Speech Therapy’s Role under the Patient Driven Payment Model

October 2019 brings about the new Patient Driven Payment Model (PDPM) which will change the way SNFs are reimbursed for Medicare Part A patients and elevate the importance of Speech Therapy to an entirely new level.

CMS has recognized the need for speech language, swallowing and cognitive therapy to the patients of the SNF thus creating the need for a robust Speech Therapy Department with strong clinicians who are passionate about treating in the SNF setting and understand the highly complex regulatory environment.

Within the new Patient Driven Payment Model is the newly created Speech Language Pathology (SLP) component.  For the patients of Skilled Nursing Facilities, it means a whole new level of access to Speech Therapy Services and a whole new focus on treating swallowing disorders and other medically driven issues that require the skill set of a Speech Language Pathologist.

Speech Therapy is now one of 5 case-mix adjusted components under PDPM (Speech Language Pathology, Nursing, Physical Therapy, Occupational Therapy & Non-Therapy Ancillaries) that are separately calculated and unique categories under PDPM.  The Skilled Nursing Facility will now be operating a Speech Department that includes per-diem speech therapists and part time speech therapists as well that needs to function in an entirely new fashion.  Furthermore, the SLP category has the largest dollar variation from top to bottom (SA $15.86 to SL $92.81) than any of the other clinical categories.  Therefore, coding the SLP component in PDPM correctly is essential for optimal and accurate reimbursement.

Under the Patient Driven Payment Model, the newly developed SLP component has 12 distinct levels of reimbursement.  These levels are the result of the speech language pathologist answering five questions, and these questions are grouped into two separate (and differently weighted) groups.  The second group has much more to do with eating chewing and swallowing. 

Group One:

1. Does patient’s primary diagnosis fall under acute neurologic or non-neurologic?

2. Is there an SLP related comorbidity?

3. Is there a moderate to severe cognitive impairment?   

Group Two:

4. Is there a swallowing disorder? 

5. Is the resident on an altered diet?

Language Fundamentals poised to deliver the quality care in an economical fashion that SNFs will need to be successful under PDPM.

With a strong and progressive Speech Therapy Department, SNFs can optimize PDPM reimbursement, grow case load, and provide the clinically appropriate speech care that today’s SNF patients require.

Contact us at 845-897-3330 to discuss how we can help raise the level of Speech Therapy Services provided at your Skilled Nursing Facility to an entirely new level.