Few can argue that stakeholders have worked hard to get up to speed on the Patient-Driven Payment Model. 

The Centers for Medicare & Medicaid Services has conducted a helpful awareness blitz leading up to PDPM’s Oct. 1 implementation, according to Jennifer Richter, president and CEO of Richter Healthcare Consultants. This includes the agency’s dedicated landing pages for ondemand, free PDPM education and resources.

Too few staff at the nation’s nursing homes, however, may have capitalized on them. 

“These resources and educational opportunities are more than likely taken advantage of by higher level positions within the provider community and not made fully available to the facility staff,” Richter said recently. “It falls on the selected few to educate the rest of the staff.”

For these and other reasons, the SNF community had been ill-prepared, at least until recent weeks, according to Leah Klusch, RN, BSN, FACHCA, executive director of The Alliance Training Center.

“They’re not ready at all,” said Klusch, who as of late August claimed many of her clients in 41 states and over 3,000 facilities “literally did not have core information on PDPM.”

Richter was concerned “most educational opportunities have not included change management strategies or project management road maps for providers to put to use” in the interim. Consequently, “providers without the staff to provide these strategies may struggle with the transition.” 

Klusch asserted most SNFs might have a great deal of catching up to do before Oct. 1. Their ability to code correctly depends on it. 

“There are items we’re coding in 2019 routinely and some of those items are not being coded accurately because people did not pay the appropriate amount of attention to the updates last October,” she said. 

The consequences for providers can be serious, she explained: “They’re not going to have the right coding and therefore not the opportunity to have appropriate reimbursement. They may not be coding the items aggressively enough or with the right documentation and, consequently, their reimbursement rates may be lower.” 

Klusch urged facility leadership to get a grasp of the exponential increase in MDS items and evaluate staff competency in data collection and verification so “the payment will be appropriate for the care we are delivering.” 

Richter advised SNF leadership to create a plan for completion of IPA assessments at the time of the transition, and to perform a PDPM Readiness Assessment that focuses on diagnosis management so that current diagnoses map correctly to the new PDPM categories. 

“Readiness checklists should include items for all staff training, outreach to hospitals, physicians and other community partners, and a review of the provider’s current software for technological readiness,” she said. Richter also urged management to rev up staff education on PDPM.

“Staff education is paramount for a successful transition,” she said. “Education should not be limited to PDPM but should include fundamentals of clinical assessments and documentation.” 

While the word “catastrophic” is not a word any expert observer is using when forecasting the PDPM implementation fallout, there definitely will be winners and losers from the start. 

“Providers who are already doing well with managing quality measures and documentation requirements should continue to do well, and even thrive under PDPM,” said Richter. “The poor performers will continue to struggle out of the gate, and may fail completely if they do not have a plan for the transition.

“To paraphrase [AHCA Senior Vice President of Government Relations] Clifton Porter of AHCA, the 20-60-20 rule to PDPM implementation means 20% will do quite well, 60% will muddle through and 20% will fail.”

Editor’s Note: This article appeared in similar form in the 2019 Dealmaker’s Handbook. The entire publication can be downloaded here.