ArticleJournal of the American Medical Directors Association2026
Changes in Patient Medical Complexity After Skilled Nursing Facility Payment Reform: A Qualitative Study.
Article in Journal of the American Medical Directors Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
2 citing papers in PubMed.
- Too Sick to be True? Evaluating Potentially Problematic Diagnosis Coding Practices in Medicare's Patient-Driven Payment Model.Health services research · 2026Article
- The role of declining therapy volumes in skilled nursing facility outcomes: a mediation analysis.Health affairs scholar · 2026Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
objectivesThe skilled nursing facility (SNF) patient-driven payment model (PDPM) is intended to align payment with patient clinical characteristics to more accurately compensate complex and resource intensive care. However, it is unclear whether and how SNFs shifted their admission practices to align PDPM's financial incentives. This study examined SNF leaders' perspectives on changes in admission practices and patient case mix in order to understand variation in responses to PDPM implementation.
designA qualitative study. SETTING AND
participantsA purposive sample of SNF leaders from across the United States [eg, average to high (3-5 stars) and below-average (1-2 stars) care quality].
methodsNinety-four SNF leaders participated in one-on-one semistructured interviews between January 2021 and December 2022. Thematic analysis examined leaders' perspectives of their organization's response to PDPM, including changes in admission practices and patient case mix, as well as contextual factors contributing to their response. We then examined patterns by SNF quality rating and admission practice changes.
resultsDescriptions of whether and why SNF case mix change differed based on their history of caring for a medically complex patient population. Leaders of SNFs that historically cared for rehabilitation patients frequently described strategic changes in their admission practices (eg, enhanced preadmission screening) after PDPM to prioritize the admission of medically complex patients, including those with higher nursing-related care needs (eg, tracheostomy, wounds, peritoneal dialysis). These leaders tended to represent average or high-quality SNFs, whereas leaders from below-average quality SNFs more frequently reported minimal or no case mix changes, in part reflecting a history of admitting medically complex patients before PDPM. CONCLUSIONS AND IMPLICATIONS: Results suggest that PDPM's intended effect of shifting SNF admissions to more medically complex patients varied by baseline SNF admission patterns and characteristics. These findings can inform longitudinal national evaluations of organizational responses to PDPM implementation.
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