The Patient Driven Payment Model, Skilled Nursing Facility Coding Intensity, and Medicare Expenditures

How did the implementation of the Patient Driven Payment Model (PDPM) affect diagnostic coding intensity, Medicare expenditures, and patient outcomes in skilled nursing facilities (SNFs)?In this retrospective cohort study of more than 2 million Medicare beneficiaries, PDPM was associated with a statistically significant increase in SNF coding intensity and Medicare expenditures, particularly among patients with medically complex health care needs. No significant changes were observed in rehospitalization or mortality rates.The incentive structure of PDPM appears to have influenced SNF coding and spending patterns without affecting short-term outcomes, highlighting the need for continued monitoring to ensure alignment between payment policy and high-quality care.

Corresponding Author: Fangli Geng, PhD, Department of Health Services, Policy fangli_geng@bown.edu).

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