For better or worse, the long-term care landscape is awash with PDPM experts and advisors. You can’t swing a therapy cat by the tail nowadays and not hit someone claiming divine knowledge.
The Patient-Driven Payment Model is entirely new and nobody, the feds included, knows how it will shake out until a few months after its Oct. 1 start date.
But the feeding frenzy continues. As well it should. Among all the angst, it should be noted there are going to be some great opportunities. Call it the uprising of the non-therapy ancillaries, a category that you will hear mentioned a lot.
PDPM is designed to be budget-neutral. So for every loser, there should be at least one winner. Stock in nurse assessment coordinators undoubtedly has risen. With MDS information driving reimbursement, nurses — and assessment coordinators — will be treasured more than ever for revenue-finding skills. In other words, if your name is the American Association of Nurse Assessment Coordinators, you’re sitting pretty.
Other potential big winners? Pharmacists. With the emphasis changing from rehab to actual medical condition, pharmacists could be used more than ever to optimize planning and coding early in a resident’s stay. This is especially true, given the new importance of making spot-on initial assessments.
“The wonderful thing about nursing services is, it’s not regressive payment,” pointed out recent McKnight’s webinar speaker Nancy Losben. “Once it’s set, that payment rate will remain the same.” There will be “great value” in taking more complex patients, she added, “because we’ll be compensated for it.”
IV medications will reap 25% greater payments, for example. And younger patients might mean better reimbursement. Federal regulators clearly want providers to accept higher-acuity patients.
“We must get over the fear of taking residents with HIV, or those who have a trache or need a ventilator,” Losben stressed. “We may even see the return of the respiratory therapist to our buildings.”
The importance of medical directors, pharmacists and others is about to rise considerably. With potentially huge drops in some rehab billings, that means money is going to pay for other aspects, including nursing, pharmacy and electronic records.
There’s a new age coming. The key to thriving is to look for solutions in new places.