PDPM Success with Advantage

Patient Driven Payment Model

The new Skilled Nursing Facility payment and classification system, Patient Driven Payment Model (PDPM), will go into effect October 1, 2019. This model will place Medicare Part A residents in one group for each of the five case-mix adjusted categories – PT, OT, SLP, Nursing, and Non-Therapy Ancillaries – and provide a single payment based on the sum of these individual classifications. The shift from focusing on therapy minutes as a volume-driven system to one with the emphasis on patient characteristics, the needs of the whole patient, and the value (outcomes) of the services delivered, will introduce significant and long-lasting impacts on our SNF partners.

The Advantage Clinical Compliance and Strategic Innovations department has been preparing for over a year for this change. During the week of June 10th, we held multiple PDPM Executive Overview training sessions across the state. These sessions offered 4 CEUs and an interactive environment for SNF staff (NHA, DON/ADON, RNAC/MDS Coordinator, CFO, social services, billing office) to learn: the PDPM payment drivers, RUG-IV and PDPM differences, financial projections and calculations, and clinical and operational strategies for success.

Next steps will include education and training sessions individualized for each of our partners with our clinical specialists, ICD-10 certified nurse consultants, and management team members. Topics will include: ICD-10 coding, NTAs, Nursing Case-mix Groups, Documentation, MDS Coding Accuracy, and Restorative Nursing Programs. We will also be providing additional training for our therapists on Evidence-based Clinical Pathways, Modes of Therapy, Functional-based Treatments, and documentation to ensure our clinical philosophy continues to drive successful outcomes for the residents we treat every day.

At our biannual Collaboration for Success Meetings over the last few months, we have shared PDPM projection reports from our Optima BI module. PDPM partnership pricing discussions are currently taking place with the intent of finalizing addendum pricing in August. We appreciate our SNF partnerships and are excited to collaboratively transition into PDPM successfully. Through all of this, Advantage is committed to a patient-centered post-acute continuum of care model designed to maximize care, reduce costs, and achieve successful patient outcomes.

For more information about PDPM, please contact Amy Hancock, President/CEO and Co-Owner: ahancock@feeltheadvantage.com or Dave Lishinsky, Vice President of Clinical Compliance of AdvantageCare Rehabilitation: dlishinsky@feeltheadvantage.com