The Patient Driven Payment Model (PDPM) was implemented in U.S. skilled nursing facilities (SNFs) in October 2019, shortly before COVID-19. This new payment model aimed to reimburse SNFs for patients’ nursing needs rather than the previous model which reimbursed based on the volume of therapy received. Through 156 semi-structured interviews with 40 SNF administrators from July 2020 to December 2021, this qualitative study clarifies the impact of COVID-19 on the administration of PDPM at SNFs. Interview data were analyzed using modified grounded theory and thematic analysis. Our findings show that SNF administrators shifted focus from management of the PDPM to COVID-19-related delivery of care adaptations, staff shortfalls, and decreased admissions. As the pandemic abated, administrators re-focused their attention to PDPM. Policy makers should consider the continued impacts of the pandemic at SNFs, particularly on delivery of care, admissions, and staffing, on the ability of SNF administrators to administer a new payment model.
AlnsourM. A. (2022). Using modified grounded theory for conducting systematic research study on sustainable project management field. MethodsX, 9, 101897. https://doi.org/10.1016/j.mex.2022.101897
2.
BarnettM. L.HuL.MartinT.GrabowskiD. C. (2020). Mortality, admissions, and patient census at SNFs in 3 U.S. cities during the COVID-19 pandemic. Journal of the American Medical Association, 324(5), 507–509. https://doi.org/10.1001/jama.2020.11642
3.
BarnettM. L.WakenR. J.ZhengJ.OravE. J.EpsteinA. M.GrabowskiD. C.MaddoxK. E. J. (2022). Changes in health and quality of life in U.S. skilled nursing facilities by COVID-19 exposure status in 2020. Journal of the American Medical Association, 328(10), 941–950. https://doi.org/10.1001/jama.2022.15071
BrazierJ. F.GengF.MeehanA.WhiteE. M.McGarryB. E.ShieldR. R.. . .GadboisE. A. (2023). Examination of staffing shortages at U.S. nursing homes during the COVID-19 pandemic. JAMA Network Open, 6(7), e2325993. https://doi.org/10.1001/jamanetworkopen.2023.25993
6.
BrazierJ. F.MeehanA.ShieldR. R.WhiteE. M.GrabowskiD. C.GengF.GadboisE. A. (2023). “All hands on deck”: Administrator perspectives on managing COVID-19 outbreaks in U.S. nursing homes. Journal of Long-Term Care, 2023, 297–310. https://journal.ilpnetwork.org/articles/10.31389/jltc.237
ChenA. T.RyskinaK. L.JungH. Y. (2020). Long-term care, residential facilities, and COVID-19: An overview of federal and state policy responses. Journal of the American Medical Directors Association, 21(9), 1186–1190.
9.
DuBrinA. J. (2013). Fundamentals of organizational behavior: An applied perspective. Elsevier.
10.
GadboisE. A.BrazierJ. F.MeehanA.GrabowskiD. C.ShieldR. R. (2021). “I don’t know how many nursing homes will survive 2021”: Financial sustainability during COVID-19. Journal of the American Geriatrics Society, 69(10), 2785–2788. https://doi.org/10.1111/1475-6773.14104
11.
GadboisE. A.BrazierJ. F.MeehanA.RafatA.RahmanM.GrabowskiD. C.ShieldR. (2023). Perspectives of nursing home administrators across the United States during the COVID-19 pandemic. Health Services Research, 58(3), 686–696. https://doi.org/10.1111/1475-6773.14104
12.
GrabowskiD. C.MorV. (2020). Nursing home care in crisis in the wake of COVID-19. Journal of the American Medical Association, 324(1), 23–24. https://doi.org/1010.1001/jama.2020.8524
13.
LesterP. E.HolahanT.SiskindD.HealyE. (2020). Policy recommendations regarding skilled nursing facility management of coronavirus 19 (COVID-19): Lessons from New York state. Journal of the American Medical Directors Association, 21(7), 888–892. https://doi.org/10.1016/j.jamda.2020.05.058
14.
LevereM.RowanP.WysockiA. (2021). The adverse effects of the COVID-19 pandemic on nursing home resident well-being. Journal of the American Medical Directors Association, 22(5), 948–954. https://doi.org/10.1016/j.jamda.2021.03.010
15.
