One of the unplanned byproducts of a proposed new payment system could be a better legal image and standing of therapy and rehab providers.
A key provider advocate said in mid-July that the proposed Patient Drive Payment Model could spare operators from therapy upcoding lawsuits like the one that will cost nine nursing facilities and a consultant $10 million in a settlement with the Department of Justice.
Implementation of PDPM will reward value of services provided, rather than volume of services, pointed out Cynthia Morton, executive vice president of the National Association for the Support of Long Term Care.
“While moving to a new payment system is fraught with problems, we look forward to a model that is not based on volume and that measures patient outcomes, because that is what really matters,” Morton said.
The new system is targeted to be in place by Oct. 1, 2019.
“While it is not tied directly to outcomes, we do have outcome measures on the very near-term horizon that will help measure our patients’ functional change, which is largely driven by the rehab therapy provided to the patient,” Morton noted.
The July 18 settlement involved Southern SNF Management Inc., Dynamic Rehab and nine affiliated SNFs in Florida and Alabama.
The case covers October 2009 through December 2013, when the accused allegedly encouraged the delivery of “medically unreasonable and unnecessary therapy without regard for patients’ individual clinical needs.”
Three whistleblowers, former employees of one of the facilities, initiated the case and will receive $2 million of the recovery funds, DOJ officials said.
Provider lobbyists have said that regulators and authorities should pay more attention to outcomes rather than just staffing numbers.
From the August 01, 2018 Issue of McKnight's Long-Term Care News
