Renee Kinder
Renee Kinder

Never, ever bet on a horse wearing blinders.

Why, you ask?

Because, of course, a horse wearing blinders must be irresponsible, uncontrollable and, worst of all, completely unaware of its surroundings. At least as a child who spent my summers at the track, that was my logic.

Other tips?

Always bet on the gray horses, because they are unique.

Always bet on Pat Day, because he was a jockey with a proven track record.

Always arrive prepared, and read your racing form, a technique I was trained to master by age 8.

Speaking of being prepared, it appears changes to the PPS system as we know it could be coming, and they could be the most significant changes the industry has seen since the original implementation in 1998.

Providers should ensure that their rehab partners are aware of the potential changes in structure and are preparing their clinicians. Those who turn a blind eye could unconsciously be left at the starting line.

MedPAC recently finalized its recommendations for the skilled nursing industry, which urge officials to revise the PPS system.

Additionally, the Centers for Medicare & Medicaid Services has consulted with Acumen in an effort to establish a comprehensive approach to Medicare Part A PPS SNF payment reform.

An updated report from the October face-to-face meeting at CMS headquarters was recently published.

Project aims include efforts to:

•  Develop a comprehensive payment alternative for SNF services that promotes payment accuracy and positive resident outcomes

•  Assess the impact of the payment alternative on SNF residents, SNF providers, and the overall Medicare system

•  Recommend adjustments for adoption by CMS

The recommended structure could change from current volume-based reimbursement that considers therapy; nursing; and non-case mix to a system based on patient characteristics that considers payments in “buckets” for the following areas: physical plus occupational therapy; speech language pathology; nursing; non-therapy ancillary; and non-case mix.

As noted in a recent McKnight’s article, the days of counting therapy minutes may soon be gone.

Proposed payments could include an array of arrangements, including:

•  Block/linear: Daily payment is constant for the first set of days, and then declines linearly thereafter

•  Front-loaded/linear: Substantial fraction of payment for stay is made on first day, and remainder follows a linear function thereafter

•  Non-linear/Block: Non-linear declining daily payment with constant daily payments after a certain day

In closing, now is not the time to bet on a long shot.

Prepare your team to stay ahead of the pack as the industry awaits upcoming changes. Remember to find your gray horse — and beware of those running blind.

Renee Kinder, MS, CCC-SLP, RAC-CT currently serves as Director of Clinical Education for Encore Rehabilitation and acts as Editor of Perspectives on Gerontology, a publication of the American Speech Language Hearing Association (ASHA).