Feature
The PDPM...
(Continued from page 12)
Next, we encourage SNF providers to perform a “Deep
Dive” review of current processes & systems to address
the issues that will ultimately impact reimbursement
under the new system. Analyze existing communication
pathways and workflow – such as admissions, ICD-10
coding, nursing documentation, case management and
care transition planning, clinical pathways, finance/
billing (triple check) and up/downstream partnerships
– to define what changes must be made during the
upcoming months to successfully transition to PDPM.
Based on the Crosswalk analysis and the “Deep Dive” review, SNFs should design their
“Strategic Work Plan” no later than Q1-Q2 of 2019. Having this customized, well-defined
roadmap will be the key to successfully navigating the
transition to PDPM and not only surviving, but thriving!
It’s important for SNF providers to understand how
Additionally, it cannot be overstated how important education
and training is for the interdisciplinary team. In addition to
new skill sets and core competencies, the transition to PDPM
PDPM.
will require a significant “culture change” among the SNF rank
and file. This will necessitate that SNFs invest in ongoing IDT
communication/training in support of embracing change. SNFs must start now and continue
even beyond the transition in October 2019.
each proposed pricing methodology supports/aligns
with success drivers under
Q: What will pricing for outsourced therapy look like under PDPM?
No doubt pricing for outsourced therapy contracts will be very different under PDPM, and
many industry leaders are modeling options. It’s important for SNF providers to understand
how each proposed pricing methodology supports/aligns with success drivers under PDPM.
Among the many pricing methods, HealthPRO Heritage is advocating for the Risk Share Per
Diem method which best aligns incentives for both therapy provider/SNF and holds both
accountable to quality patient outcomes, compliance and financial success. We encourage
SNF leaders to learn more about this pricing approach where the therapy provider bills the
SNF a per diem rate per PDPM therapy group. SNFs are guaranteed profit for each PDPM
rehab group, and therapy partner is paid a capitated per diem rate per PDPM therapy
group. We predict this model best aligns incentives to balance outcomes, utilization, costs,
compliance and revenue capture.
When vetting pricing methodologies, questions worth asking your therapy provider include:
•
•
•
•
What’s the best therapy pricing method under PDPM to align incentives?
How do I ensure my patients receive the right amount of therapy for positive outcomes?
How much therapy staff and minutes am I able to afford based on the patients’ clinical
characteristics and respective PDPM group payment rates?
How do I ensure I still meet compliance requirements under PDPM, a “managed care
like” capitated system?
Q: Additional recommendations or concluding remarks?
As an Endorsed Vendor for LeadingAge New York, HealthPRO® Heritage is proud to be
among industry leaders paving the road to success under PDPM. Our experts agree: CMS’
PDPM system will breathe new life into care delivery models, and we are, in fact, excited for a
new world where our success will be measured by the evidence-based therapy we provide and
the outcomes we achieve on behalf of our clients and patients.
(See The PDPM on page 14)
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Adviser a publication of LeadingAge New York | Fall 2018