Skilled Nursing Facilities New Medicare Payment System Takes Effect ~ Is It Patient or Profit Driven?

Skilled Nursing Facilities New Medicare Payment System Takes Effect ~ Is It Patient or Profit Driven?

As of October 1, 2019, Medicare is implementing a new payment system for skilled nursing facilities (SNFs), according to an update from our partners at California Advocates for Nursing Home Reform (CANHR). It is called the Patient-Driven Payment Model (PDPM), yet how “patient driven” the complicated payment system is (or is not) remains to be seen. The Centers for Medicare and Medicaid Services (CMS) claims it will change the financial incentives for SNFs to better serve residents.

Advocates expect that many skilled nursing facilities will aggressively game the new system to serve their financial interests rather than residents’ needs. A particular concern is that Medicare beneficiaries will receive less therapy than they do now and that SNFs have an incentive to replace individual therapy services with less effective but cheaper group therapy services. Another concern is that skilled nursing facilities will cut off Medicare coverage and push out Medicare beneficiaries even faster than they do now. CANHR is interested in hearing from Medicare beneficiaries on their experiences with nursing home coverage under PDPM. You can contact them via their website: canhr.org.

Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.