Welcome to the HealthPRO® Heritage Blog

Imagine a world where reimbursement isn’t based on the volume of therapy visits. Instead, therapists care for patients and drive outcomes based exclusively on clinical need. 

HealthPRO® Heritage experts agree: PDGM will breathe new life into how, when, and why therapists deliver care. 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.

McKnight's Long-Term Care News recently featured an article – "PDPM Has Possibilities" – with input  from HealthPRO® Heritage's Hilary Forman, Chief Clinical Strategies Officer and Ian Tucker, VP of Clinical Informatics and Product Management: 

Reminder: HealthPRO® Heritage customers can participate in the second webinar of our PDPM University series: 
DEEP DIVE INTO NTA AND NURSING COMPONENTS • 1pm EST 
Contact education@healthpro-heritage.com for more information.

Under PDPM, CMS has broken the singular nursing component of RUG-IV into two separate components – Nursing and Non-Therapy Ancillary (NTA) – to adeptly account for the wide-ranging variations within the skilled population. This change represents a very different and much-needed approach to efficiently managing patients with higher complexity and/or multiple conditions. It also opens many doors of opportunity for providers and patients alike. For example, providers will now be able to identify specific groups of conditions – and subsequently build specialized care programs recognized by referring hospitals as best practice. 

So this all makes sense, and there’s nothing to worry about.  Right?  Not so fast! 

In today’s world of Medicare, the use of cognitive testing – specifically the Brief Instrument for Mental Status, or BIMs – is completed in order to satisfy Section C: Cognitive Patterns on the Minimum Data Set (MDS) to effectively guide care planning for residents with confusion or a cognitive impairment. 

Under PDPM, cognitive testing will become more important.  Knowing whether a resident has a mild-to-severe cognitive impairment will truly impact:

• Care planning and the interdisciplinary team’s approach, and
• SNF revenue – by increasing the Case Mix Index related to the SLP component under PDPM  (because a cognitive impairment requires more resources, it will therefore will pay more in the new system).

Please read on for our latest input on coding support. Register to watch any of our pre-recorded PDPM webinars here. 

As we look to the future of skilled therapy under PDPM, it is important to remain focused on documentation that not only supports the provision of skilled therapy but the provision of skilled nursing services and accurate coding on the MDS. Case in point: during a recent review of documentation, a reviewer denied speech therapy services because of clear discrepancies between the speech pathologist’s documentation and nursing documentation. The reviewer argued that while the Speech Therapy Evaluation reported swallowing problems as evidenced by results from the MASA (Mann Assessment of Swallowing Ability), the 30-day MDS had not identified a swallowing disorder and according to the physician’s History and Physical, “the beneficiary had no problems with swallowing.” The reviewer’s conclusion? That skilled speech therapy was not medically necessary.

 With ~8 months to go, ask yourself: Are you on track for the transition to PDPM? Do you have the right therapy partner? This PDPM "To-Do" Checklist offers direction:

TODAY: PDPM “To-Do” Checklist

The more things change the more things stay the same.

CMS has been very clear that in order to receive Medicare Part A reimbursement under PDPM, the following will still hold true:  

Are you concerned about whether your EMR is equipped to handle the transition?  You’re not alone!

MDS coding experts must remain vigilant! Beware coding pitfalls when it comes to Section G versus Section GG.

The tide is turning! Imagine a world where revenue is not based on managing therapy treatment minutes, but will be aligned to care delivery. PDPM will set reimbursement based on patients’ clinical profiles, as captured within various coding and assessment scoring factors from the interdisciplinary team (IDT).

This fundamental change will rely on input from all clinical team members, however, nursing and MDS will be under exponential pressure to understand the nuances of PDPM, document and code accurately, and communicate effectively. In the “Brave New World of PDPM”, there are huge financial implications for anything less than thorough and flawless documentation and coding.