PDPM: Why Therapy Is More, Not Less


Out with the old, in with the NEW! Unlike the system it is replacing (PPS), the Patient Driven Payment Model (PDPM) focuses on individual patient characteristics and comorbidities in deriving payment.  Every patient will be unique, each an individual.  The care provided to patients under PDPM will need to be individualized as well. The “one size fits all” mentality will not lead to success under PDPM, as PPS has done little to account for or address a patient’s unique medical issues and comorbidities. PDPM will change care as we know it.


If your current therapy provider has historically over utilized resources under PPS, delivering care will prove to be a challenge under PDPM. All members of the interdisciplinary care team will need to change mindset as well as processes – your therapy team is no different.  All staff will need to be educated on how to be successful under the new rules and guidelines. How success has been typically managed and gauged will need to be reassessed.  So why all the change? The focus is ensuring patients receive the individualized care that is required.  Outcomes are key! Reducing hospital readmissions is a primary focus! Returning patients to their highest functional level of independence by providing the services they really need is essential!


PDPM will expose those therapy providers who relied on delivering the bare minimums, both in staffing and treatment. The key to finding a solid partner in this transition lies in the therapy companies who already operate with a “patients come first” focus.  Ask the tough questions; make sure the partnership you share with your therapy provider gives you the right tools to succeed under PDPM.


Pathways, Program and Outcomes, Oh My!

What will therapy look like under PDPM? Successful therapy partners will look to have the following initiatives under the new payment system.

  • Creating and modeling care pathways for each of the major patient characteristics/diagnosis.
  • Program development tied to and connecting care pathways. Therapy programs designed to yield specific outcomes and results in a timely and focused manner can result in improved outcomes, which can lead to increased referrals from hospital partners.
  • Full time staff who is available to work with patients and their families on an individualized care plan as well as to ensure right level of therapy to gain their independence or functional improvement.
  • A comprehensive staffing model in which each discipline is a key player in monitoring any patient changes and reporting that to MDS.
  • Integration – your therapy team should be ingrained into the fabric of your facility. You should never hear, “This is our therapy provider”; What you seek is, “This is our therapy team here at Happy Acres Nursing and Rehab”.
  • A strong focus on education and all healthcare partners involved. Balancing therapy provision to outcomes is key. Too little and the SNF risks rehospitalization, poor outcomes and ultimately a poor reputation in their community.
  • Frequent communication in efforts to support the SNF under PDPM. Therapists will have a role in helping with assessments as well as delivering care and monitoring patients for declines.
  • Accurately utilizing group and concurrent therapy. Remember, CMS is watching how we utilize this tool.
  • Tracking outcomes is also important. CMS as well as referring hospitals will be watching to see who can deliver the best care within an efficient window of time.
  • Recruiting the best of the best. Having the right therapy team with the right mindset and clinical skill sets in your facility will be an important factor come October 1st. You want therapists who have the skill and passion for treating clinically complex patients. Your therapists should view the clinical complexities and comorbidities of your patients as puzzles that MUST be solved. Hospitals refer to facilities who have proven success and who they feel confident will have the knowledge base to provide an individualized level of care.
  • Building relationships with open communication. Is your therapy company willing to be a part of the relationship building process? Are they walking the walk with you or just talking the talk? During the payment transition and ultimately for the long road ahead, all hands should be on deck when it comes to establishing solid relationships and expectations with hospitals and SNFs.


Think About This…

  • How does your current therapy provider stack up against these initiatives?
  • Are you confident you have the resources, time, expertise and longevity needed to run an in-house program under PDPM?
  • Given the climate of PDPM, is your therapy provider a business partner or just a therapy staffing company?
  • Who will be your partner to communicate and liaise with hospitals?
  • Therapy accounts for three of the five reimbursement silos under PDPM, how strong is each department? Do they have the clinical competencies to produce better outcomes under PDPM and be able to justify and support it in their documentation?
  • Is your therapy team embedded into the fabric and culture of your facility? How is their communication and relationships with the other members of the care team?
  • Operational support. Like facility staff, therapy staff will change. How is your current therapy provider positioned to offer training, education and support to new members to the therapy team?

If you are unsure how your therapy provider stacks up, reach out to us today for more information on our services! The only poor decision is an uniformed one.


For more PDPM education for you and your team, check out PDPM Basics: Navigating our Medicare Future on our youtube channel.

Kristi Fredieu

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