Implementing the Patient Driven Payment Model-Perspectives from Skilled Nursing Facility Administrators

Area of Science:

• Healthcare Management
• Health Economics
• Geriatric Care

Background:

• The Patient Driven Payment Model (PDPM) is a significant Medicare payment reform for skilled nursing facilities (SNFs) implemented in October 2019.
• Understanding administrator perspectives is crucial for evaluating the impact of such payment system changes.

Purpose of the Study:

• To explore SNF administrator retrospective views on their preparation and initial implementation of the PDPM.
• To identify strategies used by SNFs during PDPM transition.

Main Methods:

• Qualitative analysis of 156 interviews conducted with administrators across 40 SNFs in eight U.S. markets.
• Retrospective examination of administrator experiences and preparedness for PDPM.

Main Results:

• Administrators reported feeling well-prepared for PDPM implementation.
• Preparation involved staff training on patient assessment and documentation, and recognizing incentives for complex patient admissions.
• Therapy staffing changes primarily affected contract employees, with less impact on SNF-employed therapists.

Conclusions:

• Payment reform's financial incentives necessitate careful consideration of long-term effects on care quality and access.
• Reimbursement structures should align with the actual cost of providing high-quality SNF services.
• Continuous monitoring of PDPM's impact on SNF care quality and patient access is recommended.