PDPM Part 6: High Fives, Whys, Collaboration and Communication

Earlier this month, Reliant hosted regional directors for its annual leadership conference in Plano, Tx. The first day, attendees were inspired by Roy Tuscany of the High Fives Foundation. He offered a patient’s perspective for clinicians and presented a call to shift from the “standard protocol” to the “patient protocol.”

Through his personal story and rehabilitation journey he detailed the importance of cultivating hope in our patients and a killer high five. He emphasized it’s not just the control, attitude, and effort of the patient that effects outcomes and recovery, but the clinician’s control, attitude, and effort that ignites success.

Day two opened with keynote Heath Slawner. Heath passionately detailed the importance of claiming and living out purpose. He led the audience through an exercise to evaluate personal reasoning for our daily choices, during which he stated “start with why.” What is your why? Recognizing and embracing the reason we set out to become a clinician, administrator, or other healthcare professional provides perspective. Knowing your company’s why allows for a common culture and approach to executing product delivery.

These speakers offered the perfect complement to the remainder of the conference which focused greatly on planning and preparing for PDPM. This is the sixth installment of the Reliant Reveal PDPM series. Previous articles have focused on the structural frame work of the model, details surrounding function score calculation, strategies for training, and coding success. Within each article, and the education we have created to date, a complementary theme is emerging: the importance of collaboration and communication.

Success under PDPM may be related to contract considerations, amassed resources, and field education; however, longitudinal success- the success that produces outcomes, will be directly impacted by each care professional’s ability to effectively collaborate and communicate for the patient’s care needs.

Facilities should begin moving from the standard protocol of care to an elevated, patient-driven protocol. This protocol will empower the evaluating therapist to collaborate with nursing to ensure comorbidities are accurately and timely identified. Therapists will bring to the table the clinical characteristics to be identified on the MDS, discharge planning notes, and knowledgeable discussions surrounding the clinical reason for admission.

The successful facility under PDPM will have a clearly defined “why” complemented by Reliant’s why: Care Matters. This is the heartbeat of our daily practice, service delivery, communication and collaborative approach to patient care.

Patient Driven Payment Model (PDPM) Updated Wepage

CMS provides a Patient Driven Payment Model (PDPM) web page which houses a variety of resources (comorbidity mapping tools), fact sheets, and a training presentation.

During the open door forum, CMS announced updates to the materials found on the PDPM webpage in response to stakeholder feedback including:

  • The training presentation has been replaced with the National Provider Call from December 2018,
  • The classification walk-through document has been updated, and
  • The FAQ document has been updated.

PDPM Part 5: Quantity to Quality: PDPM Assessment Schedule

Over the years, the burden associated with the current Medicare required assessment schedule has become “just part of the job.” Staffing of the MDS office is largely driven by Medicare part A census because all residents admitting to a facility for a skilled part A stay will receive a 5-day assessment and depending upon their length of stay may also have a 14-day, 30-day, 60-day, and 90-day assessment. Changes in therapy delivery trigger an additional set of required assessments.


CMS has boasted The Patient Driven Payment Model (PDPM) will reduce provider burden by implementing a significantly reduced required assessment schedule outlined as:5-day Scheduled PPS Assessment | Completed days 1-8 | Covers payment for ALL Part A daysPPS Discharge Assessment | Set as Medicare A stay end date. | Does not affect payment.


In addition to all OBRA requirements remaining the same, the Medicare required PPS assessment schedule consists of these two assessments. That’s it. CMS does acknowledge that changes in the resident’s clinical condition may affect resource use; therefore, they have created an optional Medicare assessment: Interim Payment Assessment (IPA) | Date facility chooses | Payment begins same day as ARD.(triggering event)


Read more about the importance of quality in our MDS assessments here.

Patient Driven Payment Model (PDPM) Frequently Asked Questions

CMS provides a Patient Driven Payment Model (PDPM) web page which houses a variety of resources (comorbidity mapping tools), fact sheets, and a training presentation. An additional resource is the 37 page PDPM Frequently Asked Questions document.
This document covers 14 PDPM topics and answers 92 questions as of 1/28/2019. On the December provider call, stakeholders requested revision dates be provided for reviewers to identify the most recent document update and CMS indicated this would be implemented.
As we progress toward PDPM’s implementation date, be sure to reference CMS’ website frequently to ensure up to date information and clarification.