PDPM – The Question on Everyone’s Mind

by Vanessa Cardenas, Chief Operating Officer

The question on everyone’s mind regarding the new payment model, the Patient-Driven Payment Model (PDPM) is, “Since, counting therapy minutes does not affect reimbursement under PDPM, will my facility still be paid for all three therapy components (PT, OT, and SLP) even if therapy is not actively treating or only one discipline is treating minimally?”

The answer is YES!

While that might be great news for your bottom-line, “getting paid” for not providing, it will cost you gravely on the back end.

Under-utilization of therapy will be a target area with a massive bullseye on it.
The lack of therapy will be used against your facility under PDPM.

Think of it this way, if your facility averages 75% RU in the last few years and there is a significant change in the amount of therapy provided once October 1, 2019 rolls around, you can be sure that your facility will be under watch.

CMS will be monitoring therapy minutes under this new payment model by way of the Discharge PPS Assessment. You can bet with eighteen (18) items added to the MDS Discharge Assessment, related exclusively to provision of therapy, CMS is carefully monitoring.

“If we discover that the amount of therapy provided to SNF residents does change significantly under the proposed PDPM, if implemented, then we will assess the need for additional policies to ensure that SNF residents continue to receive sufficient and appropriate therapy services consistent with their unique needs and goals.”


[Federal Register Volume 83, Number 89 (Tuesday, May 8, 2018)]

[Proposed Rules] [Pages 21018-21101]

From the Federal Register Online via the Government Publishing Office

Looking into the future, do you think your referral sources will continue to recommend your facility when outcomes suffer, re-hospitalization rates increase, star ratings decline, and the therapy gym is a ghost town since you decided to cut therapy services under PDPM?

What will Prime Rehabilitation Services do in the PDPM era?

Simply, we will continue to deliver the amount of skilled therapy services necessary to get the most effective outcomes for all patients in the most cost effective manner for our clients.

When the dust settles, when you do right by the patient by giving them all that they need in this highly competitive value based market, you have nothing to worry about. The data along with each patients’ outcomes will speak for themselves.

In this competitive market, you will need to think outside of the box when it comes to therapy, outcomes, and preferred provider partnerships. Trust that Prime Rehabilitation Services will be instrumental in your successful transition to PDPM.




  1. Roxie Jackson on September 20, 2018 at 8:38 pm

    Two words, trust and instrumental. Visionary statement, wonderfully written Vanessa Cardenas COO

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