PDPM Strategies

The Patient Driven Payment Model (PDPM) has been approved to go into effect October 1st, 2019This new case-mix payment model focuses on resident clinical characteristics rather than volume-based services provided to determine the Medicare payment. This new model will replace the current Resource Utilization Group (RUG) system that has been in effect since 1998.

How PDPM Will Impact Your Reimbursement

Functional Pathways has developed an Impact Analysis Tool to identify the financial changes under the new payment model.

Our PDPM Strategies


Care Management via RightTrack

  • Evidence-Based Nursing and Therapy Protocol Guide
  • Live Data Diagnostics, Optimizing Clinical Care, Outcomes, and Costs
  • Facility and Resident Specific Section GG Outcome Tracking and Reporting
  • Efficient Communication with Resident, Family, and Next Level Providers
  • Effective Discharge Execution to Appropriate Level of Care
  • Training on Quality Reporting Program Best Practices


Impact Analysis

  • Regulatory Review with Interpretation
  • Facility Specific Impact Analysis (Readiness Assessment)
  • Care Remodeling Education and Training
  • Process Development for Clinical Collaboration and Documentation/Coding Accuracy
  • Ongoing Revenue Optimization Assessment

Advanced Initiatives

  • Specialized Interdisciplinary Programming to Align with Referral Market
  • Clinical Education and Training for High Acuity Patients
  • Support Nursing Programs: Restorative and Respiratory
  • Training and Competency Checks for Supportive Documentation and MDS Coding
  • Training on Quality Reporting Program Best Practices

Strategic Positioning

  • Education on Established Preferred Provider Networks
  • Market Position Analysis via AvelereTM
  • Acute Care Alignment by Identifying Clinical Specialty Needs
  • Solidification of Acute Care Partnerships Through Facility Scorecard Reporting
  • Establish Downstream Relationships with Preferred Home Health Providers