Skilled Nursing Facility Providers around the country are beginning to prepare for the Patient Driven Payment Model. PDPM is scheduled to be implemented on October 1, 2019.  Anytime a new system is introduced, industry stakeholders face a learning curve to prepare for the implementation in hopes of coming out on top.  We at Language Fundamentals are no exception and recognize that we as an industry still have much to learn.

Here are the Top 5 Things I’ve Learned about PDPM (so far):

  1. Nursing should justify skilled care – This has always been a best practice, but somewhere along the way, SNFs began relying too heavily on therapy.    Identifying the primary reason for stay and all medical complexities in our coding and documentation will be essential under PDPM.
  2. Speech Therapy is now front and center – PDPM has shifted money to the new SLP Component which has the largest variation or “spread” in per diem reimbursement between the highest level of speech needs and the least ($92.81 vs. $15.06). Therefore, Speech must have a high level of competency in evaluating the patient, identifying speech-related comorbidities, and developing a plan of treatment. Those who devote the optimal resources to having a versatile and proactive Speech Therapy Department should see a positive outcome 😊
  3. ADL coding will be confusing- Functional Score will be derived from Section GG and will have different yet significant impacts on the PT / OT and Nursing components.  A higher score in GG will now mean more functional independence and will have an inverse effect on said PT / OT and nursing components.  In Case Mix states, section G will still be used to determine ADL score while still using the traditional scale.
  4. Efficiency in PT / OT will be their mission- Since the number of therapy minutes will no longer be a driver of reimbursement, our colleagues in PT and OT are now tasked with obtaining the best outcomes with the maximum amount of efficiency.  Concurrent and Group Therapy could become useful tools once again.  The number of minutes delivered will still be tracked in MDS Section 0.  Could this be a potential audit area?
  5. Accuracy of Diagnosis Coding – Every ICD-10 code is linked to 1 of the 10 clinical categories.  It’s time to really hone our skills when it comes to coding and also engaging our physicians in the process.

There will certainly be a great deal of debate and discussion over the next year. We’d love to hear your thoughts and insight.  Please use the comment box below!