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What are the "Do's and Don'ts" for PDPM Success?

HealthPRO® Heritage Announces Our Top 10 “Do” List for PDPM Success

  1. Stay focused on marketplace dynamics and other CMS initiatives (Bundled Payment Advanced, outcomes/referral source, QMs, CMI, etc…).
  2. Revisit your Facility Assessment; consider strengths related to clinical capabilities profile and staff competencies.
  3. Seek to align behavioral incentives as you consider therapy pricing options with vendors.
  4. Discuss with vendor partners RE: their level of preparedness and ask for examples of how they can support your facility through the transition.
  5. Pursue partnerships with vendors able to demonstrate:
    1. Experience with the myriad of managed care requisites
    2. Ability to track outcomes/diagnosis & DRG
    3. Sophisticated care management models proven to help improve quality and episodic cost.
  6. Understand new areas of risk/CMS monitoring.
  7. Understand your NTA mix and relative weight of case/cost management.
  8. Review your CMS' projected Impact File. 
  9. Consider engaging expert support to translate real-time MDS data to accurately reflect PDPM’s impact on reimbursement. (HealthPRO® Heritage utilizes our data analytics model – “The PDPM Crosswalk Tool.”) During the months leading up to the transition, clients are able to assess/reassess how their facility will ultimately fare under PDPM. 
  10. Conduct a “Gap Analysis” to uncover areas for improvement on the following “Top PDPM Success Drivers:”
    1. ICD10 coding/timeliness
    2. MDS scoring accuracy/timeliness
    3. ADL & functional scoring
    4. Cognitive scoring/interplay with SLP
    5. Proactive, aggressive case management
    6. Nursing documentation redesign for better MDS alignment
    7. Therapy clinical protocols/pathways

Just as Important…HealthPRO® Heritage Releases The “Don’t” List

  1. Wait until it’s too late to adequately prepare.
  2. Remain convinced your facility won’t thrive in the post-PDPM era!
  3. Think that changes made today will have a negative impact on current operations/reimbursement. Instead, ease the transition with implementing clinically-oriented process changes today that may even positively impact current reimbursement. (THINK: ADL scoring.)
  4. Limit your focus to cost control only. (Hint: This requires a comprehensive understanding of the relationship between clinical services, documentation and revenue opportunity.)
  5. Believe compliance risk goes away.
  6. When contemplating MDS staffing levels, don’t forget about the OBRA MDS schedule and ongoing need for strong MDS staff.

Keep checking back here for more details related to the topics touched on above. Can’t stand the suspense? Click here to talk directly with our PDPM Expert Panel on how you can lead your organization to PREPARE. EXECUTE. SUCCEED.

Written by: Hilary Forman, PT, RAC-CT, Chief Clinical Strategies Officer

Tags: CMS Update 2018, Payment Reform, Patient-Driven Payment Model, PDPM