Editor’s note: This article has been updated to include comments from Jennifer Leatherbarrow.
The wait is now over and the Patient-Driven Payment Model has officially arrived. One organization believes many skilled nursing providers still aren’t prepared for the change despite months of preparation.
Many providers “are still not ready” for PDPM even though they’ve spent the last 14 months preparing for its implementation, said Erin Shvetzoff Hennessey, chief executive officer of Health Dimensions Group, a consulting company for post-acute, long-term care and senior living providers.
“Providers understand the concepts, but not all have redesigned their processes to support the new framework,” she told McKnight’s. “We also have heard time and time again that because the original impact estimates were positive, that ‘we will be okay,’ but because those impact estimates were made prior to marketplace changes and final specification of policies, we continue to believe that all providers could benefit from a deep dive on rates, impact and systems to support PDPM.”
Hennessey noted that PDPM will be more than a “switch for fee-for-service patients” and providers will see more payers moving to reimburse for SNF care using the PDPM payment model.
It’s time for providers to “remove the silos and tear down the walls because NF staff will need to work together in order to be successful with PDPM,” said Jennifer Leatherbarrow, RN, BSN, RAC-CT, IPCO, QCP, CIC, manager of clinical consulting at Richter Healthcare Consultants.
“Every discipline plays a role in the PDPM process and you will only be as strong as weakest link,” she told McKnight’s. “This first week should be a gathering of information week and everyone should take part. Facilities should also start to review admissions and potential admissions through a PDPM lens in order to capture the best reimbursement.”
Hennessey also reminded that the payment model will place a strong emphasis on clinical coding documentation and execution of the interdisciplinary team and today marks the beginning of a shift in the emphasis of therapy on volume to a focus on outcomes and the broader holistic needs of those we serve.
“We encourage all providers to continue to evaluate performance, increase clinical capabilities and understand the holistic care of patients that drives reimbursements and outcomes, both for PDPM and the ongoing push towards value-based transformation,” she said.
Hennessey added that Health Dimensions views the “new payment model as a major opportunity for SNFs to increase clinical integration with hospitals and truly show their value within the healthcare ecosystem and improving the lives of patients.”
