How To Be A Winner with CMS’ New PDPM Change in 2019

Centers for Medicare and Medicaid Services (CMS) announced a new change in the reimbursement model for October 2019. It is called the Patient-Driven Payment Model or PDPM. Essentially, the plan is to decouple therapy minutes from reimbursement rates.
In the current model, the more therapy (billable minutes), the higher the Medicare reimbursement rates. With a model like this, it naturally incentivizes more therapy! Is that the right allocation of resources to improve patient care and patient outcomes?
CMS is asking the same question with the change to PDPM. More isn’t always better.

How does this change impact your organization?

Skilled Nursing must become smarter and more sophisticated.

With PDPM, the world is flipped upside down, more therapy equals lower margins!  With this change, PDPM will incentivize lower therapy minutes.  But don’t go too low, they will be auditing for large dips in therapy minutes.

Currently, the therapy business is measured on productivity (billable minutes / minutes worked) & Cost per minute.  It makes sense, these metrics are key to making sure your therapy resources are (a) improving reimbursement rates and (b) keeping costs low and (c) improving patient care.

What metrics should you be tracking with the upcoming PDPM change?  I think the answer is to become more granular in our views.  We need to dive into the data!

Here are two ideas!

  1. Find out what therapy approaches produce the best outcomes for a diagnosis with the least therapy.
  2. Which therapists are producing the best results in those programs?

Like in online marketing, (A/B) testing is critical to testing new ideas and optimizing to improve website traffic conversion.  This whole process is iterative and builds upon itself as you pivot and adjust creating a better and better product.

Skilled nursing can be doing the same thing to optimize the patient experience and improve patient care. 

The result of these activity can be massive.  You will not only improve your therapy program with a lower cost, but you will have case studies that you can market to your community of hospitals and doctors. You will have improved patient outcomes, at the end of the day results speak the loudest.

I think this is the goal of PDPM.  To help get the Skilled Nursing industry to become smarter, do more with less.  This change is going to create winners and losers in the market.  Some of the larger companies who have data services teams to help them analyze their data are going to naturally have a competitive edge.

Will you be ready?

By starting sooner and setting up these systems now, you can go into October 2019 as a winner.

PointClickCare (PCC) Views for Therapy Data

Did you know you can pull therapy minutes from the PCC data relay (if you use a therapy software that integrates with PCC like Rehab Optima or Casamba)?

This is a great way to track billable minutes automatically!  The downside of these views is that you can only view minutes by Discipline.

With these views, you can’t track minutes down to employees or patients.  Also, you cannot calculate productivity since the data is lacking minutes worked.  For more advanced views and metrics, you will want to tap directly into your ROX or Casamba database.

[view_ods_therapy_type_mapping] – List of different therapy disciplines.

[view_ods_th_minutes] – Billable therapy minutes by resident by facility by type & day.

Read about the SNF PPS Payment Model Research at >>

Kevin Baker
Data Services Partners

Hi, I’m Kevin.

As former Director of Data Services at Ensign Services, a publicly traded company, I have an extensive background and expertise in the Skilled Nursing sector and the needs of both the management and information technology sides of the business. We’re experts in the systems and metrics that support Skilled Nursing and Post Acute Healthcare businesses.

My passion is helping businesses transform their data into actionable information to make better business decisions. We are developers you can trust. Data is our passion.

If you have a question about this article, or want to have a discussion about it, let’s chat!

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