It’s too early to officially gauge how successful the new Patient Directed Payment Model is, but anecdotal evidence points to success for both nursing home providers and residents, according to American Health Care Association President and CEO Mark Parkinson.
“Providers are telling me they are taking care of patients they didn’t take care of before,” Parkinson told McKnight’s Long-Term Care News on Monday. “They are getting sicker patients that would have stayed in the hospital for an extra day or would have gone to an LTAC (long-term acute care facility) or IPR (inpatient rehab facility).”
It will be interesting to see if data bears this out on a nationwide basis, he added, “because we’ll be saving the system a lot of money, taking care of high-acuity patients in skilled nursing facilities as opposed to the hospital.”
Therapy levels have not changed much under PDPM, which took effect on Oct. 1 and emphasizes the patient’s clinical profile versus volume of rehab services. Anecdotally, providers “aren’t seeing a serious reduction in therapy minutes,” Parkinson noted, adding that there has been a “modest” 10% to 15% increase in group and concurrent therapy.
Upcoming quarterly earnings reports from publicly traded companies will reveal just how positive the program is for providers, he explained. Patient outcome data will come later, further building a case.
“If CMS needs to make changes on the revenue or other side, we’ve got to have patient outcome data to know what the logical changes will be,” he said. “We’re going to have to be patient.”
He praised the Centers for Medicare & Medicaid Services for the policy and launch: “It is a better system than our old reimbursement system,” he said, calling the previous RUGs-based system “too dependent on therapy.”
Parkinson, the leader of the largest nursing home association in the country, praised CMS officials for their timely release of software and programs that eased implementation and transition issues.
“There are thousands of moving parts with PDPM and thousands of ways it could have gone wrong,” Parkinson noted, “and CMS got it right.”