Patient-Driven Payment Model (PDPM)
Definition: The Medicare payment model for skilled nursing facilities that classifies patients into payment groups based on clinical characteristics rather than the volume of services provided. Replaced the RUG-IV system in October 2019.
In Practice
PDPM uses five case-mix adjusted components: Physical Therapy, Occupational Therapy, Speech-Language Pathology, Nursing, and Non-Therapy Ancillary. Payment is driven by patient characteristics documented in the MDS assessment, making accurate MDS coding essential for appropriate reimbursement.