PDPM Preparedness | CareTeam - The collaborative platform.

PDPM is coming.

Are you ready to adapt?

Beginning Oct 1, 2019 all PDPM-related policies will take effect.
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CareTeam, the collaboration platform for SNFs

The Patient Driven Payment Model (PDPM) is the new Medicare payment rule for Skilled Nursing Facilities (SNFs) regarding their short-stay patients (staying 100 days or less). PDPM is intended to replace the Resource Utilization Group, Version IV (RUG-IV) system.

The outgoing RUG-IV model compared to the new PDPM model for 2019 and beyond

Why is CMS switching to PDPM?

Medicare reimbursements are currently associated to the amount of therapy minutes a patient receives. Under RUG-IV, SNFs get paid less for patients that do not receive therapy. This incentivizes facilities to often over-deliver services regardless of patient's needs, goals or the clinical benefits.

PDPM mandates that providers focus on the patient's unique needs, rather than the volume of services provided. PDPM is designed to be budget-neutral, so the focus will be on reducing costs via elimination of 'unnecessary' services and streamlining care.

PDPM casse-mix adjusted components, per patient

PDPM Classification

PDPM daily rate will be calculated from the 5-day admission MDS data, where the reason for stay is identified as a Primary Diagnosis (ICD-10). This determines the category for reimbursement. All patients are classified into groups for each of the five case-mix adjusted components:

  • Physical Therapy (PT)
  • Occupational Therapy (OT)
  • Speech Language Therapy (SLT)
  • Non-Therapy Ancillary (NTA)
  • Nursing

PDPM arrives in

Don't get caught unprepared!