As an advocate for nursing home residents, Rothkoff Law Group strives to educate our clients, their families and consumers about regulatory changes that may affect the care their loved ones receive.   In October 2019, the Centers for Medicare and Medicaid Services (CMS) implemented a new payment model for skilled nursing facilities (SNFs), the Patient-Driven Payment Model (PDPM).  PDPM is described by CMS as a patient-driven care model  that focuses on the diagnoses and characteristics of the patient rather than the services, including the therapy services, provided to them. The system creates different financial incentives for SNFs than previous models.  For instance, facilities now receive a higher reimbursement rate for residents who are more clinically complex, including those who need ventilators and/or IV medications, are severely cognitively impaired, and residents with depression.  At the same time, the more therapy a resident needs, the less the SNF is paid.

As a result of the new therapy payment reimbursement model, there is an incentive for SNFs to give less individualized therapy.  Additionally, under PDPM, Medicare has a “declining per day payment rate”, which means that a facility is paid more on the first day of a patient’s stay than on the last and lengths of stay exceeding 15 days bring in lower rates.  There are concerns that this could incentivize SNFs to discharge residents before they are physically ready to leave the facility and without proper accommodations made for their continued care.   

There are many issues arising during a nursing home stay that do require proper advocacy.  Should you have any questions regarding these issues, please feel free to contact our office.   Below is an article by the National Consumer Voice for Quality Long Term Care explaining in detail the new PDPD and the issues involved.  

The New Medicare Patient Driven Payment Model (PDPM): What Does It Mean for Residents?