How the Patient Driven Payment Model Shifted Admissions Strategies and Understanding of Care Needs According to Skilled Nursing Facility Administrators

The Patient Driven Payment Model (PDPM), a major reform in the way Medicare reimburses for skilled nursing facility (SNF) care, went into effect in October 2019, prioritizing intensity of nursing care provided over volume of therapy. The purpose of this study was to understand how the PDPM shaped SNF admissions and care delivery, using SNF administrator perspectives. Findings from this qualitative thematic analysis suggest that the PDPM created incentives for SNFs to prioritize more clinically complex patients over patients requiring less complex rehabilitation, improved care coordination between hospitals and SNFs, as well as within the SNF interdisciplinary care team, and emphasized the patient documentation review required for reimbursement. Findings suggest that these changes contributed to SNF care teams better understanding patients' care needs. When considering how best to balance efficiency and quality in patient care delivery, it is important to understand the nuanced changes the PDPM has on SNF operations.