Three Strategic Imperatives for SNFs Under PDPM

Posted by Kelly Cooney

| Skilled Nursing Facilities PDPM Trends

How do you eat an elephant?  One bite at a time!  The elephant in the room in our industry right now is the Patient Driven Payment Model. To eat this elephant, skilled nursing facilities will need to begin gathering information, having conversations with their team and thinking through what their skilled nursing facility might look like under PDPM. We wanted to provide you with some strategic initiatives or, at minimum, important topics of conversation that skilled nursing facilitates can begin to have with their teams around PDPM.

1. Anticipate Patient-Level Impact

SNFs will need to look at the characteristics of the patients they treat and determine what they will get paid under PDPM compared to what they get paid now.  The interdisciplinary team will want to analyze drivers such as length of stay, admissions diagnosis trends, RNA use, diabetes, IV, depression, and diet texture. This information will help them to assess the changes they need to make at their center to better align their outcomes with their payment incentives. In order to accomplish this, SNF’s will need to enhance their internal QA processes and represent care in their coding and documentation that has not traditionally been tied to their payment. Therapy Specialists, in partnership with our EMR, Casamba, can help your facility analyze where current patients might end up in the PDPM model and assess opportunities for enhancing coding or improving service delivery. 

2. Adjust Your Admission Processes

Under PDPM, when a patient is admitted to a skilled nursing facility the SNF will need to have an interdisciplinary team with the expertise to properly document and code the diagnosis, as well as identify the key patient characteristics that justify the patient's need for skilled care. Essentially, the patient's initial assessment will determine the level of care the center is reimbursed for.  Mistakes on the initial assessment will effect your reimbursement for that patient.  The ability to not only identify, but accurately represent the characteristics in the patient’s chart and on the MDS will be essential to supporting payment that will drive the entire stay. 

3. Expand Your Capability with Higher Acuity Patients

Over the last few years, nurses have been asked to see more complex patients and that trend will only continue under PDPM. The new model shifts things from a therapy driven payment system to one that takes into consideration the overall care being provided to the patient. Skilled and specialized nursing care will play a far greater role in the outcomes that patients achieve under this new model. SNF’s should be ensuring that they have skilled staff that can not only provide but also accurately document the skilled services that represent the patient’s characteristics. In our case, we work closely with Proactive Medical Review and Avalere to provide access to educational resources and best practices. Our therapists and nursing teams will have opportunities to work very closely to plan for and coordinate cost effective, value-based care in order to make a smooth transition from volume-based reimbursement to PDPM.

Want to learn more?  In the upcoming months, Therapy Specialists will be providing resources on PDPM to our customers and colleagues in the industry.  For additional information on PDPM, please take a look at our video about the group/concurrent therapy cap.

Author Bio:

Kelly has twenty years of experience in the senior living industry including management positions in operations as well as clinical support for single site, multi-site, and multi-state organizations. She advocates for superior patient care, a supportive and positive work environment for staff, and cooperative partnership with customers and associates. Kelly is a long-standing member of the American Speech-Language- Hearing Association (ASHA), and most recently, received her certification in healthcare compliance (CHC). Kelly also serves as the President for NARA, the National Association of Rehab Providers and Agencies.