Journalists are supposed to be “words” men and women, but to be honest, I love a good set of numbers as much as anything. Especially when they’re tied to a pertinent analysis.
That’s why I find these early months of the transition with the Patient Driven Payment Model intoxicating. There’s mystery (Will providers fare well under the overhaul?), cunning (How might providers get the best bang for their buck?) and suspense (What will regulators yank back if they don’t like what they’re seeing?).
And numbers. Lots and lots of numbers.
Recently, I discussed initial PDPM signs with three of the biggest LTC numbers crunchers around, Marc Zimmet, Vince Fedele and Steven Littlehale. The topic was Zimmet Healthcare Services Group’s initial PDPM reimbursement analysis of the first month of Medicare claims.
The overall impression coming out of it? You’re going to be alright, providers. Just as many had predicted, those who did their homework — and vow to keep getting better — should be just fine.
Those who paid attention in their PDPM educational classes were making, on average, more than $50 more per patient day then they would have under the old RUGs-IV system. In addition, Zimmet estimated that providers could gain another $40 per patient day more once they get better at coding and, well, simply remembering to claim what they have coming.
While OT and PT therapy pay rates won’t necessarily budge much, speech language therapy, nursing and non-therapy ancillary services might provide additional funds, Zimmet explained.
The biggest worry isn’t so much what PDPM will do to providers’ bottom lines, but what the Centers for Medicare & Medicaid Services will do to cash flow when it eventually recalibrates pay rates.
Zimmet predicted with “95% confidence” that a rate readjustment will be coming. Providers will know in “less than a quarter” how finances will shake out, which means just about any time now. But CMS will likely take about another three months before it makes any pronouncements about rate readjustments.
Make no mistake: This is good. It means you’re not getting riffed out of the gate, wondering how to make ends meet. The CMS policy apparently is not budget neutral thus far — but in a good way.
And the best thing is, you can capture more revenue once you get better at coding and stop leaving money on the table.
From the January 2020 Issue of McKnight's Long-Term Care News
