Starting on October 1, 2019, the Patient-Driven Payment Model (PDPM) radically changed how skilled nursing facilities (SNFs) are reimbursed for Medicare Part A services. Implemented by the Centers for Medicare & Medicaid Services (CMS), this model redefines payments for physical, occupational, and speech-language pathology services, impacting therapy delivery.
What is PDPM?
Before PDPM, SNFs used the resource utilization group prospective payment system (RUG-IV PPS) since 1998. RUG-IV classified therapy payments based on service days and minutes across six levels: Ultra-High, Very-High, High, Medium, Low, and Therapy Non-Case Mix. However, PDPM introduces separate per-diem payment rates specifically for PT, OT, and SLP services, thus encouraging a more personalized approach to care.
Patient-Driven Payment System: A New Approach
PDPM fosters a patient-centered care paradigm, emphasizing that therapy groups are not a requirement. CMS endorses clinical judgment in choosing therapy modes for each patient.
- Emphasize Outcomes: Patient results are now a cornerstone of reimbursement. AOTA has developed an evaluation checklist to highlight occupational therapy’s unique contributions.
- Monitoring: CMS closely observes staffing levels and patient outcomes under PDPM. Changes in therapy amounts or delivery methods could trigger program reviews.
Want to explore the detailed differences between PDPM and RUG? Our full guide provides in-depth case examples and interactive quizzes to enhance your understanding.
PDPM Occupational Therapy Implications
The shift to PDPM significantly influences occupational therapy practices. AOTA actively works to address and mitigate potential impacts, advocating for the profession’s role under the new model.
PDPM Payment Model Insights
By replacing the RUG levels therapy model, PDPM offers opportunities for providers to focus on value-driven care rather than volume-based services. Are you familiar with how PDPM can affect reimbursement strategies? Engage with our comprehensive content to grasp all essential insights.
PDPM and Physical Therapy
For physical therapy services, PDPM tailors per-diem payments, reinforcing individualized patient plans. As a future NBCOT® professional, understanding these payment structures is crucial for aligning practice with reimbursement policies.
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What is the Patient-Driven Payment Model (PDPM)?
PDPM is a payment model implemented by CMS on October 1, 2019, that changes how skilled nursing facilities are reimbursed for Medicare Part A services by establishing separate per-diem payment rates for physical, occupational, and speech-language pathology services.
How does PDPM differ from the RUG-IV PPS?
While the RUG-IV PPS classified therapy payments based on service days and minutes across six levels, PDPM provides separate per-diem payments for PT, OT, and SLP services, encouraging a personalized approach to care.
How does PDPM impact occupational therapy?
PDPM emphasizes outcomes and encourages a patient-centered care model, which significantly influences occupational therapy practices. AOTA is actively working to mitigate potential impacts and highlight occupational therapy’s role under PDPM.
What are the implications of PDPM on staffing and patient outcomes?
Under PDPM, CMS closely monitors staffing levels and patient outcomes. Any changes in therapy amounts or delivery methods could prompt program reviews to ensure effective treatment and reimbursement alignment.
How does PDPM affect physical therapy reimbursement strategies?
PDPM tailors per-diem payments for physical therapy services, which supports individualized patient care plans and allows providers to focus on value-driven care rather than volume-based services.
