of an impact on SNF budgets.

Are You Prepared for PDPM?

October 2019 is almost here! As it nears, here are some ways you can prepare your SNF for PDPM:

Focus on Families:

Keeping family members in the loop can help SNFs stay on track with mutually-important goals. Discharge managers should keep families in mind. They should clearly communicate options for future medical and therapeutic care post-SNF discharge. This helps keep families informed throughout the process. It also provides a buffer for any preparations or accommodations they will need to make in advance.

Provide Efficient Care:

Keeping the entire care spectrum in mind will lead to improved resident outcomes. (And better reimbursements.) SNF’s goals should be reflective of caregivers at the next facility. They should also consider the atmosphere there, as well as the need for potential changes to living arrangements.

Use Data:

No matter what data you have access to or where it’s located, make decisions based on the best available information possible. Care that is both designed and backed by research has been proven to lead to more timely and positive outcomes.

In Summary:

The CMS has shifted the focus away from patients paying for care quantity. They’re also placing greater emphasis on care quality. Because of this change, SNFs should avoid strategies centered around clever billing and coding techniques. Instead, SNFs should focus on patient care plans that address the care their residents need.

More PDPM Resources: