It’s hard to believe, but summer is just around the corner. And we all know what that means…barbecues, beaches…and PDPM preparation! Wherever you sit on the readiness scale, it’s important to dispel a few of the misconceptions about PDPM, so you’re building and executing against a sound strategy based in reality and practicality, not hype. What are some of the myths circulating out there? Let’s take a look:
Myth: We’ll See a Mass Reduction in Therapy
One of the biggest myths around PDPM is that it will drive a mass reduction in therapy in skilled nursing facilities. It’s easy to understand how this myth has gained momentum. The traditional RUG-IV model reimburses based on the volume of therapy minutes provided—that’s the world everyone knows. Under PDPM, reimbursement is based on patient characteristics and needs.
Keep in mind that the amount of therapy provided should not significantly change under PDPM, as the needs of the patient should always be the determining factor. The only thing that’s changing is how we record and monitor the data. It’s also important to note that CMS has allocated reimbursement dollars specifically for therapy to each and every resident in a SNF and reasonably expects therapy services to be provided accordingly. In fact, CMS will be monitoring the modes of treatment and amount of therapy delivered as recorded on the MDS discharge. So, providing dramatically less therapy for similar patient caseloads would indicate that the provider was either over-delivering therapy under the RUG system to increase revenue or under-delivering therapy under PDPM for financial reasons.
Myth: Old Rules Don’t Apply
Another myth we keep hearing is that the old rules of service delivery don’t apply under PDPM. This is particularly curious as PDPM only applies to changes at the reimbursement level. It does not impact the clinical model—so whatever course of care the patient needs prior to October 1st is going to be the same course of care they’ll need after. Of course, there will be changes in documentation and the number of assessments. There are also new rules around delivery approaches with group and concurrent therapy. But, ultimately, there shouldn’t be any changes to the care itself. As mentioned earlier, CMS will be tracking the amount of therapy and modes of treatment provided under PDPM, and it will also be looking at other metrics, such as Section GG data and readmission rates to monitor the overall quality of care. In other words, it all goes back to your core mission as a provider—delivering the appropriate level of care for each patient and focusing on good outcomes.
Myth: To Survive, You Must Bring Therapy In-House
A third myth revolves around going in-house. Of course, as is the case with any change in reimbursement structure, providers will want to re-evaluate their business practices. However, there are a number of factors that need to be considered, such as the complexity of managing those minute volumes based on patient needs. The patient population and profile are also going to continue to change, and providers will need to flex staff to meet those changes. There’s also going to be a lot of education and training needed to advance the skills of therapists under PDPM, which could be costly.
That’s not to say an in-house model won’t work. As mentioned in an earlier blog post, a strong in-house program functioning well under the RUG system will also be able to have good results under PDPM. But it will be important to look all the issues involved and potential benefits of working with outsourced therapy providers, including:
-Potential savings and support that could be gained with a risk-sharing contract
-Additional protections, such as indemnification against therapy-based denials
-Other therapy best practices and use of data analytics
Ultimately, it’s about making an educated decision based on the specific needs of your organization.
There’s no question that change can be scary, and we have a tendency to resist it initially. But in the face of change, it’s important to separate fact from fiction to ensure we’re not resisting something that will ultimately be a positive. PDPM is no exception.
We recently hosted a webinar, “Top 10 PDPM Myths Busted,” that gathered a panel of industry experts to address these and other common myths and concerns being circulated about PDPM. To learn what they had to say, view the recorded webinar here.
