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Measuring Success & Emerging Trends Under PDPM

We all survived the PDPM transition on October 1. Now what?

As the dust settles, SNFs may be wrestling with an important question: How will the industry define and measure success under PDPM & Beyond?

No Shortcuts

Only by providing exceptional, well-coordinated care can SNFs achieve high marks on the relevant performance measures aligned with new CMS expectations. Specifically, look for higher benchmarks for Star Ratings, Quality Measures and other key performance indicators (ALOS, hospital re-admission rates, episodic costs, etc.) that will continue to dictate inclusion in ACOs, strategic partnerships, and referral networks. Importantly, CMS will be watching whether patient outcomes remain the same, decline, or improve. This increased pressure to perform – in addition to managing costs + optimizing reimbursement rates – will be what drives bottom-line results for SNFs. The degree to which SNFs are impacted by PDPM will depend on their ability to:

  • Assure processes are in place to capture the best and most accurate ICD-10 coding
  • Capture nursing acuity
  • Redesign therapy and nursing documentation
  • Redesign compliance and IDT workflow processes
  • Efficiently deliver positive, well-documented performance outcomes
  • Leverage the strength of a rehab program that meets all of the following standards:
    • Proven history of exceptional patient outcomes (delivered compliantly)
    • Utilizes evidence-based clinical pathways to assure optimal outcomes AND provide a framework for delivering cost efficient therapy
    • Collaborates effectively with Nursing to coordinate care and documentation practices
    • Understands the incremental steps – as well as the Big Picture perspective – to advance PDPM success drivers and optimize reimbursement
    • Invest in innovation, technology and top-notch clinicians who…
      • Are well-educated/prepared/empowered to treat higher acuity residents
      • Work-at-the-top-of-their-license and utilize sound clinical judgement
      • Leverage the value of Group/Concurrent Therapy in ways that drive exceptional resident outcomes

We Are On the Right Track

HealthPRO Heritage is proud to report our teams and our clients are optimistic about the future under PDPM & Beyond. Our confidence is based on the following:

HealthPRO Heritage has historically delivered exceptionally strong outcomes – even in markets dominated by managed care. In fact, our clients’ Star Ratings and Quality Measures are consistently higher than National Average. Our high-quality performance has earned us recognition among several industry leaders, including Remedy Partners who chose HealthPRO Heritage as a Preferred Provider for Post- Acute Standards of Rehabilitative Care.

“All that training is paying off.” Frontline clinicians are applying the countless hours of our rigorous ongoing PDPM education initiated in January 2019. Our focus has been to empower clinicians and clients with the knowledge and tools needed to provide exceptional care and optimize clinical and reimbursement outcomes.

Frontline therapists are effectively leveraging the power of Group and Concurrent Therapy, as per CMS’ guidelines and innovative programming ideas and strategies. And therapists and residents love it!

Well-resourced clinicians employ clinical judgement and expertise – in conjunction with our proprietary Clinical Pathways – so as to assure high quality outcomes. Important to note: Our long-view strategy and operations model has always been focused on providing only the most appropriate level of care on behalf of our clients. It’s a strategy that – especially now in light of PDPM expectations – has served us well.

Our PDPM fee structure is based on a holistic, long-range construct with the presumption that our partnerships will help customers achieve broad clinical success across PDPM rate components, while assuring reasonable therapy costs. This long-view strategy assures a sustainable model that creates a win-win-win (for clients, patients, and therapists alike!).

Emerging Trends

HealthPRO Heritage is watching the following trends:

Industry Intel: Consolidation of therapy providers is likely, especially among the smaller providers in specific states/regions to help mitigate the pressures of PDPM.

PDPM TrendWatch: Forecasts support ~60% of SNFs will see a positive reimbursement impact under PDPM. The majority (two-thirds) of those SNFs expected to lose reimbursement dollars will take a <$100k hit. The good news: this prediction does not take into account potential coding and scoring improvements that may drive revenues higher over time. The better news: Savvy SNFs that invested time and effort into understanding PDPM nuances will increase the speed/likelihood of early and sustained success.

HealthPRO Heritage’s 24/7 TeleMDS Hotline: Our exclusive hotline service gives us a front row seat to FAQs and the issues the industry is struggling with. To date, we’ve fielded ~1500 client questions, so we have a unique perspective of what compliance, coding, and strategy issues are tripping-up providers.

Clinical Frontline: Clinicians will be required to work-at-the-top-of-their-license. Advanced training will be necessary to raise the bar for the IDT to empower them with tools, resources, knowledge to thrive in the New World of PDPM. (HealthPRO Heritage remains committed to providing comprehensive, progressive education for all HealthPRO Heritage staff to assure skills and competencies that build success stories!) Stay tuned for an upcoming blog RE: working-at-the-top-of-your-license. 

Business Matters: Mid-November 2019 through January 2020: SNFs / CCRCs / Life Plan Communities will evaluate their fiscal and operating budgets in an effort to understand PDPM’s impact, the ROI of current therapy services, as well as strengths & opportunities for improvement. Short-term therapy contracts may be re-evaluated/measured against industry benchmarks to compare global fiscal and clinical performance. 

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Tags: snf, Patient-Driven Payment Model, PDPM