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Toledo, Ohio 43617

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WHY ARE CARE PATHWAYS SO CRUCIAL UNDER PDPM?

Updated: Apr 26, 2019


Clinical care under PDPM is going to be as important as ever for our Medicare Part A beneficiaries. Even though CMS is not going to base payment on Therapy minutes any longer, care decisions will be made based on the clinical characteristics of our patients, which means we are going to be held accountable to meeting their needs.  CMS has indicated they do not expect a change in Provider behavior based on payment. Every decision that is made must be supported in our documentation as it relates to patient need.

​The question then is, how will we be able to do that effectively, as an interdisciplinary team, and continue to support quality patient outcomes?  

Once the patient’s characteristics are established through interdisciplinary collaboration and the Case Mix Grouper (CMG) is set for each discipline involved in their care, the next logical step to bring value to the patient is for each discipline to follow a prescriptive path per CMG.  In accordance with the characteristics that establish the CMG, these patients will have similar needs. Therefore, we are able to prepare a path for the clinicians and patient to follow which will lead them through a script of best practice interventions.

Of course, within this path there must be room for individualization of the care plan as the team identifies varying co-morbidities and patient response to treatment, but in general, the Care Pathway will be a useful guide towards optimal patient satisfaction, positive outcomes, and value in quality care. ​

Allen Johnson, OTR/L, MBA Director of Clinical Services, Concept Rehab, Inc.

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