The Patient Driven Payment Model has replaced the current reimbursement model, RUGS IV. Under PDPM, Medicare providers are reimbursed for the resources required to provide services for a patient’s condition and level of function. Medicare will no longer reimburse providers for the volume of services provided. Medicare will focus on quality vs. quantity and outcomes will become the priority of PDPM.
How Synchrony Rehab Helps Client Facilities Navigate PDPM
- Patient Care Expertise — To focus on the patient’s condition and resulting care needs rather than on the amount of care provided in order to determine Medicare payment.
- Outcomes Focus — Through innovations care-giving and through meaningful quality measure reporting.
- Cost Management — Helping our facilities reduce administrative costs and increase focus on resident care.
The Impacts of PDPM
- Clinically Relevant Factors — PDPM focuses on clinically relevant factors, rather than volume-based service for determining Medicare payment, by using ICD-10 diagnosis codes and other patient characteristics as the basis for patient classification.
- Non-Therapy Ancillaries — PDPM includes a case mix group for Non-Therapy Ancillary Services (NTAs), which are items and services not related to the provision of therapy such as drugs and medical supplies, thereby more accurately addressing costs associated with medically complex patients.
- SNF per diem payments — PDPM adjusts the SNF per diem payments over time to reflect varying costs throughout the stay.