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The PDPM is a shift away from volume-driven SNF payment to a model that focuses on the unique characteristics, needs, and goals of each patient.

Medicare’s Patient-Driven Payment Model was implemented in October 2019 to improve payment accuracy by addressing each patient's circumstances independently and classifying patients into payment groups based on specific, data-driven patient characteristics. PDPM redefines the relationship between payment and quality measures, realigning payment incentives and quality incentives.

The implementation of PDPM makes it ever more important to show the value and cost-effectiveness of physical therapist services within skilled nursing facilities.

Claims that the PDPM itself mandates reductions in care simply aren't true. Similarly, assertions that the new system requires maximum use of group therapy, sets out productivity requirements, limits medically necessary therapy service, and dictates which therapy disciplines provide care based on payment categories are not accurate. These myths should not be the basis for any changes to facility protocols that impact patient care.

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CMS' SNF final payment rule proceeds with implementation of the Patient-Driven Payment Model (PDPM).

SNF, IRF Final Rules Follow Through on Proposed Shifts in SNF Payment Syste...

Aug 01, 2018 / News

The final 2019 rules for SNFs and IRFs are substantially similar to what CMS proposed in the spring, but that's not to say PTs should assume it's a "same rule, different year" situation.