I had the opportunity to represent the National Association of Rehab Agencies and Providers (NARA) this week at the NASL (National Association in Support of Long Term Care) conference in Washington, D.C. We had incredible access to policymakers and leaders in the skilled nursing industry including Governor Mark Parkinson, President and CEO of AHCA, and John Kane, the SNF team leader from CMS instrumental in the development and implementation of PDPM. I heard from both the policy and provider sectors, three main areas that we need to focus on this year:
- Facilitating the transition to PDPM without overly dramatic practice shifts that impact patient outcomes.
- The need for enhanced inter-disciplinary care for ongoing success.
- The need for therapy providers to show value.
1. Facilitating Transition
Governor Parkinson highlighted the unusual relationship that rehab providers have had with their customers, where the product we have provided was a top line benefit to our customers. We now need to demonstrate our value differently, through partnering for Value Based Payment (VBP) drivers, driving clinical outcomes, and providing a high level of education. He reports that the CEO’s he is speaking with are sensitive to a sudden drop in minutes of therapy, especially if followed by a decline in outcomes. They know that this will create both quality and service issues. Keeping perspective on past and coming changes in demographics, and the Medicaid funding and REIT trends that have impacted the industry on a national level are important for us to understand as we partner with our customers moving into PDPM. He recommends the following three focus areas: Seek inclusion in every network, decrease rehospitalization rates, and drive quality and 5-star ratings.
John Kane from CMS was clear in his reasoning for the backbone of PDPM: “We need to know a lot more about the patient than we have in the past to know what CMS is paying for.” CMS wants to better capture care, and provide reimbursement for clinically complex patients. Everyone has therapy and non-therapy needs during their stay, but the current payment model is overly focused on the therapy needs. The NTA payment, and in particular the enhanced payment for the first 3 days of stay is designed to help providers in a practical way better care for a more clinically complex resident that may have more up front costs (e.g. medication). Recently program integrity and review efforts have been focused on therapy. PDPM has a more holistic approach, so supporting coding for all PDPM related areas in documentation will be more important. Reviews will be more concrete. Either the medical record does or does not support a certain diagnosis, or a certain assessment was or was not completed. He did warn that a possible trigger for review will be major changes to therapy utilization not based on patient characteristics. He was clear that PDPM does not change what your patient needs.
2. Increasing Collaboration
As post acute/skilled nursing providers, we are tasked with taking care of the whole patient. We have to account for all 5 components of the PDPM model. We must do this with each component (PT, OT, ST, Nursing, NTA) without countering the other’s intent. This should come from a more interdisciplinary assessment process, where current silos are broken down, and collaboration becomes best practice. Can our Speech Language Pathologists partner with social services and dietary to bring their additional expertise to capture dysphagia needs, or identify issues with cognition that must be captured accurately on the PDPM MDS? Are our OT and PT staff collaborating on functional levels with professional nursing staff to best represent the usual clinical picture of the resident for nursing and therapy needs in PDPM? Is everyone on the team keeping issues like depression, or rehospitalization risk top of mind?
3. Providing Value
As providers, we need to work with our business partners to determine what value in PDPM looks like for them. PDPM does not lend itself to a “cookie -cutter” approach. A skilled nursing center with a robust FFS Medicare population may need or want a far different approach than one that has a high utilization of ACO/Medicare Advantage. We must go to where the care is happening and where care decisions are made. Our team must spend time in the therapy gym, spend time in IDT meetings, and assess trends and data. This will allow us to determine where gaps in knowledge and service may exist that will be impactful in PDPM, and provide education, suggestions, use pilot programs to trial ideas, and measure success. We must share ideas and best practices.
In summary, with change comes opportunity. I came away from the 2019 NASL Annual Conference feeling energized about the opportunities we have in post-acute care. At Therapy Specialists we have a diverse customer base, with unique needs, but common goals. We all want excellent care, we all want excellent customer/ resident satisfaction, and we all want our businesses to grow and be successful. These changes in our profession will give us opportunities to be able to further align our goals and achieve success together.
Want to learn more? For additional information on PDPM, please take a look at our most recent video on the Evolution of the IDT Under PDPM.