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Do SNF providers agree with CMS’ documented advantages of PDPM?

CMS reports the following advantages of the new Patient-Driven Payment Model.


1. Removes therapy minutes as the basis for therapy payment

2. Establishes separate case-mix-adjusted component for Non-Therapy Ancillaries (NTA) services, thereby improving targeting of resources to medically complex beneficiaries and increasing payment accuracy for these services.

3. Enhances payment accuracy for nursing services by making nursing payment dependent on a wide range of clinical characteristics rather than being primarily a function of therapy minutes and functional status.

4. Improves targeting of resources to beneficiaries with diverse therapy needs by dividing single therapy component into three separate case-mix-adjusted components: PT, OT, and SLP.

5. Provides additional resources to facilities for treating potentially vulnerable populations, including beneficiaries with the following characteristics: high NTA utilization, extensive services (ventilator, respirator, or infection isolation), dual enrollment in Medicare and Medicaid, end-stage renal disease (ESRD), longer prior inpatient stays, diabetes, wound infections, IV medication, bleeding disorders, behavioral issues, chronic neurological conditions, and bariatric care.

6. Enhances payment accuracy for all SNF services by: (1) basing payment for each component on predicted resource utilization associated with clinically-relevant resident characteristics and (2) introducing variable per-diem payment adjustments to track changes in resource use over a stay.

7. Promotes consistency with other Medicare and post-acute payment settings by basing resident classification on objective clinical information while minimizing the role of service provision in determination of payment.


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