Here’s Why You Must Begin Prepping Now for Skilled Nursing PDPM Implementation

Patient-centered care: Recently it’s a term you’ve heard promoted widely in the healthcare field, along with “data-driven” and “real world evidence” (RWE). The Centers for Medicare & Medicaid (CMS) is catching on to the trend and updating its programs accordingly.

For instance, CMS has replaced the existing case-mix classification methodology—the Resource Utilization Groups, Version IV (RUG-IV) for skilled nursing facilities (SNFs)—with the new patient-driven payment model (PDPM), notes compliance trainer Renee Kinder. So, now, being Medicare compliant means learning the PDPM. Kinder explains this new system inside and out in the webinar “Medicare Skilled Nursing and the Patient-Driven Payment Model.”

Prioritize Value Over Volume

CMS started the process of moving away from RUG-IV by announcing the Resident Classification System (RCS). After receiving feedback, CMS made the changes that led to the PDPM, and although the PDPM is in some ways similar to RCS, it’s more than just a new name for the update.

So what exactly is different? The quick answer is: how you get reimbursement.

Previously, RUG-IV emphasized high amounts of therapy. That is, providers could give these services to patients regardless of each resident’s individual goals and needs. Under the skilled nursing PDPM, however, you must carefully manage services to provide exactly the right level of care to each patient.

Beware: Overproviding won’t get you more reimbursement, and underproviding could lead to Medicare audits and takebacks.

4 Ways PDPM Will Impact You

With PDPM implementation set for October 1, 2019, many providers are wondering how exactly this program will affect their SNF. Here are 4 main ways in which the skilled nursing PDPM will likely affect you:

  • Logistics: Each resident will be assigned a case-mix classification that drives the daily reimbursement amount for that patient. You’ll have to know these classifications inside and out. There are five: physical therapy (PT), occupational therapy (OT), speech-language pathology (SLP), nursing, and non-therapy ancillary (NTA).
  • Staffing: PDPM implementation means reduced demand for therapy minutes, which in turn means reduced demand for therapists in SNF settings. A key upside on this is that, since you’ll be hiring fewer people, you can spend more time finding quality staff.
  • Finances: PDPM will, as you are probably thinking, affect your SNF’s finances. Several therapy dollars can now be reallocated to nursing, and you can offset loss in therapy reimbursement with higher reimbursement for the nursing care you’re already providing.
  • Paperwork: CMS predicts PDPM will save SNFs approximately $12K annually and providers approximately 183 hours in administrative burden.

5 Tips to Prepare for PDPM

As for how your SNF can prepare for the skilled nursing PDPM, begin with these 5 tips:

  • Evaluate your SNF’s current care and resources to determine if you’re prepared or if you still need to implement systems/trainings to be ready.
  • Acquire and wisely use business intelligence, data analysis, and care planning tools to make accurate future predictions. Remember the focus is on leveraging actionable insight, and the most successful SNFs will be those that adopt and effectively use such tools to provide exactly the right care for each patient.
  • Establish data-driven protocols, using the tools mentioned above and taking into account patient reimbursement levels.
  • Decide how you will lower costs and communicate this plan to your contracted therapists. To succeed with PDPM, your therapists will need to provide more treatments to more patients through group and concurrent modes of treatment.
  • Augment revenue sources, starting with identifying residents who aren’t covered by Medicare Part A but who would benefit from therapy services.

Prepare for an Overnight Change

Unlike other programs that are phased out before a new one is officially adopted, on October 1, 2019 RUG-IV will come to a hard stop and the PDPM will begin.

Without a soft transition period, you’ll need to quickly figure out your logistics to make Medicare happy, advises Renee Kinder in her webinar, “Medicare Skilled Nursing and the Patient-Driven Payment Model.” Now is the time to get started!

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