Providing PDPM-ready therapy staffing to skilled nursing facilities throughout the Tampa Bay Area, Sarasota, and Land O' Lakes.
Changes are coming to how Medicare pays for therapy services at skilled nursing facilities, and you need to be ready for how it could affect your facility. The Patient Driven Payment Model replaces the Research Utilization Group model in October 2019, and your facility needs to prepare. Under PDPM, payments are comprised of six different components. Those components are:
- Physical therapy (PT)
- Occupational therapy (OT)
- Speech-language pathology (SLP)
- Non-therapy ancillary services (NTA)
- Non-adjusted component
One of the biggest ways PDPM differs from RUG-IV is by breaking out the Therapy Base Rate into PT, OT, and SLP Base Rates. Those Base Rates are then multiplied by similarly broken out Case-Mix Indices (CMI), then multiplied by a Variable Per Diem (VPD) adjustment over the course of the stay except for SLP. What do these PDPM changes mean for providing and getting paid for therapy services in skilled nursing facilities?
Fewer hours for therapy. PDPM “focuses on the unique, individualized needs, characteristics, and goals of each patient,” improving accuracy and encouraging care tailored to the patient, according to the Centers for Medicare & Medicaid Services. This means SNFs must more judiciously report to Medicare how their therapy, nursing, and other resources are used by each resident, and could lead to reductions in your therapy staff, an increase in planned group therapy sessions, or other changes.
You don’t have to worry about your residents getting the attention they need. iRehabNow offers your skilled nursing facility the staffing agency you need to manage your therapy professionals and provide for your patients in an effective, Medicare-ready way. Additionally, we can provide services by the hour to develop a flexible model where your staffing matches your exact needs at any given time. You can take any of the HR challenges off your plate as we will handle it all for you. Contact us now for more information!
Frequently Asked Questions
Medicare’s new Patient-Driven Payment Model replaces the Resource Utilization Group models on October 1, 2019. You should have a plan for your skilled nursing facility’s therapy staffing ready before that. Contact us for help.
All information on PDPM is available from the Centers for Medicare and Medicaid Services here on their website. The information on our site primarily discusses the changing components to billing and staffing for therapy.
PT Base Rate * PT CMI * VPD Adjustment Factor, where PT CMI refers to your Physical Therapy Case-Mix Index, and VPD refers to the Variable Per Diem.
OT Base Rate * OT CMI * VPD Adjustment Factor, where OT CMI refers to your Occupational Therapy Case-Mix Index, and VPD refers to the Variable Per Diem.
SLP Base Rate * SLP CMI, where PT CMI refers to your Speech-Language Pathology Case-Mix Index. Currently, SLP is not subject to a VPD Adjustment Factor.
Physical and occupational therapy receive periodic payment adjustments depending on a patient’s length of stay. For the first 20 days, the adjustment factor is 1.0. The factor drops to .98 in Days 21-27 of a qualifying stay, and drops by .2 roughly every week until the stay is completed. The NTA component adjusts to three times the amount for the first three days, then drops to 1.0 for the remainder of the stay.
The HIPPS code stays five characters long. Instead of a RUG Code followed by an Assessment Indicator, the HIPPS code provides one character each for PT/OT, SLP, Nursing, NTA, and Assessment Indicator. You can find new HIPPS codes here, courtesy of the Medicare Learning Network.