CMS has been very vocal about their desire to change the payment structure for skilled nursing facilities by placing an emphasis on the need for quality over volume. As a result, the Patient Driven Payment Model (PDPM) was put in place to accomplish this lofty goal. Effective October 1, 2019, PDPM replaces our current RUGs IV system, requiring organizations to rethink their workflow processes. Employers will need to focus on education, training, and evaluation of staff competence to stay ahead of the curve. Since PDPM will allow greater reimbursement for organizations with more clinically complex residents, there will be potential to find a specialty niche. Facility reimbursement will be impacted by capturing the most accurate clinical picture of each resident at the time of admission. Facilities will need to be forward thinking and begin the planning process now to maneuver through this paradigm shift.