LiuZ.MeehanA.BrazierJ. F.ShieldR.GadboisE. A. (2024). Implementing the patient driven payment model—Perspectives from skilled nursing facility administrators. Journal of Applied Gerontology. Advance online publication. https://doi.org/10.1177/07334648231223296
16.
LTCFocus. (n.d.). Public Use Data sponsored by the National Institute on Aging (P01 AG027296) through a cooperative agreement with the Brown University School of Public Health. https://doi.org/10.26300/h9a2-2c26
17.
McGarryB. E.GrabowskiD. C.BarnettM. L. (2020). Severe staffing and personal protective equipment shortages faced by nursing homes during the COVID-19 pandemic. Health Affairs, 39(10), 1812–1821. https://doi.org/10.1377/hlthaff.2020.01269
18.
McGarryB. E.WhiteE. M.ResnikL. J.RahmanM.GrabowskiD. C. (2021). Medicare’s new patient driven payment model resulted in reductions in therapy staffing in skilled nursing facilities: Study examines the effect of Medicare’s Patient Driven Payment Model on therapy and nursing staff hours at skilled nursing facilities. Health Affairs, 40(3), 392–399. https://doi.org/10.1377/hlthaff.2020.00824
19.
MeehanA.GadboisE. A.BrazierJ. F.MadrigalC.GrabowskiD. C.ShieldR. R. (2023). “It’s not a sprint, it’s a marathon”: Stages of managing a nursing home throughout the pandemic. Journal of the American Medical Directors Association, 24(10), 1579–1585.e2. https://doi.org/10.1016/j.jamda.2023.04.024
RahmanM.WhiteE. M.McGarryB. E.SantostefanoC.ShewmakerP.ResnikL.GrabowskiD. C. (2022). Association between the Patient Driven Payment Model and therapy utilization and patient outcomes in U.S. skilled nursing facilities. JAMA Health Forum, 3(1), e214366. https://doi.org/10.1001/jamahealthforum.2021.4366
22.
RitchieJ.LewisJ. (2012). Qualitative research practices: A guide for social science students and researchers. Sage.
23.
SaundersB.SimJ.KingstoneT.BakerS.WaterfieldJ.BartlamB.BurroughsH.JinksC. (2018). Saturation in qualitative research: Exploring its conceptualization and operationalization. Quality & Quantity, 52(4), 1893–1907. https://doi.org/10.1007/s11135-017-0574-8
24.
ShenK.McGarryB. E.GrabowskiD. C.GruberJ.GandhiA. D. (2022). Staffing patterns in U.S. nursing homes during COVID-19 outbreaks. JAMA Health Forum, 3(7), e222151. http://doi.org/10.1001/jamahealthforum.2022.2151
25.
StraussA.CorbinJ. (1994). Grounded theory methodology. In DenzinN. K.LincolnY. S. (Eds.), Handbook of qualitative research (pp. 217–285). Sage.
26.
UlyteA.WakenR. J.EpsteinA. M.OravE. J.BarnettM. L.MaddoxK. E. J.GrabowskiD. C. (2023). Medicare skilled nursing facility use and spending before and after introduction of the public health emergency waiver during the COVID-19 pandemic. JAMA Internal Medicine, 183, 637–645. http://doi:10.1001/jamainternmed.2023.0770
27.
UnruhM. A.KhullarD.JungH. Y. (2020). The patient-driven payment model: Addressing perverse incentives, creating new ones. The American Journal of Managed Care, 26(4), 150–152. https://doi.org/10.37765/ajmc.2020.42831
28.
U.S. Government Accountability Office. (2021). COVID-19 in nursing homes: Most homes had multiple outbreaks and weeks of sustained transmission from May 2020 through January 2021. https://www.gao.gov/products/gao-21-367
29.
YangB. K.CarterM.NelsonW. (2021). Trends in COVID-19 cases, related deaths, and staffing shortage in nursing homes by rural and urban status. Health Services Research, 56, 6–6. https://doi.org/10.1111/1475-6773.13719
30.
ZhangW.LuckJ.PatilV.Mendez-LuckC. A.KaiserA. (2022). Changes in therapy utilization at skilled nursing facilities under Medicare’s patient driven payment model. Journal of the American Medical Directors Association, 23(11), 1765–1771. https://doi.org/10.1016/j.jamda.2022.06.003
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