MDS Essentials: Tracking /Discharge MDS: PPS Discharge Assessment

The Patient-Driven Payment Model (PDPM) represents a significant shift in how Medicare reimburses skilled nursing facilities (SNFs) under the Prospective Payment System (PPS), focusing on the patient’s condition and care needs rather than the volume of services provided. This model, which began on October 1, 2019, impacts various aspects of SNF operations, including the approach to PPS Discharge Assessments. Here’s an overview of how PPS Discharge Assessments integrate with PDPM:

Purpose of PPS Discharge Assessments under PDPM:

PPS Discharge Assessments serve to finalize the resident's Medicare Part A stay, documenting the end of this service period. Under PDPM, these assessments are crucial for capturing the patient's clinical status at discharge, which can directly influence the facility's reimbursement and highlight the effectiveness of the care provided during the stay.

Components and Implementation:

• Completion Timing: The PPS Discharge Assessment must be completed when a resident's Medicare Part A stay ends, but they remain in the facility, or upon their actual discharge from the facility.
• Clinical Information: This assessment captures key clinical information relevant at the point of discharge, including changes in the resident's condition, achieved outcomes, and any ongoing care needs.
• PDPM Classification: Information from the PPS Discharge Assessment contributes to finalizing the resident’s PDPM classification for the duration of their stay, ensuring accurate and appropriate reimbursement.

Significance in PDPM:

• Accurate Reimbursement: Under PDPM, accurate and comprehensive documentation in the PPS Discharge Assessment is vital for ensuring that reimbursement reflects the resident's care needs and the services provided.
• Outcome Measurement: These assessments can provide valuable data on patient outcomes and the effectiveness of the care provided, informing quality improvement initiatives.
• Regulatory Compliance: Completing PPS Discharge Assessments in accordance with CMS guidelines is essential for compliance with Medicare requirements and for supporting audit and reporting processes.

Integration with MDS Assessments:

• Final PDPM Classification: The PPS Discharge Assessment impacts the final PDPM classification by capturing the resident's status at the end of the Medicare Part A stay, affecting the SNF's reimbursement.
• Care Planning: While the primary purpose is related to discharge, information from the assessment can inform ongoing care planning for residents who continue to reside in the facility without Medicare Part A coverage.