Welcome to the HealthPRO Heritage Blog

What is the Key to Successfully Navigating the PDPM Transition?

With only 14 months to prepare for the industry’s biggest change in 20 years, HealthPRO® Heritage offers this advice:  Don’t be overwhelmed by the complexities of PDPM.  Instead: 


To successfully navigate the transition to PDPM, providers can focus TODAY on developing & honing very specific core competencies without impacting their performance under the current RUGS.    

TO START: Understand the revenue implications of PDPM capitation.  SNF providers can crosswalk their current patient population from RUGS to PDPM groups for a realistic view of the fiscal impact.  

NEXT: Optimize care management systems and processes to assure appropriate clinical reimbursement.  Under PDPM, providers must be very good at the following core competencies:

  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

ADDITIONALLY:  Providers may be more motivated to attract higher acuity patients. 
To manage this shift in referral mix, ask:  How must care management processes change?  How will staff competencies evolve?  What downstream partner relationships must be in place? 

FINALLY: Providers should seek to work with therapy partners experienced in delivering exceptional outcomes at affordable prices under an ambiguous capitated system. Simply put, the current approach to therapy must be refined under PDPM to align incentives and share risk.

THE RESULT: Appropriate reimbursement and continued profitability.  Flawless execution on the above core competencies will be the key to successfully navigating the transition to PDPM and not only surviving, but thriving!

SEEK SUPPORT: HealthPRO® Heritage’s PDPM Expert Team is focused on delivering practical solutions that position clients for success.  Need help getting started?  Contact us today to seek a crosswalk analysis of your data.  Many resources are available to support your leadership and cross-functional teams with education, strategy and implementation on key initiatives during this transition. 

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



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