Understanding the Impact of the Patient Driven Payment Model

Need help navigating all the Patient Driven Payment Model (PDPM) talk out there? We are here to guide the way! Over the last year and a half, Mark has combed through CMS Updates for PDPM info and penned previous summaries (August 2018 & April 2018). Once again, he’s taken the time to go through all the information out there and create a new September 2019 edition as our PDPM Final Review, so it’s time to tear up the previous summaries and then read or download this new one to understand the upcoming regulatory changes…

UNDERSTANDING THE IMPACT OF THE
PATIENT DRIVEN PAYMENT MODEL

Seagrove Rehab Partners • PDPM Final Review
September 2019

Another Game Changing Proposal: The Patient Driven Payment Model

What a difference a year makes. One year and one day ago we posted about the "Game Changing" Proposed Final Rule, and here we are with a new proposed rule! Mark finished that update with, "Isn't Medicare Fun?" And it still is! To keep it fun, if you are awake all the way to the end, we’ll throw in some photos from last weekend when Mark digested all 266-pages of the new update and penned this summary. (If you are attending this week’s NARA Conference, the captions could prove helpful if your flight home is canceled - it’s a beautiful place about an hour from D.C. that would be fun to discover.) Without further ado, may we introduce you to the industry’s latest game changer, the Payment Driven Payment Model…

Initial Review of the Proposed Patient Driven Payment Model

The Game Changing Proposed Final Rule

As some of you may know, CMS just posted the SNF PPS Proposed Final Rule (https://www.federalregister.gov/public-inspection/current) on Thursday of this week. Below is a copy of the fact sheet that accompanied the proposed rule, which is essential for skilled-nursing facilities to understand. Most importantly, in this new rule, there is an entirely new methodology proposed for calculating RUG payments to SNFs. This new payment system would be patient characteristic-based and not therapy-volume driven, which will mean a significant shift in the way we manage therapists and therapy programs once it is implemented. Later this year, or closer to their implementation, look for Seagrove Rehab Partners to set a date for a live webinar to discuss the Proposed Rule and how it may impact your therapy programs. And in the meantime, the following fact sheet information should help introduce you to the changes.

Risky Business: Safeguard your Skilled Nursing Facility

Historically when a Skilled Nursing Facility (SNF) outsourced their therapy to a contract provider, they partly did it to abdicate the headache, responsibility, and liability. Those reasons for outsourcing are no longer valid thanks to recent legal precedent. The following settlements between the Federal Government and SNF providers show that even when a facility contracts with an outside rehabilitation therapy provider, the facility now has a continuing responsibility related to the provider’s actions. This responsibility, if neglected, could cost you millions, so I wanted to take a minute to share a few links to those articles with you and some thoughts I have regarding the overarching issue of managing your therapy program: