Last week at the Leading Age of New York Annual Convention in Saratoga Springs, NY, we attended an excellent presentation. Zimmet Healthcare Services Group presented on the new Patient Driven Payment Model (PDPM) slated for an October 1, 2019 implementation.

The Patient Driven Payment Model System is proposed to replace the RUG-IV System for Medicare Part A reimbursement to Skilled Nursing Facilities. PDPM is an updated version of the RCS-1 system introduced last Spring.

The PDPM System is touted as “budget neutral” even the CMS Proposed Rule calls for a large infusion of capital ($850M) into the system.  Whenever any change is introduced as “budget neutral,” that means by definition there must be winners and losers.

If the Patient Driven Payment Model is implemented, we will see the most significant change in the world of Medicare reimbursement since MDS 3.0 in 2010.

The highlights will include:

1. A streamlined MDS Schedule with fewer required assessments.
2. Section GG will be used to record ADLs and will utilize a different scoring mechanism than Section G.
3. Speech Therapy will have its own category, and the skill set of the Speech-Language Pathologists will now play a greater role, especially in assessing new SNF admissions.
4. Reimbursement will be driven by patient characteristics and co-morbidities, instead of the number of therapy minutes delivered.
5. The number of therapy minutes delivered will still be tracked, placing a premium on efficiency and outcomes. RCS-1 left the minute tracking requirement in doubt, and PDPM has clarified.  Critics of the SNF industry historically have objected to a system in which the delivery of therapy minutes is the driver of reimbursement.

Experts feel the PDPM system certainly will remove that from the equation. The public comment period to CMS is open until June 26, 2018. Providers & other stakeholders should share their thoughts.

We’d love to hear your thoughts.