Providers overall saw higher reimbursements under the Patient Driven Payment model than what would have come under the Resource Utilization Group system during its first month of implementation, an initial analysis found.
The PDPM-realized average for skilled nursing facilities was about $615 per day, while it was simulated to be $563 per day under RUG-IV, according to a November analysis by consulting firm Zimmet Healthcare Services Group.
The review found that 91.5% of SNFs were “winners,” meaning they enjoyed a positive PDPM impact, while just 8.5% experienced reduced payments.
Zimmet experts said federal regulators are expected to recalibrate rates. They also warned of tougher audits for SNFs, and urged providers to ensure that “everything being captured is being documented” in order to maximize reimbursements.