Beginning October 1, 2019, a new case-mix model titled the Patient-Driven Payment Model (PDPM) is set to take affect and replace the current case-mix classification methodology, Resource Utilization Groups model. Have you considered PDPM impact on your organization? The following is a summary of potential challenges to your organization:
Do you have a restorative nursing program at your facility?
Under PDPM, residents who are more clinically complex or who have other indicators of acuity, including a higher ADL score, depression, or restorative nursing services, would receive a higher payment. Evaluate your restorative program to determine how best to document and maintain goals achieved from therapy services. Restorative should supplement therapy services for residents to maintain their highest level of well-being.
Are your software vendors ready for PDPM?
Changes in reimbursement and other areas will need to be updated in your organization software systems. Make sure to contact your software vendors to guarantee that they’ll be ready for full implementation by Oct. 1, 2019.
Does anyone in your organization have ICD-10 expertise?
CMS adopted its proposal to categorize a patient into a PDPM clinical category for purposes of PT, OT, and SLP classification using the ICD-10 code. Under PDPM these classifications will have a significant impact on Medicare reimbursement. Does anyone on your staff know and understand ICD-10 code? Have you considered having someone ICD-10 certified? The current certification process can up to 9 months to complete.
Do you understand financial impact of the PDPM?
Based on the CMS modeling, the new reimbursement system will be budget neutral. However, on the individual provider level we will see increases or decreases in comparison to RUGs reimbursement. Have you determined impact of your current average length of stay? Do you know if your current staffing level will be appropriate with the potential increase in the restorative nursing services? Consider involving your accounting firm in your budget process.
Does your MDS staff understand assessment changes under the PDPM?
Since your initial MDS assessment will set reimbursement for the SNF stay, it is crucial for your MDS staff to be trained. MSL has strategic partners who can provide you with various options for MDS training.
Are you ready for a new therapy delivery model?
CMS proposed that under PDPM, SNF therapists (physical and occupational therapists and speech- language pathologists) would be able to use up to 25% of a resident’s treatment time per discipline per stay, using concurrent or group therapy modalities. Is your therapy team working on implementation of these changes in their therapy delivery process?
Have you talked to your therapy company about a new therapy contract?
Therapy minutes will no longer play a role in determining payment. However, CMS will still require therapy minute reporting on the Discharge MDS, with utilization of concurrent therapy and reimbursement changes based on the length of stay. It is time to assess your current therapy contract to reflect these changes. For providers utilizing an in-house therapy model, now is the time to perform an analysis of your existing therapy delivery model on your future PDPM reimbursement.
For more information, please contact MSL CPAs & Advisors at 800-683-5401. [Read more…] about Medicare Part A – Patient-Driven Payment Model (PDPM) for Skilled Nursing Providers