Harmony Healthcare International (HHI) Blog

Therapy Modes of Care Under a Patient Driven Payment Model (PDPM)



Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency

Young physiotherapist exercising with elder disabled person-2Patient Driven Payment Model (PDPM) is the proposed SNF Payment System that correlates payment to the patients’ conditions and care needs rather than volume of services (Cost Based) provided or resources rendered (PPS RUGs System).

Per CMS:

“The proposed new PDPM is designed to improve the incentives to treat the needs of the whole patient, instead of focusing on the volume of services the patient receives, which requires substantial paperwork to track over time. Under the new SNF PPS case-mix model, patients will have that offers services tailored to their more opportunity to choose a skilled nursing facility condition and preferences, as the payment to nursing homes will be more based on the patient’s condition rather than the specific services provided by each skilled nursing facility.” 

One component of the Patient Driven Payment Model (PDPM) is the tapering of payment the longer the patient stays. It is common practice for therapists to develop patient specific transitions of care.  These mechanisms are not new but may have been overlooked under the current payment system. 

Transitioning a patient from daily skilled therapy to a lower intensity of services requires proper planning, clear instructions and multiple methods of educating the caregiver to: 

  • Ensure the Caregiver is competent with rendering the assistance in a safe and effective manner. (i.e., Caregiver Training)
  • Prevent Decline
  • Mitigate Decline
  • Establish an “effective” Maintenance Program 

Communication of the techniques and patient specific needs is not a “one and done” interaction.  The therapist needs to verify and observe the care giver providing the prescribed program without cues or instruction. 

Harmony Healthcare International (HHI) recommends that Caregiver Training is completed prior to the discontinuation of skilled therapy.   

Caregiver Defined 

  • Family Members
  • Nurses
  • Nurse Assistants 

Caregivers are persons who interact and render assistance to the patient along the continuum.  Caregiver training is an essential component of the skilled therapy regimen and is necessary regardless discharge destination i.e., home, assisted living, independent living and the skilled nursing facility. 

Multiple care givers may be involved in the patient’s care.  The therapist must validate that all caregivers are knowledgeable and educated on the daily regimen including but not limited to: 

  • Transfer Techniques
  • Adaptive Equipment
  • Therapeutic Exercises
  • ADL Techniques
  • Cognitive Techniques 


Lower Intensity Modes of Care 

The “hand-off” may vary by patient and continuum.  The mode of the transition may be completed in several ways such as: 

  1. Rehabilitation Low

    Decreasing the frequency from 5 times per week 3 times per week in conjunction with a formalized delivery of restorative 6 times per week is another mechanism for caregiver training. 
  2. Frequency Reduction 

    Decreasing the frequency from 5 times per week to 4 or 3 times per week allows time to monitor the patient’s reaction with less treatment time via the therapist but more time with the stated caregiver. 
  3. Restorative Nursing 

    Depending on the structure of the facility specific Restorative Nursing Program, therapists may integrate the transition from skilled to nonskilled care via the restorative aide.  
  4. Maintenance Therapy

    Daily therapy may continue at various frequencies for patients at risk of decline to mitigate or slow the progression of degenerate prognosis.  This mode of therapy may be required for a period of time to ensure medical safety.  

There is a lot to learn over the next year in preparation for the Patient Driven Payment Model (PDPM).  

Please join us May 25th for our Free-Key Friday Webinar: Patient Driven Payment Model (PDPM) Click to Register

Harmony Healthcare International (HHI) performs monthly compliance audits. If you need help with this area, please contact us by clicking here.  Looking to train your staff?  Join us in person at one of our our upcoming Competency/Certification Courses.  Click here to see the dates and locations. 

 Join us November 1st & 2nd, 2018 at Mohegan Sun Resort for harmony18
7th Annual LTPAC Symposium
Click Here to Register
harmony20 October 29-30 2020 Encore Boston Harbor

Topics: Patient-Driven Payment Model

Kris Mastrangelo, OTR/L, LNHA, MBA


Kris Mastrangelo, OTR/L, LNHA, MBA

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