In 2018, 1 in 25 U.S. adults (or 11.4 million people) had a serious behavioral health need. Patients residing in skilled nursing facilities present with a variety of mental health needs that require treatment and care including dementia, adjustment disorder, depression, post-traumatic stress disorder and bipolar illness to name a few.

Under the previous RUG-IV reimbursement model, skilled nursing facilities faced difficulties accepting residents with complex behavioral health needs due to the considerable requirements for providing specialized care. We saw several barriers to offering patients the care that they needed, from a shortage of specialists and difficulties with access to limited treatment options to the expenses associated with referring patients to outside behavioral health treatment.

The new Patient-Driven Payment Model brings a significant change to how skilled nursing facilities bill for specialized care for residents with complex behavioral health needs. At MediTelecare, we are beginning to hear from our partners about new challenges they are encountering. For example, capturing cognitive impairment early in the resident’s admission can be demanding on staff and may feel burdensome to patients who are just beginning to settle into the facility.

PDPM also places emphasis on the Brief Interview for Mental Status (BIMS), as a screening tool for establishing cognitive impairment. From a clinical standpoint, however, it is important that providers and facilities recognize that the BIMS may not be a sensitive enough instrument to detect cognitive impairment in its mild and moderate forms.

For now, facilities will likely still rely on the BIMS to assess cognition for PDPM purposes. Behavioral health partners, however, should be committed to providing the most accurate assessment and diagnosis of residents not only to assist in PDPM but most importantly to ensure that those residents receive the quality of care they deserve.

We know, for instance, that early detection and intervention is so important in treating and slowing the progression of dementia. To achieve this goal, we use the information obtained from the BIMS in combination with clinical interview, neurocognitive screening, record and history review, and behavioral observations to arrive at the most accurate diagnoses of your residents. 

MediTelecare is also ensuring its partnering facilities are prepared for a potential influx of residents being appropriately diagnosed with cognitive impairment, depression and other behavioral health concerns by offering early assessment and diagnosis and following up with ongoing treatment and care tailored to each resident’s individual behavioral health needs. 

As their behavioral health partner, here are some of the ways we’re helping facilities prepare for a PDPM:

  • Expedited evaluation of residents to ensure up-to-date diagnosis that reflects any behavioral or cognitive symptoms 
  • Neurocognitive screening to identify cognitive impairments 
  • Real-time diagnosis updates, communicated to their designated point person for entry into their medical record 
  • Assistance with BIMS and PHQ-9 interpretation 
  • Follow-up visits to ensure facility compliance with service delivery for behavioral health needs 
  • Training and education for staff on understanding behavioral illnesses and managing challenging behaviors. 

While meeting the new PDPM standards, facilities have a responsibility to ensure that residents with behavioral health needs receive the care and treatment they deserve. With the additional financial support brought to skilled nursing facilities by a PDPM, residents will not only benefit from a more integrated care model, but facilities will be able to improve overall patient outcomes.