Thank you for joining us for week 6 of our blog series, “Preparing for the Patient Driven Payment Model (PDPM).” This week, we will discuss length of stay as it relates to PDPM.
The Centers for Medicare & Medicaid Services (CMS) has stated that the PDPM is budget neutral. This means that reimbursement under the PDPM will be the same compared to the current Resource Utilization Groups classification system (RUG-IV) based on the data from FY 2017.
According to the CMS technical report, here is the summary of the advantages of PDPM:
|Advantages of PDPM|
Unlike the current RUG-IV system wherein meeting and maintaining the required therapy minutes for the category during the entire episode of care are the keys to the reimbursement rate, the PDPM’s five case-mix groups: Physical Therapy (PT), Occupational Therapy (OT), Speech Language Pathology (SLP), Nursing, and Non-Therapy Ancillary; comprises the calculation for the reimbursement rate. Each of these case mix groups have their own formula for calculation.
Under the PDPM system, facilities with a length of stay of approximately 20 days or less would fare well. That is true when looking at the PDPM PT and OT case-mix rate calculation within the first 20 days of the SNF stay. Starting from day 21, the PT and OT case-mix rate decreases by 2% every 7th day.
|Day in Stay
||PT/OT Adjustment Factor|
The length of stay is only one factor that would affect the reimbursement when the PDPM goes into effect. There are several aspects of this payment model that must be considered as well. Facilities would have to assess their current practices and programs to make the appropriate changes on how to provide the necessary care for each of their patients. Dealing with this as early as possible would assist in the facility’s successful transition to the PDPM. One thing is for sure, the focus is still achieving positive clinical outcomes.
To recap our series from the beginning, check out week 1.
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