PDPM: Skilled Nursing’s Y2K?
Do you remember all the hype around Y2K? In the end, there were no catastrophic meltdowns when the clock struck midnight. Is the new Patient-Driven Payment Model (PDPM) the Y2K for the skilled nursing industry? I don’t think so, and here’s why.
There is no doubt that the PDPM is a significant change in how skilled nursing facilities (SNFs) are paid by Medicare, but will it be catastrophic? In theory, it shouldn’t because the care provided to individuals in a SNF should be the same regardless of changes in the payment methodology. Direct care staff helping “Mrs. Smith” dress or attend dinner aren’t thinking about what they need to do differently because the payment methodology has changed. Their care delivery should remain consistent. What does need to change is the focus on how to appropriately document the care provided to “Mrs. Smith.” This is to ensure the nursing home will actually get paid for that care because the PDPM allows SNFs to be paid for the extensive services provided to individuals regardless of the amount of therapy provided. As we enter 2019 and start preparing for this significant change in payment methodology, it is important to focus on two things: what needs to change and what doesn’t. In most cases, the care provided to individuals will not need to change. That care still needs to be delivered to patients with the upmost respect and dignity.
What we should focus on is completing the Minimum Data Set (MDS) assessment as accurately as possible when someone enters a SNF. The entire team needs to communicate more effectively to ensure the primary reason for the SNF stay is reflected not only in the MDS assessment, but also in the ICD-10 coding and the billing. The care team, including therapy, also needs to be involved in determining the care plan for each individual. This increased focus on the details across all disciplines in the team will help ensure the SNF appropriately documents and is paid for the care provided to each individual. An increase in communication and collaboration can only be a good thing for patients and the industry as a whole.
Obviously, the PDPM removes the focus on therapy minutes as the driver of payment. This means SNFs need to focus on renegotiating therapy contracts. This is a great opportunity, regardless of whether the organization utilizes contracted therapy or in-house therapists, to make sure the therapists are part of the bigger care delivery team and share in responsibility for outcomes. Collaboration with therapists during the completion of the MDS assessment for the therapy, nursing, and non-therapy ancillary components will be important to make sure these correlate and don’t create errors when determining payment.
So, what should SNFs be thinking about now in expectation of the PDPM start date on October 1, 2019? ( View CLA’s webinar on preparing for PDPM) First, don’t panic!! Second, prepare! Now is the time to look at your processes for completing the 5-day MDS Assessment. Although you currently still have the ability to use multiple assessments during an individual’s stay, the 5-day MDS Assessment is the only assessment under PDPM and will be critical for determining the appropriate payment rate. Take the time now to improve the process and make necessary changes before there is a financial impact. Third, if not already using a triple check process, implement one. Again, this is the time to make changes and improvements before there is a financial impact. And finally, take a deep breath and prepare. Just like Y2K, preparation will be the key to a successful transition to the Patient-Driven Payment Model.
Deb Freeland has over 24 years specializing in reimbursement and assurance services for senior living facilities, home health, and hospice agencies. She also has extensive experience handling the distinctive issues facing health care organizations in today's challenging payment reform environment. Deb is also a frequent speaker at various state and national association meetings and other events.
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