The Patient Driven Payment Model, or PDPM, pays skilled nursing facilities based on resident characteristics rather than therapy minutes. It has several components: physical therapy, occupational therapy, speech-language pathology, nursing, non-therapy ancillary, and a non-case-mix component. Each depends on how the Minimum Data Set (MDS) assessment captures a resident's condition and care needs.
For administrators and finance leaders, that creates a practical problem. The information that drives payment is spread across many assessments and many people. Reviewing each one is not realistic. A trend view helps you step back and ask the right questions.
Start with a small set of summary views
You do not need a hundred metrics. A few well-chosen ones can tell you whether something is changing.
- Average case-mix by component over time, to see whether the mix of your residents is shifting
- Revenue per patient day for Medicare Part A stays, tracked monthly
- Length of stay by admission source and diagnosis group, to understand what drives your volume
- Assessment timeliness, which shows whether required assessments are being completed on schedule
The goal is not to judge any one number as good or bad. It is to notice change and then ask why.
Ask what changed
When a trend moves, the first question is usually "did our residents change, or did our documentation change?" Those are different problems.
If the resident mix changed
You may be admitting from different hospitals, serving a different diagnosis mix, or seeing different lengths of stay. That may be a deliberate business decision or an unintended shift. Either way, it deserves a conversation among admissions, clinical leadership, and finance.
If documentation changed
A change in how assessments are completed, such as new staff, a vacancy in the MDS coordinator role, or a workflow change, may affect what is captured. The goal is accuracy. The assessment should reflect the resident's true condition and care, supported by the clinical record. Analytics should support complete and accurate documentation, never inflate it.
Look at it by component
Because PDPM has separate components, a single combined number can hide movement. A building might see stable total revenue while one component rises and another falls. Viewing them separately shows where to look.
Consider a hypothetical case: total daily revenue looks steady, but the nursing component has declined slightly while the therapy components have risen. That prompts questions about whether nursing-related conditions are being captured completely, or whether the resident mix simply changed. The data suggests where to look. A clinical and MDS review determines the answer.
Connect MDS timing to payment
Missed or late assessments can create payment and compliance problems. A simple weekly view of upcoming and overdue assessments, by resident and by due date, helps the MDS team plan their workload. It also helps the administrator see whether the department is stretched.
Useful questions include:
- How many assessments are due in the next seven days?
- Which are overdue, and why?
- Are certain days of the week consistently backed up?
- Is the workload evenly distributed across the team?
Keep clinical and financial teams in the same conversation
PDPM works best when finance, MDS, nursing, therapy, and admissions look at the same picture. A short monthly review that includes each of them keeps everyone aligned. Finance sees the revenue effect, clinicians see the care picture, and admissions sees how referral patterns shape the mix.
Mistakes to avoid
- Treating revenue as the only goal. The purpose of accurate assessment is to reflect real resident needs. Revenue follows from that.
- Looking at totals only. Component-level views show what totals hide.
- Reviewing too late. Monthly closing is often too late to fix a documentation gap. Weekly timeliness views help.
- Leaving the data in one department. If only one person sees the trend, nobody else can help interpret it.
Make the trend visible
The practical step is to put a few of these views on one page, refreshed regularly, and review them as a team. That moves PDPM from a once-a-month finance topic to a shared operating conversation.
CarePulse Analytics connects to your EHR and billing data, including PointClickCare, to build PDPM and MDS trend views that update automatically. If you would like to see what your own case-mix trend looks like by component, a demo can show you with your data.