A top executive for a major skilled nursing company said providers should know by the “first quarter of 2020” how reimbursement will be impacted once the Patient-Driven Payment Model is implemented. 

Martin Allen, HCR ManorCare’s vice president of reimbursement, told the American Health Care Association’s Provider magazine that November will be too soon to know reimbursement changes after PDPM is implemented. 

Providers, instead, should know by the “first quarter of 2020” once they can “look at revenue changes vs. what we expected, and also if therapy delivery and other cost centers have been impacted,” he said. Allen also noted that the first indication of any changes to provider’s bottom line will come from the Minimum Data Set, the report stated. 

“There are tools available that show patient revenue and days to compare to pre-PDPM. If we can do this, then CMS, as recipient of all the claims, will be able to analyze the impact instantly,” he said.

Allen’s claims differ from those of Mark Parkinson, president and CEO of the American Health Care Association, who recently said it should take providers only about five to six weeks to clearly understand the ramifications of PDPM. 

“I think we’re going to know five or six weeks into it how we’re doing,” Parkinson said during the fall meeting of the National Investment Center for Seniors Housing & Care two weeks ago. “We’re going to know on the therapy stuff right away because people have to report on their therapy in five days … On the revenue side, by the end of November, we’ll have a pretty decent feel for it.”

Allen also discussed the company’s — and its 175 skilled nursing centers’ — efforts to prepare for the onset of PDPM. Their preparation and training efforts have included the AHCA’s PDPM Academy educational program and keeping a steady dialogue with CMS staff and AHCA leaders and members. 

“So, having been through the RUGs [resource utilization groups] implementation in the late 1990s and kind of comparing the tools available then and now, it is like night and day,” Allen said. “The approach AHCA has taken has been comprehensive times 10. If a provider has used it [the educational training] or paid attention to available resources to develop a framework for creating their own plan, they will be prepared.”