McKnight's Long-Term Care News, May 2019, Page 4, John Kane

The Centers for Medicare & Medicaid Services is relying on data metrics regarding trends or changes in provider behavior, payments and beneficiary care quality as it considers potential adjustments to the Patient Driven Payment Model, an agency leader said Wednesday.

“As we start to approach [a post-pandemic] world, we want to try to understand what things are new [and] what aspects of PDPM do we need to revise based on this new post-pandemic world,” said John Kane, technical advisor and SNF payment team lead for CMS. 

“This is an area where — and I cannot stress this enough — that we strongly encourage stakeholders to provide feedback on any of the metrics that are out there,” he added. 

Kane’s comments came during the closing session of the SimpleLTC Virtual Symposium, where he discussed how CMS is trying to understand the impacts of PDPM during the pandemic. 

The discussion follows by weeks the agency’s decision to delay a potential recalibration to PDPM’s parity adjustment. It will be included no sooner than next year’s (FY 2023) SNF PPS proposed rule. SNF spending unintentionally increased by $1.7 billion, or 5%, under the PDPM model.

Kane said CMS has now collected data metrics for all of fiscal year 2020, and is still gathering FY 2021 and 2022 metrics to fully grasp what trends may have started under COVID versus PDPM. 

“That’s really why the data is helpful for both you guys and for us is the ability to reflect on what is going on within this space and identify are there regional issues or questions that we need to be able to answer,” Kane said.

“The data is extraordinarily helpful and can be leveraged a lot of ways to really understand both, for ourselves, the success or failure or areas of improvement of this new payment model, but also provides providers, vendors and researchers with an incredible opportunity to understand what’s going on within this space,” he added.