updates - pennsylvania association of nurse …paanac.net/resources/documents/pdpm presentation...
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UPDATES
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Goodbye RCS1… • SNF PPS Proposed Rule for FY 2019 includes a
payment reform that will replace the current RUGs
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Hello PDPM • PDPM – Patient-Driven Payment Model
• PDPM is an enhancement from the original proposed payment reform – RCS 1
• The enhancements/changes are a direct result of stakeholder comments that CMS received after the ANPRM in May of 2017.
• PDPM is proposed to be effective in October 2019.
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Goodbye RCS1 …Hello PDPM Timelines
• April 27, 2018 – SNF PPS FY 2019 Proposed Rules were released.
• PDPM was the largest part of that release
• Comment Period is open until June 26, 2018
• Sometime this summer – the SNF PPS FINAL RULE is expected to be released
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Why Replace RUGS? • RUGS is an index-maximizing system that has led to 90% of
residents having payments primarily driven by therapy services.
• CMS’ view that Therapy in SNFs is predicated on financial considerations as opposed to resident needs.
• Multiple reports and studies published by the OIG and MedPAC expressing concerns with “thresholding” and Ultra High domination.
• Insufficient Payment for Nursing Services, Extensive and Ancillary Services.
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CMS Goals for PDPM • To improve targeting of resources to medically
complex beneficiaries
• To reduce incentives for SNFs to deliver therapy based on financial considerations
• To promote consistency with other Medicare and PAC payment settings by basing resident classification on clinical information and minimizing the role of the ‘volume’ of service provision in determination of payment
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RUGS IV
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RCS 1
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Implications of PDPM
• A HUGE shift in Concept and Operations for Med A Admissions in the SNF setting
• The magnitude of the change will be felt at all levels – Nursing, Therapy, Ancillary Services, EMR vendors, MACs
• Volume of Therapy may change (?) and Mode of Treatments will change – group and concurrent therapy are allowed/encouraged (up to 25% combined)
• Part A pricing structures will change for Contracted Therapy Providers –Per Diem, Per Minute, % of CMI score
• A more balanced therapy and nursing clinical case-mix will WIN under PDPM !!!
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How should SNFs prepare for PDPM? • Evaluate interdisciplinary workflows and systems that impact
length of stay and occupancy in your community.
• Does your Admissions team understand and adhere to the expectations related to LOS ?
• Does your Social Work team understand the expectations related to the LOS and have the tools to support timely discharges to the next level ?
• Does your Nursing team understand the value of providing and optimizing the resident’s highest functional level outside of therapy services ? Do they understand how correct documentation impacts reimbursement?
*Use resources like the CRITICAL PATHWAYS from Gravity
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How should SNFs prepare for PDPM? • Evaluate your Upstream and Downstream Relationships
• To keep information exchange consistent and timely
• To keep your occupancy up and to keep the referrals/admissions coming
• To facilitate safe transitions to the next level in a timely manner in order to maintain appropriate LOS and also minimize hospital readmissions
• To have systems in place for appropriate discharge follow up
• To achieve Preferred Provider status
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Thank you for participating! Irene Henrich, Director of Quality & Compliance [email protected]
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