How can my facility’s nurse leaders get ready to admit higher-acuity residents under PDPM? 

Under the Patient-Driven Payment Model, skilled nursing facilities are likely to treat higher acuity residents and surveyors’ attention to appropriate admissions and avoidable readmissions will intensify. 

In an ongoing Centers for Medicare & Medicaid grant initiative to reduce rehospitalizations, the agency is targeting pneumonia, dehydration, congestive heart failure, urinary tract infection, skin ulcers, cellulitis, COPD and asthma as the causes of 80.3% of SNF rehospitalizations. The grant’s goal is to pay for hospital-level care in participating SNFs, preventing rehospitalizations and saving Medicare dollars. 

Points of focus for grant recipients include:

• Early identification of resident changes in condition 

• Parenteral therapy, including intravenous (IV), intramuscular (IM), and subcutaneous fluids or medications such as antibiotics 

• Nebulizer or respiratory therapy 

• Cardiac monitoring and arrhythmia management 

• Lab/diagnostic test coordination and reporting

• Complex wound-dressing changes 

• Implementation of quality improvement programs (e.g., Interventions to Reduce Acute Care Transfers)

• Training from external consultants on preventive practices to avoid acute changes in condition 

• Increased nursing (e.g., RN) presence in the facility 

• Health information technology solutions at times of transition in care

While some of these activities (like cardiac monitoring) may be beyond your facility’s current level of services, this list can help target staff competency training and program improvement. 

Please send your nursing-related questions to Judi Kulus at