Association Between the PDPM, Therapy Utilization and Patient Outcomes in U.S. SNFs

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

A team of Brown University researchers asked this question: Was the Patient Driven Payment Model (PDPM), implemented in October 2019, associated with rehabilitation therapy utilization and health outcomes of patients admitted to skilled nursing facilities (SNFs)?

Their findings: In this cross-sectional study of 201,084 patients admitted to an SNF after hip fracture between January 2018 and March 2020, those admitted post-PDPM received about 13% fewer therapy minutes than those admitted pre-PDPM, but the likelihood of rehospitalization and functional scores at discharge remained unchanged.

What this study means: Implementation of PDPM was associated with a reduction in the volume of therapy use without changes in subsequent hospitalization risk or discharge functional scores.

The main outcomes and measures were individual and nonindividual (concurrent and group) therapy minutes per day, hospitalization within 40 days of SNF admission, SNF length of stay longer than 40 days, and discharge activities of daily living score.

The link to download the 11-page PDF of this study is found on this page. The study was published in the January 7, 2022 issue of JAMA Health Forum. This is an open-access article. The study used a regression discontinuity (RD) approach among Medicare fee-for-service post-acute care patients admitted to a Medicare-certified SNF following hip fracture between January 2018 and March 2020. [Keep in mind that this study looked at hip fracture care in SNFs from January 2018 through the first six (6) months of PDPM implementation. You’ll recall that the U.S. was entering the initial months of the SARS-CoV-2 pandemic during the last 3 months of this study – in January 2020.]

I encourage you to take a look at this study if you haven’t done so already. It will be interesting to see CMS’ “take” on PDPM going forward, specifically what we’ll find in the proposed SNF PPS rule this April. Stay tuned!