Skilled nursing operators are being encouraged to start analyzing their operations in order to prepare for a possible reduction in reimbursement levels if a recalibration to the Patient Driven Payment Model moves forward.
The Centers for Medicare & Medicaid Services revealed late last week that it’s considering amending PDPM’s parity adjustment after SNF spending under the new model unintentionally increased by $1.7 billion, or 5%. The agency is seeking comments from industry stakeholders on the matter.
The revelation by CMS means that SNF operators should start preparing for decreased reimbursements, according to CliftonLarsonAllen Principal Deb Emerson, who leads the firm’s post-acute reimbursement team.
“The goal of PDPM was for CMS to reimburse facilities based on the clinical needs of patients and SNFs improved their documentation to capture the care being provided,” Emerson told McKnight’s Long-Term Care News on Monday.
“The recalibration will reduce the reimbursement to providers even as those providers are more accurately capturing patient care needs and the resources utilized for that care,” she explained.
Other industry leaders also have warned that SNFs could face a “major reimbursement change” if CMS does move ahead. Emerson predicted that CMS’ potential recalibration of the case-mix indices could result in a reimbursement reduction of $12 per patient day for operators.
“Providers have been operating under the current rates and making budget decisions based on these rates. A reduction of at least $12 per day will certainly have an impact on reimbursement and the operating decisions being made by nursing facilities,” Emerson added.
She warned that SNFs should “critically analyze their organizational operations now so they can adjust accordingly for the potential decrease in PDPM reimbursement.”