James M. Berklan

For better or worse, the long-term landscape is awash with PDPM experts and advisors. You can’t swing a therapy cat by the tail nowadays and not hit someone claiming divine knowledge.

That’s kind of curious since the Patient-Driven Payment Model is entirely new and nobody, the feds included, will know how it will shake out until a few months after its Oct. 1 start date. 

But the feeding frenzy continues. As well it should. The incredible turnout for the special McKnight’s webinar Tuesday on the clinical care aspects of PDPM showed that providers are taking this seriously (click into the registration to hear it again, or for the first time).

While initial reports about PDPM almost consistently emphasized the declining emphasis on therapy, webinar speakers Todd King and Nancy Losben made it clear that there are also going to be some great opportunities. Call it the uprising of the non-therapy ancillaries, a category that you are going to be hearing a lot more about.

PDPM is designed to be budget neutral. So for every loser, there should be at least one winner. Stock in nurse assessment coordinators undoubtedly has risen. With MDS information driving reimbursement, nurses — and assessment coordinators — will be treasured more than ever for their revenue-finding skills. In other words, if your name is the American Association of Nurse Assessment Coordinators, you’re sitting pretty.

Other potential big winners? Pharmacists. At least that’s according to Tuesday’s speakers, both of whom not coincidentally happened to be … pharmacists. Regardless, their case was compelling.

With the emphasis changing from rehab to actual medical condition, pharmacists could be used to optimize planning and coding early in a resident’s stay. This is especially true, given the new importance of making spot-on initial assessments.

“The wonderful thing about nursing services is, it’s not regressive payment,” Losben pointed out. “Once it’s set, that payment rate will remain the same.”

There will be “great value” in taking more complex patients, she added, “because we’ll be compensated for it.”

IV medications will reap 25% greater payments, for example. And younger patients might mean better reimbursement. Federal regulators clearly want providers to accept higher-acuity patients.

“We must get over the fear of taking residents with HIV, or those who have a trache or need a ventilator,” Losben stressed. “We may even see the return of the respiratory therapist to our buildings.”

Transfusions needed? More residents who have had an organ transplant? More conditions that need multiple, compatible drugs? The importance of medical directors, pharmacists and others such as dietitians is about to rise considerably.

As King pointed out, there also could be good opportunities with generic drugs that can restrain costs while maintaining clinical effectiveness.

Historically, pharmacists have been used for a retrospective look at patients in a skilled nursing facility. That’s about to change. The value of pharmacists closer to the admissions process will grow. Opportunities are ripe there.

The parting advice? Spend a few minutes every day understanding the development of this PDPM animal. Nobody truly knows it fully yet, and it is evolving. With as much as a 33% drop in rehab billings, that means money is going to pay for other aspects, including things like nursing, pharmacy and electronic records.

There’s a new age coming. The key to thriving, as King puts it, is to, “Look at places you might not have looked at before. We’re all in this together to provide the highest level of care we can.”

Follow Editor James M. Berklan @JimBerklan.