A Deep Dive Into A Patient Driven Payment Model (PDPM) – An Educational Seminar Highlighting Therapy

By: Vanessa Cardenas, COO

On May 22, 2019, the Corporate Management team of Prime Rehabilitation Services and Mobile Therapy Services hosted a follow-up education seminar diving deep into Patient Driven Payment Model (PDPM) for our Directors of Rehabilitation.

The overall theme was that skilled therapy services are still a key driver of reimbursement in the PDPM model.  While this reimbursement model is no longer based on the volume of minutes, it is based on the patient’s outcome and clinical needs.

Therapy will still play a key role within the interdisciplinary team to identify skilled needs, appropriate diagnosis and clinical category selection, the classification of the true function of the patient as well as determining the patient’s cognitive status and accurately documented in several very important sections of the MDS.

Our dedicated directors were engaged as we focused on PDPM, its’ role, and opportunities, along with modes of therapy delivery, including group suggestions.

Yaffa Liebermann PT, GCS, CEO, and Eli Liebermann, Ph.D., MBA, President, provided a presentation on the most recent version of the RAI Manual related to defining the three main modes of therapy, used for documenting therapy minutes on the discharge MDS and within therapy documentation.

As a reminder:

  • Individual Minute: The treatment of one resident at a time. The resident is receiving the therapists’ or the assistants’ full attention. Individual minutes do not need to be done consecutively. The total number of individual treatment minutes should be added together for each treatment day.
  • Concurrent Minute: The treatment of 2 residents at the same time. These residents are not performing the same or similar activities. Both of these residents are in line of sight of the treating therapist or assistant.
  • Group Minute: The treatment of 4 residents, regardless of payer source, who are performing the same or similar activities, and are supervised by a therapist or assistant who is not supervising any other individuals.

Each Director also had the opportunity to present suggested group activities that will engage their patient population. Many wonderful suggestions and questions were discussed during the various presentations throughout the day.

At the end of the day, all in attendance were inspired this the new opportunities that PDPM offers along with the clearer understanding of Mobile Therapy Services role in therapy delivery arena.

We are certain that outcomes will be a critical driver in the near future, which has been our core focus in our best practices.

Within this value-based reimbursement model, we strongly believe Prime Rehabilitation Services is poised to be a strong leader within the post-acute care setting today, tomorrow and beyond.

Action Item

Prime Rehabilitation Services firmly believes that respective organizations should play a major role in framing new regulations.

Most recently the American Physical Therapy Association (APTA) released the following:

APTA Regulatory Action Alert – Comment Opportunities

Below are proposed federal regulations and guidance that may have an impact on you and your practice setting. APTA staff are reviewing them and will be submitting comments. We encourage you to submit individual comments, as well, in response to these proposed regulations and requests for information. Should you do so, please follow the submission instructions provided within each proposal and use APTA’s regulatory advocacy template letter as a guide.

CMS Skilled Nursing Facility Proposed Prospective Payment System for FY 2020: The Centers for Medicare and Medicaid Services (CMS) has released its proposed rule for the Fiscal Year 2020 skilled nursing facility prospective payment system (PPS). No significant changes are proposed to the new case-mix model, the Patient-Driven Payment Model (PDPM), which becomes effective October 1, 2019, the start of FY 2020. Among the PPS proposals: CMS would revise the definition of “group therapy” from consisting of exactly 4 patients performing same or similar activities to consisting of 2-6 patients—to align with the definition used in the PPS for inpatient rehab facilities. CMS also proposes to use a subregulatory process to make nonsubstantive changes to the list of ICD-10 codes used to classify patients into clinical categories under the PDPM. Additionally, CMS would adopt a number of standardized patient assessment data elements that assess cognitive function and mental status; special services, treatments, and interventions; medical conditions and comorbidities; impairments; and social determinants of health. APTA will provide comments, and individuals may submit comments independently using APTA’s specific template letter (link below). We particularly encourage individuals to respond to CMS’s proposal to revise the group therapy definition.

Deadline for Comments: June 18, 2019
Review Proposed Rule (.pdf)
Review fact sheet
Take Action: Submit comments | Submit comments using APTA’s unique template letter (.doc)


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