Patient Driven Payment Model (PDPM)
PDPM - Are You Ready?

Patient Driven Payment Model (PDPM)

Spectramed leads the way in medical & rehabilitation tools & education to improve efficiency & clinical outcomes under PDPM.

What is PDPM?

The Patient Driven Payment Model (PDPM) is the new case mix classification model that will go into effect on October 1, 2019.  PDPM will replace the resource utilization groups (RUG) that have been in place for years.  In contrast to the RUG levels that where payment was based on minutes, PDPM aims to provide payment determined by patient clinical characteristics.

 What settings will change over to PDPM?

PDPM will be implemented in Skilled Nursing Facilities (SNF) as part of the Prospective Payment System (PPS).  The case mix classification model will be used for patients that are in the facility for a Medicare Part A covered stay.

How does this PDPM impact me as an SLP?

Payment for rehabilitation services received by Part A patients will transition from a minute based system to a system of outcomes & efficiency.  Therefore, there will be an increased focus on the SLP role in the management of the Medicare Part B population. 

For the SLP component, PDPM uses a number of different patient characteristics that were predictive of increased SLP costs:

  • Acute Neurologic clinical classification
  • Certain SLP-related comorbidities
  • Presence of cognitive impairment
  • Use of a mechanically-altered diet
  • Presence of swallowing disorder
SLP Comorbidities
Aphasia Traumatic Brain Injury
Laryngeal Cancer ALS
CVA, TIA, or Stroke Tracheostomy (while Resident)
Apraxia Oral Cancers
Hemiplegia or Hemiparesis Ventilator (while Resident)
Dysphagia Speech & Language Deficits

Based on these factors, patients will be placed in a case mix group.

It’s also important to highlight that CMS has identified a combined limit of 25% total for concurrent and group therapy for each patient per discipline.

For the first time, speech has its own classification group.  Payment reduces every week by 2% for PT and OT day 20.  Payment does stay constant for SLP services. As mentioned above, appropriate identification of dysphagia and cognitive needs will increase payment for the facility.  Clear definition of our plan of care and efficiency of treatment will become more important than ever before for our patients.

What can I do to make the most of PDPM?

  • Evaluate patients early to ensure that cognitive deficits and/or dysphagia have been identified.
  • Plan ahead for therapy sessions to increase efficiency during treatment time.
  • Get creative with group and concurrent therapy ideas to benefit the patients that you treat.
  • PDPM promotes interdisciplinary collaboration. Be prepared to collaborate with PT and OT to promote overall advancement toward goals.
  • Use modalities, as appropriate, to promote progress toward goals in the most efficient manner.

How can Spectramed help?

Join one of our offered courses:

Advanced Practices in Dementia & Dysphagia

NMES and sEMG in Dysphagia Management: The Guardian Way

NMES in Dysphagia Management: The Guardian Way

We provide continued clinical support for all clinicians that attend our courses.

Written by Rick Fisher