PDPM and PDGM UpdatesSNF Patient-Driven Payment Model (PDPM) began October 1, and the Home Health Patient-Driven Groupings Model (PDGM) begins January 1, 2020.
Both PDPM and PDGM align payment with patient characteristics, conditions, and needs, and eliminate the connection between reimbursement and the volume of therapy services provided—time spent and number of visits. This change makes it ever more important to show the value and cost-effectiveness of physical therapist services within SNFs and home health care. At the same time, what doesn't change is the coverage criteria or documentation requirements associated with the skilled therapy service coverage under PDPM and PDGM. More important, there is no change to the care needs of patients, which should be the primary driver of care decisions, including the type, duration, and intensity of skilled therapies.
APTA has been working to keep the profession up-to-date with the evolution of the PDPM and PDGM through our news and social media outlets, webinars, phone-in sessions, and other free, open access resources on the APTA SNF and Home Health Payment Models website.
- Other resources include:
- #PTTransforms blog: 2-part series on PDGM
- PT in Motion News: Tips to navigate PDPM and PDGM
- Center for Integrity in Practice: Product of the APTA's Integrity in Practice Campaign. It is designed specifically for physical therapists, physical therapist assistants, educators, and leaders to better understand fraud and abuse in health care and the impact they have on the profession of physical therapy, on individual clinicians, and on their freedom to practice.
APTA also has been actively communicating with the press to highlight concerns surrounding the industry's implementation of PDPM and potential inappropriate behaviors. Recent articles include:
Questions? Comments? Concerns? All physical therapists and physical therapist assistants (members and non-members) are encouraged to share their PDPM and PDGM experiences at firstname.lastname@example.org. Also, if you'd like to join the Post-Acute Care online community (Hub), please contact Kara Gainer at email@example.com.
Kara R. Gainer, JD
Director of Regulatory Affairs
American Physical Therapy Association
1111 North Fairfax Street
Alexandria, VA 22314