PDPM’s Effects Could Stretch Far Beyond Medicare for Skilled Nursing Facilities

Medicaid Services

On paper, the Patient-Driven Payment Model (PDPM) will only affect one pillar of the payment equation for skilled nursing facilities. But as players start to unpack the coming rule changes, PDPM’s reach begins to extend far beyond Medicare.

Medicare Advantage and Medicaid frequently base rate calculations on the existing Medicare structure, a pair of experts noted at the American College of Health Care Administrators’ (ACHCA) annual convocation in Louisville, Ky. — and those other payers will increasingly take cues from the PDPM system once the current model goes away.

The Centers for Medicare & Medicaid Services (CMS) will no longer support the existing Resource Utilization Group (RUG) system starting in the fall of 2020, BKD director Robert Lane said Monday, causing a cascading change to the multiple ways SNFs receive reimbursements.

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