5 Big Changes That Will Determine Winners AND Losers Under the Patient Driven Payment Model

Last week at the Leading Age of New York Annual Convention in Saratoga Springs, NY, we were able to attend an excellent presentation performed by Zimmet Healthcare Services Group on the new Patient Driven Payment Model (PDPM) slated for an October 1, 2019 implementation.The Patient Driven Payment Model System has been proposed to replace the RUG-IV System for Medicare Part A reimbursement to Skilled Nursing Facilities and is an updated version to the RCS-1 system introduced last Spring. The PDPM System is being touted as “budget neutral” even the CMS Proposed Rule calls for a large infusion of capital ($850M) into the system.  Whenever any type of change is introduced as “budget neutral,” that means by definition there must be winners and losers. If the Patient Driven Payment Model does go into effect, we will see the most significant change in the world of Medicare reimbursement since MDS 3.0 in 2010. 

The highlights will include: 

1.       A streamlined MDS Schedule with fewer required assessments.

2.       Section GG will be used to record ADLs and will utilize a different scoring mechanism than Section G.

3.       Speech Therapy will have its own category, and the skill set of the Speech Language Pathologists will now play a greater  role, especially in assessing new SNF admissions.

4.       Reimbursement will be driven by patient characteristics and co-morbidities, instead of the number of therapy minutes delivered.

5.       The number of therapy minutes delivered will still be tracked, placing a premium on efficiency and outcomes. RCS-1 left the minute tracking requirement in doubt, and PDPM has clarified.  One thing is for certain, critics of the SNF industry have been outspoken against a system in which the delivery of therapy minutes is a key driver of reimbursement. 

Experts feel the PDPM system has certainly removed that from the equation. With the public comment period to CMS open until June 26, 2018, sharing the thoughts of industry stakeholders, providers especially, is encouraged. We’d love to hear your thoughts.