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The Patient-Driven Payment Model (PDPM): What Does It Mean for Skilled Nursing Facilities? (Recorded Webinar)

presented by Ellen R. Strunk, PT, MS, GCS, ACEEAA, CHC, RAC-CT

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Disclosure Statement:

Financial: Ellen Strunk receives compensation from MedBridge for this course. There is no financial interest beyond the production of this course.

Non-Financial: Ellen Strunk has no competing non-financial interests or relationships with regard to the content presented in this course.

Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

MedBridge is committed to accessibility for all of our subscribers. If you are in need of a disability-related accommodation, please contact [email protected]. We will process requests for reasonable accommodation and will provide reasonable accommodations where appropriate, in a prompt and efficient manner.

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This course is a recording of a previously hosted live webinar event. Polling and question submission features are not available for this recording. Format and structure may differ from standard MedBridge courses. On July 31, 2018, the Centers for Medicare and Medicaid Services (CMS) finalized a plan to replace the Skilled Nursing Facility's (SNF) Resource Utilization Groups (RUGs) payment system with a new model for Medicare Part A payment, to be effective October 1, 2019. While the model is similar to the one proposed in April 2018, CMS made some refinements. The new payment methodology will be called the Patient-Driven Payment Model (PDPM). This new payment model will create both opportunities and challenges for SNF providers and SNF therapists, including more focus on Minimum Data Set (MDS) coding, specifically ICD-10 and Section GG coding. Additionally, managing length of stay and managing the amount and type of therapy delivered will be important strategies for providers. Understanding the new system will be critical to future success.

Meet Your Instructor

Ellen R. Strunk, PT, MS, GCS, ACEEAA, CHC, RAC-CT

Ellen R. Strunk, PT, MS, GCS, CEEAA, CHC, RAC-CT, has worked in various roles and settings as both a clinician and a manager/director. Ellen is an expert at helping customers understand the CMS prospective payment systems in the skilled nursing facility and home health settings, as well as outpatient therapy billing for all provider types.…

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Chapters & Learning Objectives

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1. Components of the PDPM

The Patient Driven Payment Model (PDPM) is the SNF Payment System that correlates payment to the patients’ conditions and care needs rather than volume of services (Cost-Based) provided or resources rendered (PPS RUGs System). This chapter will describe the basis for changing the system and the essential components that calculate the new PDPM.

2. The Clinical Categories for PT, OT, and SLP

The first step in determining the patient’s per diem in the new Patient Driven Payment Model (PDPM) is to classify patients by clinical category. This chapter will define those categories, as well as how the patient is classified into one or another.

3. The Role of Function, Cognition, and Nursing Categories

While the role of function has always been an important part of determining the appropriate frequency and intensity of services to be delivered, the Patient Driven Payment Model (PDPM) elevates its importance by linking it directly to the case-mix index. As a result, it will become an important part of determining how much a skilled nursing provider is paid.

4. The Variable Rate Per Diem (VPDA) and MDS Changes

Tapering of therapy services as a preparatory step to discharge planning is not a new concept. What is new is that the Patient Driven Payment Model (PDPM) incorporates this concept into the payment model beginning on Day 21 of a patient’s stay. This chapter will explain how the calculation will work and why it is being used.

5. Action Steps to Prepare for the Implementation of a Change in Payment

The Centers for Medicare and Medicaid Services (CMS) has openly discussed how the Patient Driven Payment Model (PDPM) will provide patients an opportunity “to choose a skilled nursing facility that offers services tailored to their condition and preferences”. This chapter will explore how the PDPM will do this. The role of quality and value will also be discussed, and the important part the interdisciplinary team, including PT, OT, SLPs, Nursing, Activities, Restorative and Dietary professionals have in their facilities.

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