PDPM < PAC

 

Beginning on October 1, 2019, post-acute care (PAC) facilities will be paid for Medicare A services under the Patient Driven Payment Model (PDPM). As a result, PAC facilities are in store for substantial changes in their organizational structure. Skilled nursing facilities (SNFs), assisted living facilities (ALFs), Home Health Agencies (HHAs) and Hospice are all included under the PAC umbrella. Staffing, wages, and supplier increases are already pressing concerns for these organizations. However, PDPM updates entail new requirements. The goal of PDPM is to align specific services with each individual resident’s need.

Here are three ways the new PDPM structure will change the daily operations for PAC facilities.

The Need for Minimum Data Set (MDS) Accuracy

The previous MDS admission assessments are changing from five to one (upon admission). In the past, the MDS occurred at specific intervals over an SNF resident’s length of stay. Now, there is only one chance to enter the patient’s data accurately. For this reason, there is increased pressure to ensure the assessment is correct the first time. Condition (the reason for admission), Cognition and Co-Morbidities must be appropriately evaluated to secure accurate payment terms.

Variable Per Diem Implementations

PDPM will include a new variable per diem. Payments will be highest during the resident’s first three days of their stay. After the third day, the adjustment factor will reduce to a 1x multiplier for days 4 through 100. PAC facilities must keep the variable per diem top of mind to avoid miscalculations.

Reimbursement Model Changes

As a result of PDPM, financial incentives to prove longer therapy times as a reimbursement driver will end. The SNF facilities will have to objectively match the number of therapy minutes to specific resident goals. Overall, there will be a much higher payor scrutiny level for positive outcomes (for dollars paid) and lengths of stay.

Now is the time for your organization to prepare for PDPM, before the October 1st start date. Your organization should be familiar with specific changes that will impact your PAC facility. For instance, MDS Coordinators will need to acquire a new skill set: learning ICD-10 codes. Although the MDS Coordinators won’t need to have a comprehensive knowledge of ICD-10 code specifics, they will at least need to know the most common resident admission codes for proper reimbursement.

To gain additional insights on proper PDPM preparation, download our latest whitepaper, “Addressing Changes in Post-Acute Care: Is your organization prepared?“.