Tim Ashe

With Oct. 1 now in the rearview mirror, providers in the long-term care (LTC) industry, including nursing homes and skilled nursing facilities (SNFs), must adapt to new regulations that impact their Medicare and Medicaid reimbursements.

Providers across the U.S. have spent several months preparing for the implementation of the Patient Driven Payment Model (PDPM), created by the Centers for Medicare and Medicaid Services’ (CMS). Although PDPM presents new changes and challenges, the mandate is aimed at ensuring that providers deliver accurate and appropriate care to patients that improves their health outcomes.

PDPM is part of the larger, industrywide shift toward value-based payment systems that rewards providers for delivering high-quality care for people in need. While PDPM now requires more tracking and reporting for LTC providers and SNFs, particularly in terms of ICD-10 coding, the ultimate goal is providing better patient care.

PDPM is the next evolution of value-based care post-acute settings. We’ve seen this shift already in acute care industry’s transition from fee-for-service care to value-based care through various mandates (such as meaningful use). The LTC industry can look to acute care’s example to identify what worked, what didn’t, and best practices to make the transition to PDPM easier and more seamless.

Now that we’re in this new era of PDPM, what should facility management teams, care providers and other stakeholders focus on as the industry moves into this new uncharted territory? What can LTC leaders do in the short term to help guide this change with providers and staff? Here’s how you can thrive under PDPM:

  • Understand that transition takes time: Everyone realizes that adapting to change is disruptive, and it takes time for clinicians, care providers and staff to transition between old and new processes. CMS developed a website listing several of resources for stakeholders to use in educating and training staff on how best to implement and follow the new PDPM process.
  • Prioritize training and education: SNF managers should continue to schedule PDPM trainings — such as ICD-10 coding education — to provide a consistent cadence of instruction and repetition of the subject matter and help educate staff while also reinforcing the new PDPM protocol.
  • Use technology to improve standardization and automation: To improve the accuracy and consistency of documentation and data in a patient’s profile, organizations can leverage technology and other automated tools within their EHRs. These tools can improve accuracy of documentation and also standardize and automate workflows — so care providers can focus on individual patients and their needs during a visit, instead of splitting their focus on data entry.
  • Get external consultation: For organizations that don’t have the in-house resources to provide ongoing PDPM training and education, you can hire external experts experienced with payment and reimbursement to help audit procedures after PDPM goes into effect. This will ensure reporting processes comply with CMS mandates, in addition to identifying internal organizational needs to comply with PDPM.
  • Make investments in your PDPM success: While every organization has different resources to dedicate to their PDPM transition, CMS resources provide insights and guidance on how to make this happen more smoothly. Moreover, organizations and investors need to understand that CMS created PDPM to be budget-neutral; any early gains, commonly seen within the first few months on a systemwide level, will likely even out with corrective measures throughout the rest of the reporting year.
  • Build more cohesive internal collaboration, alignment and communication: By working diligently with their managers, providers and staff can establish closer, more open lines of communication to identify any issues early in on the PDPM reporting process. Focusing on effective communication and collaboration can help avoid any potential errors that could create reimbursement issues.
  • Align patient need with patient care: To better comply with PDPM, providers will need to identify additional patient needs, beyond a patient’s medical history, and connect them to other resources that assist in care delivery. This is the core principle behind CMS establishing and implementing PDPM — to strengthen the delivery of value-based care by focusing on the unique needs of each individual patient.

Any significant change to our healthcare system in the United States is difficult and takes time. We’ve seen that with PDPM over the past year, and we’re continuing to face it now during the early days of the transition. But by developing enhanced documentation and coding, improving accurate and consistent payment, and aligning these principles with individual patients and their specific needs, PDPM is an opportunity to align reimbursement with quality care and improved outcomes. With PDPM, the healthcare industry can continue fostering more collaborative, comprehensive, interdisciplinary, efficient and effective care that improves patient outcomes.