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CMS Makes Direct Link Between Outcomes and Medical Review

By Caralyn Davis, Staff Writer - September 11, 2019

Under the Patient-Driven Payment Model (PDPM), resident outcomes will be key to avoiding medical review, said officials with the Centers for Medicare & Medicaid Services (CMS) during the August 14 Skilled Nursing Facility Quality Reporting Program (SNF QRP) training session, Patient-Driven Payment Model: What Is Changing (and What Is Not). Note: Find the session slides here.


The goal of PDPM is for SNFs to provide value-driven care, said officials. “Fundamentally, it comes down to a balance. A high-value and efficient provider is one that is able to achieve high-quality outcomes at low cost.”


CMS measures SNF quality of care in three main ways:

  • The SNF QRP;

  • The Skilled Nursing Facility Value-Based Purchasing (SNF VBP) program; and

  • The Five-Star Quality Reporting System on Nursing Home Compare.