Inevitably, healthcare incentives continue to transition from the traditional fee-for-service (FFS) model to a value-based payment system. A recent modernization to how the Centers for Medicare & Medicaid Services (CMS) will pay providers for skilled nursing facility (SNF) performance is proof. And if you want to achieve success in alternative payment models (APMs), such as bundled payments and accountable care organizations (ACOs), the new SNF payment model is something to pay close attention to.
Over the summer, CMS announced the Patient-Driven Payment Model (PDPM), which was confirmed in the Final Rule for the SNF Prospective Payment System. Effective Oct. 1, 2019, the PDPM replaces the current case-mix classification model (the Resource Utilization Group system) for Medicare Part A FFS payment to SNFs. While skilled nursing providers have some time to prepare, those participating in bundled payments or ACOs should also take note of this major change.