The patient-driven payment model (PDPM) has revolutionized health care for providers and their patients. These systems heighten treatment accuracy and ensure clients receive accurate billing for their visits. How does PDPM optimization improve facility financial performance? Since its 2019 implementation, it has helped health care providers become more stable and prevent losses.
What Is PDPM?
The Centers for Medicare and Medicaid Services made PDPM official in October 2019 under Medicare Part A. Skilled nursing facilities (SNFs) use this novel reimbursement system to determine how much patients pay based on their needs. In previous systems, providers calculated the payment based on the patient’s time receiving care.
Transitioning to PDPM models marked a significant shift in the health care industry. By replacing the Resource Utilization Group (RUG) system, healthcare providers cut waste and more accurately reflect each patient’s care. A 2024 Journal of Applied Gerontology study concluded this reimbursement system accurately reflected services while maintaining quality care.
How Does PDPM Optimization Improve Facility Financial Performance?
Optimizing PDPM services includes training staff, accurately assessing patients and collaborating with care teams. When you enhance these systems, you increase efficiency and boost financial performance for your health care organization. Here are a few ways your company financially benefits from optimized PDPM models:
- Accurate calculations: PDPMs help health care facilities more accurately determine their reimbursement. Providers can worry less about providing insufficient or too many services for patients
- Resource allocation: Wielding a PDPM lets organizations optimize staffing levels and reduce labor costs. When patients receive the correct care, employees are more effective while providing quality care.
- Care planning: Patients receive more individualized care and tailored therapeutic services. They also benefit from more accurate payments and fewer headaches.
- Fewer denials: PDPM systems encourage improved documentation and evaluations. Therefore, the likelihood of a denial based on patient information decreases.
- Data-backed decisions: Optimized PDPM software leverages advanced analytics to make more intelligent decisions. Data drive trends and operational strategies to heighten financial performance.
Methodology for Determining the Best PDPM Programs
When health care facilities transition to a PDPM, evaluating the best services is essential. Here are five criteria necessary for judging a business’s services.
| Training programs | PDPM services should include training to educate staff on coding and other requirements. |
| Customization | Scalability is essential, as a one-size-fits-all approach doesn’t fit all health care organizations. |
| Continuous support | The service provider should provide ongoing support after installation. |
| Industry reputation | A proven track record ensures effectiveness in transitioning to PDPM platforms. |
| Data analytics | The software should wield data analytics to track performance and optimize reimbursement. |
The Best PDPM Programs for Health Care Professionals
How does PDPM optimization improve facility financial performance? This reimbursement service is essential for forward-thinking health care facilities. Here are the five best programs for professionals.
1. Medrina
Since its founding in 2010, Medrina has been an industry leader in post-acute care. The brand makes your PDPM transition easier by implementing its proprietary electronic health record (EHR) system. SNFs leverage the physiatry services for optimized financial performance, given Medrina’s proven track record. One study found its model saved over $34,000 per facility by improving reimbursement.
Key Features
| Largest physiatry group in the U.S. | Proprietary health record system |
| Communication and documentation service improvements | Targets patient independence and mobility |
2. PointClickCare
PointClickCare understands the need for value-based care, so it helps health care providers prepare for PDPM services. Its 5-part Success Program is one of its hallmarks, and its products support smooth transitions. For instance, the performance insights heighten financial visibility and operational metrics in patient care.
Key Features
| Comprehensive transition to PDPM | Continuous performance insights |
| Pre-admission assessments and eligibility verification | Real-time record coordination for physicians and residents |
3. Consonus Healthcare
Consonus Healthcare specializes in pharmacy, rehabilitation and consulting. For PDPM, it stands out as an sector leader because of its scalable solutions. If your health care facility is small, it ensures you only have the resources necessary to thrive. Once you implement your PDPM, you receive ongoing consulting guidance to smoothen operations.
Key Features
| Ongoing consulting guidance | Promotes early pharmacist intervention |
| Scalable solutions | Optimized reimbursement calculations |
4. RealTime Medical Systems
If efficiency is the top priority, RealTime Medical Systems may be the best for you. This firm shores up financial losses by identifying missed coding and reimbursement opportunities. Staff benefit from live data from nursing notes and the EHR, thus heightening transparency.
Key Features
| Live data from EHR | PDPM integration with existing workflow |
| Identifies missed coding opportunities | Pinpoints overlooked reimbursement |
5. Gravity Healthcare Consulting
Gravity Healthcare Consulting specializes in transitioning workers from old payment systems to PDPMs. The proprietary training system aids understanding by teaching the most critical elements of PDPM software. Then, trainees participate in hands-on training to learn pitfalls and test their skills. Gravity Healthcare Consulting also stands out with its auditing tools and risk identification.
Key Features
| Comprehensive training services | Scours MDS for accuracy and documentation |
| Proprietary auditing tool | Risk identification to boost accuracy |
Leveraging PDPM Models for Improved Healthcare Outcomes
Cost-effectiveness and efficiency are essential for health care facilities and their patients. Before 2019, the industry used RUG-IV, which was often too complex. However, PDPMs have user-friendly interfaces and identify cost-saving opportunities. This transition is crucial for health care organizations, so leaders should explore the best options for them.