PDPM stands for patient-driven payment model. The PDPM medicare model was created to reduce administrative burdens for health providers by focusing on each patient's unique needs. It works by classifying patients into payment groups based on their data-driven characteristics, goals and needs rather than grouping them into a single, volume-driven group.

As a result, PDPM therapy realigns payment and quality incentives of services within skilled nursing facilities. Continue reading to learn more about the benefits of PDPM, the tools you'll need to thrive under the model, and and how it impacts your center.


How Does PDPM Affect Your Facility?

PDPM affects your facility by ensuring that you provide comprehensive patient care over volume. While past models categorized patients into a single, volume-driven group, PDPM ensures facilities focus on providing unique services to meet each patient's needs, goals and characteristics. 

Comprehensive care can include therapy, nursing and non-therapy ancillaries. The model lends itself to potentially more complex, specific case mixes. As a result, PDPM may also affect your health center by keeping it fiscally healthy and dedicated to providing the best possible care for patients. 

So how does PDPM work, and what individual components does it affect within your facility?  

  • Care management: Unlike past models that incentivize high volumes of therapy to maximize payments, PDPM requires that facilities manage how they deliver services to provide the correct level of care for each patient. Each resident will has their own classification, ensuring that SNFs aren't paid for providing services beyond these individual levels. Under-delivering therapy, however, can lead to poor patient outcomes, potential Medicare audits and take-backs.
  • Financial: PDMP offsets therapy reimbursement losses with higher reimbursement for nursing care already provided. From an economic perspective, contract PDPM therapy providers may have seen a reduction in revenue. However, they may achieve neutral positive profit margins due to PDPM provisions. 
  • Staffing: Lastly, PDPM affects your facility by changing therapy and nursing demands. With a focus on high quality, value based care, the more physician expertise you have-the better the result. 

Overall, the patient-driven payment model redefines the relationship between payment and quality characteristics, realigning payment and quality incentives for PDPM therapy services within your health center. 

With the rising acuity in the subacute, physiatrists have the opportunity to make a much needed difference and improve patients' quality of life.

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Advantages of the PDPM Reimbursement Model

The PDPM reimbursement model has many advantages for centers and patients, from helping improve payment accuracy to ensuring appropriate treatment by focusing on each patient rather than the volume of services provided. It also reduces the administrative burden for providers and enhances SNF payments without increasing overall Medicare payments. 

Here's a breakdown of the benefits of the PDPM medicare system:
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1. Enhances Patient Care and Management

One of the most significant benefits of PDPM medicare is that it emphasizes patient-centered care. Under previous models, facilities were encouraged to over-deliver therapy services to receive more funding. Rather than focusing on providing a specific volume of therapy services to calculate reimbursements, the new model ensures facilities are only reimbursed according to each resident's case mix classification.  

The new model encourages nurses and care coordinators to determine carefully how the center manages and provides care to each patient. While the system prevents over-delivering therapy, it also ensures PDPM therapy is not under-delivering. PDPM prevents patient neglect, and poor outcomes as the Centers for Medicare & Medicaid Services (CMS) can issue facility f-tags and give the facility a lower quality rating. Therefore, PDPM medicare ensures nurses accurately document procedures and personalize services according to each patient. 

2. Improves Financials

The patient-driven payment model promotes improvements in your center's financial stability. It encourages accurate reimbursement calculations according to the services provided. The primary function is to offset therapy reimbursement losses with more accurate calculations. This way, you can maximize PDPM reimbursements while providing optimal care. 

As your facility is accurately reimbursed, you can free up resources in your budget and reallocate them to other areas. Ultimately, the PDPM medicare system exists to improve patient satisfaction and outcomes. 


How Can Medrina Help Your Facility With PDPM?

When you work with Medrina, we can help you maximize your PDPM reimbursement and improve your patient outcomes at no cost to your center. To do this, we: 

  • Enhance your reimbursement: Through our program and proprietary EHR, our physiatrists are able to more accurately capture and effectively document patient complexity with PDPM mapped coding. Medrina centers reviewed in an independent study featured in McKnights experienced an average increase of $34K per month. 
  • Improve communication and documentation: Our physiatrists help combat missed or stalled reimbursements, reduce unplanned discharges and advocate for appropriate lengths of stays to improve your SNF. Our providers are trained in coding for PDPM to gather the necessary information for accurate patient classification. 
  • Deliver personalized care: Our physiatrists specialize in rehabilitation, providing patient-centered care to treat patients with physical, painful or functionally limiting conditions. The primary goals are to maximize patient independence and mobility
  • Transform your SNF into a profitable center: We also aim to improve your center's key quality outcomes, improve your internal revenue sources and turn your SNF into a well-respected center. Our physiatrists can help your SNF stand above other facilities without physiatry programs.



Contact Our Team to Learn More

There are many benefits of PDPM when fully understood and maximized appropriately. To help successfully capture all potential reimbursement, partner with Medrina. Our physiatrists become helpful, hands-on members of your team. Together we will work with MDS to create, implement and document the appropriate care plans for each patient within your center. 

We aim to enhance your patient care and outcomes, maximize their functional potential and increase collaboration and communication among physicians. Contact us today to learn more about how we can help your facility.