Patient Driven Payment Model (PDPM): Preparing for success

So, to PDPM, we say ‘Bring it on’! We are ready and we will continue learning and preparing for success. As always, your success is our success. Keep moving forward with Trinity Rehab Services.
February 2, 2019
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What is Patient Driven Payment Model

The Patient Driven Payment Model (PDPM) is coming soon to a Skilled Nursing Facility near you! In short, this new payment model from the Centers for Medicare and Medicaid Services (CMS) is designed to replace the current RUGs based system (Resource Utilization Groups). This is a move by CMS toward a value-based payment model and this new model will incorporate more patient characteristics to determine reimbursement than ever before.

We succeed by being involved and communicating what we know

This new Payment Model begins on October 1, 2019. We have a Trinity Rehab Services ‘Countdown Clock’ on our website as a reminder. Even so, we will measure success not on getting TO the start of PDPM, but by getting thru and thriving within this new payment model. There are several ways we are already in the process of preparing for this success.

First, we have been involved in providing comments and feedback to CMS for nearly two years now. This started with the early analysis of the predecessor proposed model called RCS-1 all the way thru the FY 2019 Final Rule with details related to PDPM.

Second, we continued with requests for clarification by CMS thru NASL and APTA on specifics related to the new payment model. We asked about the ICD-10 coding, transitions plan, and RAI Manual specs. Yes, answers take time, but they are being provided. Along the way, we offered solutions to some of the questions we were asking. This is how we know we are ready!

Third, we have analyzed our data for FY 2017 and FY 2018. From this analysis, we have identified triggers and trends for further review. We have also identified changes that can be made today to improve care even further.

Finally, a while ago, we started our education offerings for our employees and our customers on what PDPM is and how we can be successful under this new payment model.We will continue this education process from now thru the start of PDPM and then, again, after this model is in play. As you may already know, your success is our success!

Impact on SNF Providers: Prepare today

So what impact will this have on me as a SNF Provider? We have great insight based on data, analysis, and experience. In addition to our ability to upload past MDS submissions into our system for processing, we have looked at specific patient scenarios, completed audits of medical records, and utilized various grouper tools to assess these changes. In addition, CMS has released a Provider Impact Analysis of their own.

Even with this extensive data analysis, the reality is this payment model change is an academic experiment based on past data. From this academic experiment, CMS will be applying this change, with no pilot testing, across the entire country, starting October 1, 2019.  So yes, there are preparatory activities we can all do now. These include audits and analysis for a better awareness of individual facility practice patterns. In addition, we can begin now to change the process of entering ICD-10 codes. We can also change our review process prior to submission. These changes will make the actual switch over to the new model even easier. One reality we are already finding is some of the past MDSs’ did not include all clinically relevant diagnostic data. This implies that correcting this may allow us to provide even better, even more coordinated care now and in the future. This is also why we created an MDS Checklist to help our customers in this review process. We expect our customers to do well under this new payment model and we are there to help along the way.

Impact on therapists: Continue providing excellent care

And what impact will this have on me as a therapist? Based on comments from the industry, there will be an even greater focus on functional mobility and self care outcomes in the future. Here at Trinity, we already have great insight based on our data. Our therapists have already provided us with suggestions to make the documentation process easier and more efficient. We have incorporated these suggestions and more.

In addition, for several years, our outcomes mirrored the CARE Tool, which was the predecessor to Section GG. More recently, when Section GG was updated, we updated our Outcome tool. In addition, with feedback from our therapists, we improved our documentation workflow so therapists did not need to open a new module to enter outcome information. Instead, we enter once to use this information many times. This means we enter once on the eval (Plan of Care), update on the Updated Plans of Care, and then provide the final score on the Discharge Summary. Our therapists love this change! From a reporting perspective, this means we can provide even more valuable information to our customers for their marketing purposes.

During the past few years, we have seen a significant increase in care provided under Managed Care Payers. In addition, we have had the opportunity to work within the Bundled Payments for Care Initiatives (BPCI) models and ACO models of payment. In short, this experience has helped us prepare coordinated care pathways, collaborative communication processes, and high satisfaction services for our patients and our customers.

With PDPM, we do believe their will be a time of transition. Even so, we are working now to make this transition process even easier. Ultimately, we believe therapists will be able to provide even better, more coordinated care. In short, we have kept our focus on what is important—our customers, our employees, and the residents we have the privilege to serve.


So, to PDPM, we say ‘Bring it on’! We are ready now and we will continue learning and preparing for success. As mentioned already, your success is our success. Keep moving forward with Trinity Rehab Services.