Part III: Patient-Driven Payment Model
In addition to payment and policy updates for fiscal year (FY) 2019, the skilled nursing facility (SNF) proposed rule includes a proposal to revise the payment model from the current Resource Utilization Groups (RUG-IV) case-mix classification to the Patient-Driven Payment Model (PDPM) beginning on October 1, 2019 for FY 2020.
The proposed rule offers the opportunity to provide feedback to CMS. LeadingAge will be submitting comments and seeks specific member feedback on the following topics covered in this article:
- Expansion from 2 case-mix components to 5 case-mix components and the classification approaches within each.
- Use of variable per-diem rates for physical therapy (PT), occupational therapy (OT), and non-therapy ancillary (NTA) case-mix components.
- Changes to the Minimum Data Set (MDS) assessment schedule.
- Impact of the proposed change on nonprofit SNFs.
According to a 2017 comparison between PDPM and RUG-IV, nonprofit and government-owned SNFs would see increases of 1.9% and 4.2% respectively. Smaller SNFs see increases while those with a capacity of greater than 100 certified units might expect declines. Rural providers would see increases as would facilities that serve residents with less therapy utilization. CMS has made available a number of provider-specific tools that we encourage you to examine to estimate facility specific impacts. A provider-specific PDPM impact analysis is available for the fiscal year 2017 and represents estimated payments under PDPM, assuming no changes in provider behavior or resident case-mix.
This article summarizes highlights of the proposed changes that CMS has described in the proposed rule supported by research in a technical report.
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George is the Chief Financial Officer and Chief Operations Officer for Odyssey Rehabilitation. He has a BBA in accounting from Eastern Kentucky University and his MBA in management from Vanderbilt University. He began his healthcare career working in the hospital setting as a Chief Accountant and progressed to both CFO and COO roles for various hospitals. George also has several years of experience in home health and physician office management services.
Most recently George was the CFO for a large multi-state rehab company and managing partner for a consulting company in the post acute health care arena. George is a member of the American College of Healthcare Executives (ACHA) and an advanced member of the Healthcare Financial Managers Association (HFMA). George is also a lifetime member of the Kentucky High School Coaches Association. He currently resides in Knoxville, TN with his wife and family.
Greg Hayes is the Managing Member and founder of Odyssey Rehabilitation. Prior to starting Odyssey Rehabilitation, Greg attended Fairmont State University where he received his Associate’s Degree as a Physical Therapy Assistant.
His career as a PTA began in a local out-patient clinic before transitioning into Long Term Care for a contract therapy company. Greg quickly moved up the ladder, becoming a Regional Assistant Manager, overseeing operations throughout WV.
In 2006, Greg decided to expand his career into ownership, and started Odyssey Rehabilitation. In a short amount of time, the company has grown to be one of the most recognizable contract therapy companies in the state of WV. Greg currently lives in Worthington, WV with his girlfriend Betsy and their four wonderful kids, Hannah, Tyler, Dillon, and Dalton. He enjoys hunting, golfing & Steelers football in addition to spending time with his family.
Greg is also the business owner of two family owned companies specializing in appliance sales and service, as well as, Twisted Oaks, an outdoor company specializing in hunting products.