Patient Driven Payment Model (PDPM)

PDPM is a new case-mix classification system that went into effective October 1, 2019. This model classifies patients into five components: physical therapy (PT), occupational therapy (OT), speech language therapy (SLP), non-therapy ancillary (NTA), and nursing; for purposes of providing a single payment based on the sum of these classifications and maintains a per diem adjustment factor for PT, OT, and NTA components. PDPM has a combined 25 percent limit on concurrent therapy and group therapy for each discipline of therapy provided.

Under PDPM, ONR excels in the following core competencies:

ICD-10 Coding/Timeliness
MDS Scoring Accuracy/Timeliness
ADL & Functional Scoring
Cognitive Scoring/Interplay With SLP
Proactive, Aggressive Case Management
Nursing Documentation Redesign for Better MDS Alignment
Therapy Clinical Protocols/Pathways

What ONR does to assist its facility partners with PDPM

Training

 Section GG

ICD-10

RNA

 PDMP Crosswalk

 SMART© Screening Tool

 Capture✔©

Key Takeaways with PDPM

  • This model is designed to be budget neutral, meaning no money will be removed from the system
  • While PDPM does not establish minimum thresholds for therapy delivery for per diem rates, it does offer stronger language to protect the provision of therapy at intensities on par with RUG-IV delivery
  • Optimizing therapy efficiency will be a key success strategy for both SNF operators and rehabilitation providers with PDPM
  • The PDPM better reflects the interdisciplinary needs and services that are necessary to care for individuals in SNF