PCA and PDPM

The Patient Driven Payment Model (PDPM) is the biggest reform in reimbursement in long-term care in many years. When the reimbursement system changed to the RUGS system, it was a large challenge to many healthcare organizations.

PCA Pharmacy has been watching this changing landscape since the Spring of 2017 when Medicare tipped their hand with their RCS-1 announcement. PDPM is different than RCS-1, but we felt that this was a predictor of changes that would come in some format. The PDPM changes also reflect what we are seeing in skilled nursing regulations. The “Mega Rule” made changes to the regulations that showed a new emphasis that was, more than ever, focused on the individual resident. So everything from regulations to reimbursement continue to be more and focused on the individual resident.