February 1, 2019
PDPM is the SNF Patient Driven Payment Model that will be effective Oct. 1, 2019. Notice that the first P in PDPM stands for the patient. This new system focuses heavily on patient characteristics, rather than on the volume of services delivered. According to CMS, “[b]y addressing each individual patient’s unique needs independently, PDPM improves payment accuracy and encourages a more patient-driven care model.”
SNF providers will continue to complete the Minimum Data Set (MDS) Resident Assessment Instrument to classify patients into payment categories under PDPM. PDPM, with its focus on the patient, includes a number of different changes to the MDS assessment and processes as compared to the current RUG-IV model. PDPM also incorporates information from many more items from the MDS to classify patients and thus, to determine reimbursement.