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Written by Amy Ostrem, Senior Product Manager, MatrixCare.
In August, I had the pleasure of attending several excellent educational sessions at the Zimmet Conference held in Atlantic City, NJ. The expert insights and presentations were superior. Over 1,200 people with a passion for LTPAC were in attendance. The learnings on the new Patient Driven Payment Model (PDPM) effective 10/1/2019 were enlightening, informative, and provided some great networking discussion topics. To highlight some of the key takeaways around PDPM from the Zimmet conference, I will focus on 3 major areas:
- What is PDPM?
- What are the key differences between RUGS-IV and PDPM?
- What actions can you take now in preparation for PDPM?
What is PDPM?
To begin with the WHAT, there are a couple key components to remember:
- PDPM is a Revenue Delivery System
- PDPM is Budget Neutral. Reimbursement is being shifted away from its ties to therapy to more appropriately reimburse for conditions requiring nursing time and medical expense.
- PDPM is NOT a change of benefits
Key differences between RUGS-IV and PDPM
|2 case-mix components||5 case-mix components|
|5 scheduled PPS assessments||1 scheduled PPS assessment|
|Constant reimbursement rates for the entire length of stay||Declining reimbursement rates over the length of stay|
|Maximum therapy incentivized||Minimum therapy incentivized|
What actions can you take now to prepare for PDPM?
To begin to prepare, there were many suggestions based on the key impacts and details of what is coming with PDPM. Here are some key items to consider and examples that were shared:
- Form a PDPM task force in your organization
- Educate, educate, educate! Read, attend industry seminars, vendor seminars, and other events on PDPM
- Network with other providers and consultants to brainstorm success factors
- Be sure you are documenting the reasons for skilled care on a daily basis
- Make a plan to improve coding and how it relates to PDPM. The ICD-10 codes used will be extremely critical and could equate to a gain of $30 per day just by coding the correct, most specific code! And, just as you are selecting the proper ICD-10 codes, be sure to resolve those no longer relevant (for example, you cannot have pneumonia for six years).
- Pay attention to morbid obesity and a BMI over 40 as this also adds up to more $ per day.
- With fewer MDSs, consider revising your MDS coordinator’s job description. Think of ways to be even more diligent on the 5-day MDS. Since there is no 14-, 30-, 60-, or 90-day MDS assessment due; the accuracy of the 5-day MDS is even more critical to your success! Perhaps you even have some MDS coordinators that could also assist with coding?
- With the twist on therapy with PDPM, consider enhancing your therapy team’s responsibilities. Perhaps the therapists, with their expert knowledge, could complete Section GG?
Here at MatrixCare, we ensure regulatory changes are completed for you on time. We participate in industry events such as Zimmet, we analyze CMS documentation, we go straight to CMS with questions, concerns, and additional suggestions, and most importantly, we have a strong Research and Development team that is already in the up to speed on PDPM and enjoys comparing its intricacies to other major regulatory events through the years (it’s already more than water cooler talk at MatrixCare). Client education is also critical at MatrixCare, so you will continue to receive invites for PDPM-related webinars, documentation, and short blogs such as this. Stay tuned for more updates, and let’s work together on PDPM success!