PDPM Readiness

Key Changes from RUGs to PDPM

Right now, many of you are wondering how the proposed Patient-Driven Payment Model, or PDPM for short, will impact your business. To be clear, this new reimbursement model is not just a revision of the current Resource Utilization Group (RUG) system. It’s a total overhaul of the payment model used by SNFs since 1998.

ClassificationRUG uses service-based metrics to classify patients in a SNF into one of 66 possible groups that include two case-mix indexed components:
1. Therapy
2. Nursing
PDPM groups patients into 10 primary classifications that include five case-mix indexed components:
1. Physical Therapy (PT)
2. Occupational Therapy (OT)
3. Speech-language Pathology (SLP)
4. Nursing
5. Non-therapy Ancillary (NTA)
ReimbursementRUG uses an index maximizing system – rates are based on the highest paying component – which incentivizes higher therapy utilization.

Rates are constant throughout a patient’s length of stay, as long as services provided remain constant.
PDPM uses an index combining system – which financially incentivizes each component of the case mix. Higher therapy utilization is not rewarded.

Rates decline 2% every 7 days after day 20 of a patient’s stay.
Modes of TreatmentGroup and concurrent therapy are financially discouraged.
Group and concurrent therapy are financially beneficial up to 25%
Assessments5 scheduled PPS assessments:
5-day, 14-day, 30-day, 60-day, 90-day; and unscheduled
Required assessments include the 5 day scheduled PPS assessment and the DC assessment. The Interim Payment assessment with be an optional assessment.

TMC PDPM Webinar Series

PDPM Preparedness – Dementia Staging – Learn how Dementia Staging empowers teams to have meaningful interactions with residents and its reimbursement implications in PDPM.

PDPM Preparation – Restorative Nursing – How will your Restorative Nursing program measure up under PDPM?

PDPM Preparation – MDS Coding – Learn how to accurately code the conditions and needs of your patients under PDPM.

PDPM Therapy Pricing – The 3 Things You Need to Know – Learn how to choose the PDPM pricing option that best aligns with your clinical and financial needs.

PDPM The Basics – This short webinar will review the basic components of PDPM and how case mix is determined.

PDPM Preparation is Key – Learn what you and your staff can be doing now to prepare for PDPM.

PDPM – Navigating Your Way Through PDPM – This is a comprehensive overview of PDPM that goes beyond The Basics.

PDPM: A Financial Game Plan

Click here to read TMC’s article on building a winning team, that was featured in McKnight’s Business Solutions Online.

We’re Responding with a Revolutionary Clinical Model.

Rest assured, TMC is staying ahead of the curve. We’re currently developing a proactive model of care versus the reactive model our industry uses now. This means better care for patients, and more efficient systems for you. In fact, we’ve already made impressive progress in a number of critical areas.

If you’d like to know more about how TMC is preparing for the PDPM change, and how our new processes can help you prepare, too, call us now at (800) 804-9961 or contact us.

We have used multiple therapy providers over the years and have found TMC to be the best. They have been consistent in retaining staff, have an outstanding compliance program and denial management program. They are on the leading edge with technology, which is a major plus for us, and I am sure it would be for you all as well. Outcomes and customer service surveys have been outstanding. I highly recommend TMC without reservation.
Owner, Skilled Nursing Facility Chain
Out of difficulties grow miracles.

Jean de la Bruyerre