PDPM is coming- are you, the SLP, ready?  Do you know what this means for us Speechies?  How do we fit into the changes in the new payment system? How do we make sure we, as skilled therapists and a profession, remain relevant as we move forward?  We should not see these changes as a threat to our profession, but rather an opportunity.  Speech therapy, along with physical and occupational therapy, will have a direct impact on how skilled nursing providers can achieve better, more efficient outcomes for their patients while also receiving proper reimbursement for the level of care provided.

Knowledge is a huge part of the answers to these questions.  Functional Pathways is providing multiple levels of training in preparation for the coming changes.  Our new education platform, Medbridge, is getting stocked and loaded with training and education for our directors, our therapists and our facility partners.  Functional Pathways want to ensure clients, providers and managers alike, have the necessary tools to navigate these changes.

It is going to be more important than ever that SLP’s identify the needs of our patients upon admission and throughout the episode of care in order to ensure proper classification under the PDPM system.

Components for determining classification for speech therapy:

  1. Identify the reason for the SNF stay-this will place the resident into 1 of 2 categories:
    • Acute Neurologic
    • Non-neurologic (All other clinical categories: Major Joint Replacement and Spinal Surgery, Non-Surgical Orthopedic, Orthopedic Surgery, Acute Infections, Medical management, Cancer, Pulmonary, Cardiovascular, Non-orthopedic Surgery)
  2. Determine whether there is a swallowing disorder and/or a mechanically altered diet (Sections K0100Z and K0510C2, respectively on the MDS)
  3. Determine cognitive status-using a combination of the BIMS (Brief Interview for Mental Status) and the CPS (Cognitive Performance scale)
  4. Determine whether there are any additional SLP related co-morbidities (Section I and O on the MDS)
    • Aphasia (I4300 on MDS)
    • CVA, TIA, Stroke (I4500 on MDS)
    • Hemiplegia or hemiparesis (I4900 on MDS)
    • TBI (I5500 on MDS)
    • Tracheostomy Care-during stay (O0100E2 on MDS)
    • Ventilator-during stay (O0100F on MDS)
    • Laryngeal Cancer, Apraxia, Dysphagia, ALS, Oral Cancers, Speech and language deficits (I8000 on MDS)

The above components will determine the SLP Case Mix Index. This number, combined with PT, OT, Nursing, Non-Therapy Ancillary and Non-Case Mix indexes will determine the patient’s total daily rate.

In Summary, SLP’s have a vital role to play in providing services, determining care, and affecting outcomes in the PDPM world.  Step up, educate yourself and others, ensure we identify needs, and most importantly, take the very best care of our residents.  More to come…

Jennifer Callahan
Clinical Operations Specialist