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PDPM Specs for Five-Star Measures Go Live in April

By Caralyn Davis, Staff Writer - March 18, 2020

This April, nursing homes could see “moderate to small impacts” from the Patient-Driven Payment Model (PDPM) on any Nursing Home Quality Initiative (NHQI) quality measures (QMs), including those used in the Five-Star Quality Rating System, that include Medicare Part A skilled nursing facility (SNF) stays that occur during a short-stay or long-stay episode, says the Centers for Medicare & Medicaid Services (CMS) in the new section 6, Transition to the Patient-Driven Payment Model, in chapter 1, “QM Sample and Record Selection Methodology,” of the recently updated Quality Measures User’s Manual (version 13.0).


PDPM may create these impacts in some NHQI QMs (e.g., Percent of Residents Who Newly Received an Antipsychotic Medication (Short Stay)) driven by the reduction in SNF Prospective Payment System (PPS) assessments and the introduction of the interrupted-stay policy. In April, the NHQI QMs will be publicly reported on Nursing Home Compare incorporating the PDPM data specifications that went into effect on October 1, 2019.