Adviser Fall 2018 Vol 1 - Page 14

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) 13 Adviser a publication of LeadingAge New York | Fall 2018