Skilled Nursing Facilities Patient-Driven Payment Model ...

Acumen, LLC 500 Airport Blvd., Suite 100 Burlingame, CA 94010 Skilled Nursing Facilities Patient-Driven Payment Model Technical Report April 2018 ii Acumen, LLC EXECUTIVE SUMMARY This report introduces a comprehensive alternative to the current resident classification Model (case-mix adjustment) within the Skilled Nursing facility (SNF) prospective Payment system (PPS). The current Payment Model for residents of SNFs in Medicare Part A-covered stays classifies residents into clinically relevant groups for the purpose of determining how much Medicare will reimburse SNFs for the costs of providing care. Acumen developed an alternative classification for SNF residents in Medicare Part A-covered stays pursuant to a contract with the Centers for Medicare & Medicaid Services (CMS).

Refinements to SNF PPS Can Improve Payment Accuracy As noted above, for a large majority of SNF residents, payment is determined primarily by the number of therapy minutes they receive under RUG-IV. The current payment model does not fully consider the wide range of clinical characteristics that influence the relative resource use of SNF residents.

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  Nursing, Payments, Skilled, Facilities, Skilled nursing facilities

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