Patient outcomes will be the guiding light under the Patient-Driven Payment Model, and data monitoring will empower the new payment system’s ability to illuminate.
That was one message from John Kane, SNF Team Leader at the Centers of Medicare & Medicaid Services, during the AANAC/AADNS annual conference in April in Orlando.
Documentation requirements are exactly the same under PDPM and the current RUG-IV systems, Kane emphasized.
“If they not going to benefit from group therapy now, they won’t benefit from it as of October 1,” he stressed. “If they need 720 minutes now, they’ll need it as of October 1. What the patient needs now is exactly what they need as of October 1. They do not change because we change the payment system. And we will be watching.”
Regulators will keep a close eye on comorbidity coding, mechanically altered diet levels, therapy intensity and duration, and the manner of delivering terms of concurrent and group therapy.
“If we see significant shifts in care provision between RUGs-IV and PDPM, that is likely going to draw scrutiny,” Kane said.
Audits could result if odd aberrations are found, though they wouldn’t necessarily be automatic, he added.
From the May 1, 2019 Issue of McKnight's Long-Term Care News
