Major changes are coming to the case-mix methodology and payment system for skilled nursing facilities (SNFs) under Medicare.

The following is a summary of what physical therapists (PTs) and physical therapist assistants (PTAs) need to know about the Patient-Driven Payment Model (PDPM), which becomes effective October 1, 2019—and about APTA's ongoing efforts to ensure that patient access to needed physical therapy services is ensured in pursuit of the PDPM's stated goals.

Background

In 2017, the Centers for Medicare and Medicaid Services (CMS) floated a model known as the Resident Classification System Version 1 (RCS-1) that was heavily criticized by a wide range of stakeholders, including APTA. The association argued that the plan was based on an inadequate set of patient characteristics and a poor understanding of the impact of comorbidities, that it devalued the role of physical therapy and discouraged its use, and that this likely would reduce therapy for SNF patients most in need.