| Course | HA415 Health Care Policy and Economics |
|---|---|
| Unit | Unit 5 |
| Paper type | Program analysis |
| Length | About 870 words, 6 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | BS in Health Care Administration |
| Updated | October 2026 |
Free sample paper for HA415 Unit 5
Paid for the Patient, Not the Minutes: A Program Analysis of Medicare's Skilled Nursing Facility Payment Model at a Composite 120-Bed Facility, Following the Formula, the Behavior It Rewards and the Limits Added Since
[Student Name]
Purdue University Global
HA415: Health Care Policy and Economics
Unit 5 Program Analysis
[Instructor Name]
[Date]
The facility, its residents and every payment figure are composite and bracketed; the payment rules are simplified for a course and change each year.
Purpose
Medicare covers up to 100 days of skilled nursing facility care after a qualifying hospital stay, paying a daily rate. Under the earlier system, the daily rate for most residents depended on the therapy minutes they received, which rewarded facilities for providing more therapy whether or not patients needed it. On October 1, 2019, CMS replaced it with the Patient Driven Payment Model, which classifies residents by clinical characteristics rather than services delivered.
The Mechanism
The daily rate is built from components. Five are adjusted for each resident's case mix: physical therapy, occupational therapy, speech-language pathology, nursing and non-therapy ancillary services such as drugs and supplies. A sixth component, for room and board and other costs, is the same for everyone. Each case-mix component is classified using information from the resident's assessment: the main clinical reason for the stay, function, cognition, swallowing and comorbidities (42 C.F.R. § 413.337, 2024). Two components change over the stay. The physical and occupational therapy components step down after the first [20] days, and the non-therapy ancillary component is paid at a higher rate for the first three days, when drug and supply costs are highest.
A Worked Example
[Mrs. R.], 79, is admitted after hip fracture surgery. She needs help with most activities, has diabetes requiring insulin and has no cognitive impairment. Under the model, her clinical category and function place her in a higher-paying therapy group, and her diabetes adds to the non-therapy ancillary score. Her daily rate is about [$640] for the first three days and then about [$590], declining slowly after day 20. Whether she receives [five] or [12] hours of therapy a week does not change the payment. The payment no longer rises with therapy minutes, so every minute of therapy is now a cost to the facility rather than a source of revenue.
Incentives
Therapy: Facilities now have a reason to provide only the therapy a resident needs, and possibly less. Research after the change found that skilled nursing facilities reduced therapy staffing, especially contract therapists, in the year after implementation (McGarry et al., 2021). Documentation: Payment depends on recorded diagnoses, function and comorbidities, so facilities have a reason to document thoroughly, and an incentive to code more intensively than the resident's condition justifies. Admissions: Residents with costly drug needs or complex comorbidities now bring higher payments, which may improve access for them.
The Facility's Experience
At the composite facility, therapy hours per short-stay resident fell by about [25] percent in the first year, and the facility replaced [three] contract therapists with group and concurrent sessions. Administrators interviewed in a study of the change described similar shifts toward more group therapy and greater attention to documentation and assessment accuracy (Liu et al., 2024).
Limits Added and Kept
1. Group and concurrent therapy combined may not exceed [25] percent of a resident's therapy minutes in each discipline, so facilities cannot replace individual therapy entirely.
2. Facilities must still meet each resident's assessed needs under participation rules.
3. CMS adjusted payment rates after finding that the model had raised spending more than intended in its first years.
Who Gains and Who Loses
Residents with complex medical needs, such as those on intravenous drugs or with several chronic conditions, gain, because the model pays more for them than the old system did. Facilities that had relied on high therapy volume for revenue lose, unless they adjust staffing. Contract therapy companies lose the most, since much of their work was billed under the old incentive. Medicare's position depends on whether the rate adjustments hold spending neutral over time.
The Same Resident Under the Old System
Under the earlier system, [Mrs. R.]'s daily rate would have depended mainly on her therapy minutes. If the facility gave her [720] minutes a week, she would have been placed in the highest therapy group, earning a higher rate than under the new model, even if a lower amount of therapy would have met her needs. The comparison shows how the payment rule, not the patient, used to drive the care plan.
Evaluation
The model achieved its main purpose: payment no longer rewards therapy volume. Whether residents are better off is less clear. Less therapy could mean less unnecessary care or slower recovery; studies of functional outcomes are still limited.
