Patient Driven Payment Model Advocacy

The Medicare Patient-Driven Payment Model (PDPM) was implemented in skilled nursing facilities (SNFs) on October 1, 2019. PDPM was designed to address concerns with the previous payment model that was based on the amount of therapy minutes provided, which created inappropriate financial incentives for SNFs. Under PDPM, Medicare payment to SNFs is driven by the patient's clinical characteristics and needs rather than the number of therapy minutes provided.

Impact on Everyday Practice

Beginning in the summer of 2019, with the implementation of PDPM looming, speech-language pathologists (SLPs) contacted ASHA reporting layoffs, reductions in hours and benefits, and the imposition of administrative mandates such as requiring the use of group treatment for all patients. Data later collected from the Centers for Medicare & Medicaid (CMS) reinforced these reports showing a reduction of therapy services by approximately 30% in the first quarter of PDPM implementation.

ASHA remains committed to understanding the impact of payment changes on SLPs’ employment and patient access to care in SNFs and improving the payment system. Share your story with ASHA.

Resources for SLPs in SNFs

Stay Informed

Advocacy News:

The ASHA Leader and ASHA Leader Live:

ASHA Among Professional Groups Advising Caution on PDPM Study Results (January 24, 2022)
SNFs Get Temporary Reprieve from Medicare Payment Reductions (August 2, 2021)
Proposed Medicare Rule Could Cut SNF Payment By 5% in 2022 (May 5, 2021)
After Multiple Blows, ASHA Members in SNFs Face Prolonged Recovery (February 8, 2021)
SNFs' Business Motive: A Constant Amidst Chaos (November 10, 2020)
Clinicians’ Role in PDPM Success: SLPs have opportunities to advocate for improvements in skilled nursing facilities, to help ensure patients get the speech-language services they need. (June 15, 2020)
[Podcast] ASHA Voices: SLPs in Quarantine and a Look at PDPM 6 Months Later (April 9, 2020)
[Podcast] ASHA Voices Update: Troubling PDPM Effects (October 16, 2019)
Understanding How Changes in Medicare Payment to SNFs Affect SLPs (September 5, 2019)
[Podcast] ASHA Voices: A New Payment System, Changes in SNFs (September 25, 2019)
Final Rule Overhauls Medicare Therapy-Based SNF Payments: A new system replaces therapy minutes with patient characteristics to determine payment in skilled nursing facilities. (October 1, 2019)
Medicare Proposes SNF Payment Overhaul (May 17, 2018)

ASHA’s Advocacy on PDPM

From the start, ASHA actively engaged in the development of PDPM through formal written comments, meetings with CMS, and speech-language pathology member representation on technical expert panels to ensure a move to such a payment model represented appropriate clinical practice. ASHA advocates on your behalf with CMS and other stakeholders—such as industry leaders in SNFs and home health agencies. The following list highlights some of the activities that ASHA has engaged in.

June 10, 2022: ASHA submits comments to CMS on the Fiscal Year (FY) 2023 Skilled Nursing Facility Prospective Payment System Proposed Rule [PDF]
June 7, 2021: ASHA submits comments to CMS on FY 2022 Skilled Nursing Facility Prospective Payment System Proposed Rule [PDF]
June 1, 2020: ASHA submits comments to CMS on FY 2021 Skilled Nursing Facility Prospective Payment System Proposed Rule [PDF]
May 25, 2020: ASHA initiates outreach with American Physical Therapy Association (APTA) and American Occupational Therapy Association (AOTA) by contacting patient organizations to raise consumer awareness of changes in SNFs related to PDPM
- Letters to Patient Organizations [PDF]
- Distributes consumer fact sheet: Understanding How Medicare Determines Payment for Your Therapy Services in Nursing Homes or Home Health Care [PDF]
May 15, 2020: ASHA initiates outreach with American Physical Therapy Association (APTA) and American Occupational Therapy Association (AOTA) by contacting Physician Groups on PDPM [PDF]
March 12, 2020: Meeting with the Center for Medicare Advocacy staff to discuss PDPM/Patient-Driven Groupings Model (PDGM) implementation and share ASHA’s survey results
February 24-25, 2020: National Association for Support of Long-Term Care (NASL) winter meeting (participated in a panel discussion of implementation of PDPM/Patient-Driven Groupings Model (PDGM)
February 19, 2020: ASHA/American Physical Therapy Association (APTA)/American Occupational Therapy Association (AOTA) meeting with Metalogic (predictive analytic software vendor) to discuss the use of its products under PDPM/Patient-Driven Groupings Model (PDGM)
February 25, 2020: [PRESS] ASHA quoted in Modern Healthcare discussing the implementation of PDPM/Patient-Driven Groupings Model (PDGM)
February 10, 2020: [PRESS] ASHA quoted in Skilled Nursing News discussing the implementation of PDPM/Patient-Driven Groupings Model (PDGM)
January 21, 2020: ASHA meeting with the Coalition to Preserve Rehabilitation (CPR) to discuss concerns about PDPM/Patient-Driven Groupings Model (PDGM) implementation
December 19, 2019: ASHA meeting with National Association for the Support of Long-Term Care (NASL) to discuss impact of transition on SLP employment in SNFs
December 2019-January 2020: Survey sent to ASHA members working in SNFs to collect feedback on the impact of PDPM (4,435 responses, 27.5% response rate)
November 21, 2019: ASHA Convention town hall with leaders from skilled nursing facilities
November 14, 2019: Meeting with the Center for Medicare Advocacy to discuss PDPM/Patient-Driven Groupings Model (PDGM) implementation
October 30, 2019: ASHA SIG 15 host webchat on PDPM
October 10, 2019: ASHA meeting with the S. Department of Health and Human Services Deputy Assistant Secretary for Planning and Education to discuss the importance of evaluating the implementation of PDPM
September 4, 2019: Joint webinar with CMS, ASHA, American Occupational Therapy Association (AOTA), and American Physical Therapy Association (APTA) on PDPM
August 28-September 30: ASHA LinkedIn engagement targeting people who identify as working in SNFs
August 19, 2019: Email sent to ASHA members who identify as working in SNFs to inform them that PDPM is coming October 1, 2019
July 29, 2019: ASHA hosts meeting with leadership from 8 therapy and SNF companies to discuss PDPM implementation
July 2019: Town Hall with SNF leadership held at ASHA Connect
June 17, 2019: ASHA submits comments to CMS on FY 2020 Skilled Nursing Facility Prospective Payment System Proposed Rule [PDF]
June 26, 2018: ASHA submits comments on FY 2019 Skilled Nursing Facility Prospective Payment System Proposed Rule
August 8, 2016: ASHA submits comments to CMS and Acumen summarizing recommendations made during the June 2016 TEP meeting