Payment levels remain the big mystery with new PDPM

Share this content:
The PDPM records the amount of therapy, a relieved Morton notes.
The PDPM records the amount of therapy, a relieved Morton notes.

The newly proposed Patient Driven Payment Model is a breath of fresh air to providers because it will utilize 80% fewer payment group combinations than its suggested predecessor, RCS-1.

It also will use more standardized items for payment calculations and “greatly simplify” paperwork requirements by comparison, Centers for Medicare & Medicaid Services officials said. They estimate PDPM will reduce reporting requirements enough to create $2 billion in systemwide savings over the next decade.

“This will help the providers understand how their patients will classify into the various case-mix groups and reduce provider burden somewhat,” noted Cynthia Morton, executive director of the National Association for the Support of Long-Term Care. “We see a couple big changes that NASL advocated for, including the ability to change a patient's case mix group over the life of the stay.”

CMS said the new classification system would allow patients to choose a skilled nursing facility with services tailored to their condition because payments will be tied to condition rather than each specific service provided.

“The big question is whether the application of the new model will result in assessing patients and then reimbursing for their care appropriately,” Morton said.