Recommendations for the Facility
Track functional gains at discharge, not only therapy minutes, so the facility can show that reduced therapy did not reduce recovery. Audit coding accuracy quarterly. Review group therapy use against the [25] percent limit monthly.
Conclusion
By paying for patient characteristics rather than services, the model removed one incentive and created others. Administrators need to understand both: the old reward for therapy volume is gone, and a new reward for documentation has taken its place.
References
42 C.F.R. § 413.337 (2024). https://www.ecfr.gov/current/title-42/section-413.337
Liu, Z., Meehan, A., Brazier, J. F., Shield, R., & Gadbois, E. A. (2024). Implementing the Patient Driven Payment Model: Perspectives from skilled nursing facility administrators. Journal of Applied Gerontology, 43(6), 688-699. https://doi.org/10.1177/07334648231223296
McGarry, B. E., White, E. M., Resnik, L. J., Rahman, M., & Grabowski, D. C. (2021). Medicare's new Patient Driven Payment Model resulted in reductions in therapy staffing in skilled nursing facilities. Health Affairs, 40(3), 392-399. https://doi.org/10.1377/hlthaff.2020.00824
What the HA415 Unit 5 assignment asks for
Unit 5 usually asks students to analyze a Medicare or Medicaid payment program in depth. Instructions commonly require the program's purpose and history, how payment is calculated, the incentives the method creates, evidence on how providers responded and any adjustments made since. Many prompts ask for a worked example. Expect to cite the governing regulation and empirical studies in APA style, bracket payment amounts that change yearly and keep any provider composite. Explaining the mechanism before judging it lets the incentives follow from the rules rather than from opinion, and a short comparison with the method the program replaced often makes the change in incentives clearest to the reader.
How this HA415 Unit 5 example is built
The sample opens with the program's purpose and the system it replaced, with a margin note on putting mechanism before judgment. The mechanism section lists six components and two that change over the stay, citing the payment regulation. A worked example follows a hip fracture resident, and the highlighted sentence says therapy is now a cost rather than revenue. Three incentives are traced to the formula with a margin note, citing research on therapy staffing reductions. The facility's experience cites administrators' views. Limits kept in place, who gains and loses, the same resident under the old system with a third note, evaluation and recommendations follow. The conclusion names the new incentive that replaced the old one.
Reading the HA415 Unit 5 grading rubric
Program analysis rubrics in HA 415 tend to award points for explaining the purpose, describing the payment mechanism, working an example, identifying incentives, presenting evidence, discussing adjustments, citing sources and writing clearly. Purpose points depend on the problem the program was meant to fix. Mechanism points go to an accurate description of how payment is built. Example points reward one case worked through. Incentive points require tracing each behavior to a rule. Evidence points need empirical studies of provider response. Adjustment points go to later corrections. Source points require regulation and research. Analyses that compare the program with what it replaced often earn the top band. Clear marking of payment amounts that change each year also helps.
Common HA415 Unit 5 mistakes, and how to avoid them
Program papers often lose points by describing the payment system vaguely and then listing effects without linking them to the rules. Another gap is asserting incentives without evidence that providers responded. Some papers omit adjustments made after the program began. Others give no worked example. Explain the formula in plain terms, run one patient through it, trace each incentive to a specific rule and cite at least one study of what providers did. Then evaluate whether the program met its purpose and what remains uncertain. Recommendations for a provider, such as tracking functional outcomes alongside therapy minutes, show that you can turn analysis into management.
Get an HA415 Unit 5 example written to your instructions
Which public program has the Unit 5 prompt assigned? Send its name, any scenario or data supplied and the rubric. The analysis follows one payment rule to the behavior it produces and to the program's response, in 24-48h, with a first sample free and every program fact cited to a primary source. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
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HA415 Unit 5 questions, answered
Where can I find a free HA415 Unit 5 sample paper?
The complete HA415 Unit 5 program analysis is shown here, explaining Medicare's skilled nursing facility payment model through a composite 120-bed facility, with three sources. Another payment program can be analyzed in the same order.
What is the Patient Driven Payment Model?
Medicare's skilled nursing facility payment system since October 2019, which pays a daily rate based on residents' clinical characteristics rather than therapy minutes.
What incentives does the model create?
Facilities no longer earn more for more therapy, so therapy becomes a cost, while thorough documentation of diagnoses and function raises payment.
Did therapy decline after the change?
Research found that skilled nursing facilities reduced therapy staffing in the year after the model began.
How long is the HA415 Unit 5 analysis?
About five pages in the order purpose, mechanism, incentives, evidence and adjustments.