As of this moment, you may be wondering how the proposed Patient-Driven Payment Model, or PDPM for short, will impact your business. As you are aware, this new reimbursement model is not just a revision of the current Resource Utilization Group (RUG) system. It is a total overhaul of the payment model used by SNFs since 1998.
Reimbursement under PDPM will be primarily driven by a patient’s diagnosis, rather than the amount of therapy provided. This will significantly impact the way future skilled therapy services are managed and delivered. The new payment model does make it clear that therapy cannot just be ignored because it is not reimbursed by the minute. One cannot lose sight of all factors related to Medicare payment for SNF services, including quality measurement, value-based payment, and star ratings (including monitoring of staffing levels), which remain important areas that will affect the recognition of necessary services, including skilled therapy services.
Although PDPM is currently still under careful consideration, our goal is to help you better understand this new, game-changing payment model.
In May 2018, CMS introduced a new value-based reimbursement proposal, Patient-Driven Payment Model (PDPM). CMS believes PDPM is an improvement over the RUG-IV and the short- lived Resident Classification System (RCS-1) models because PDPM better accounts for resident comorbidities and patient-specific care needs while reducing the emphasis of therapy minutes. In its announcement, CMS touted several potential benefits of the new model, such as a reduced number of payment group combinations, simplified payment calculations and reduced paperwork
PDPM is budget-neutral and classifies each resident into five categories (PT, OT, SLP, Non-Therapy Ancillaries, and Nursing) and provides a single payment based on the sum of these individual classifications.
The adoption of PDPM will have significant lasting impacts on our clients – mainly due to its emphasis on treating the needs of the whole patient instead of focusing on the volume of services the patient receives.
Prime Rehabilitation Services’ Position
Prime Rehabilitation Services is excited and prepared to help our clients succeed within this new reimbursement environment. We have already successfully upgraded our EMR software to the industry leader. Our therapy teams continue to implement CORE evidence-based approaches to standardize care models, determine effective skilled therapy treatment schedules, create new facility specific protocols, and deliver proven, result-driven skilled therapy services with data enriched reporting.
During the lead-up to PDPM taking effect October 1, 2019, Prime Rehabilitation Services’ leadership will apply three distinct categories to our approach to PDPM with our clients and our clinicians: Preparation, Strategy, and Opportunity.
Preparation: Prime Rehabilitation Services is well-prepared and poised for these changes based on our history of delivering evidenced-based therapy that is proven to achieve optimal outcomes. We remain proactive in our therapy delivery. We were ready for PPS and will be ready for PDPM.
Strategy: Through communication, training, and operational consultation, Prime Rehabilitation Services will prepare our clients and our therapists to succeed in this new environment, achieving quality outcomes for the people we serve. There remains distinct value in providing physical, occupational, and speech language pathology skilled therapy services and providing patient-centered care to achieve critical patient outcomes and help SNFs meet quality and other requirements.
Opportunity: We are actively identifying additional opportunities to meet the needs of all of our patients and clients during this industry change. This may include homecare therapy services, wellness classes, and consultation services.
We will continue to share more information on these rule changes and any modifications that take place between now and October 2019.
Rest assured, Prime Rehabilitation Services is staying ahead of the curve.