PDPM Performance in a Post- Pandemic World: Understanding Benchmarks ...

[Pages:24]PDPM Performance in a PostPandemic World: Understanding Benchmarks While Identifying

Compliance Liabilities

AUGUST 19, 2021

PDPM Heat Map ? Ranking the States

Source: CORE Analytics

PDPM Rate Scenario #1: Orthopedic Case

PDPM Rate Scenario #2: Neurological Case

PDPM Rate Scenario #3: Mixed Medical Case

The "Case-Mix Creep" by Rate Component

PT / OT

$174 $173

$173.37 $172.94 $172.43

$172

$171.44

$171

$170.36

$170 $169.06$169.48 $169

$168

$167 Source: CORE Analytics $166

Jan-21 Feb-21 Mar-21 Apr-21 May-21 Jun-21 Jul-21

SLP

$46.00 $45.50 $45.00 $44.50

$45.66 $45.51 $45.51 $45.75 $44.98 $44.36 $44.50

$44.00

$43.50 Source: CORE Analytics

NTA

$123 $122 $121

$121.54$121.73$122.07 $120.81

$120

$119.19

$119 $118.20$117.90 $118

$117

$116 Source: CORE Analytics $115

Jan-21 Feb-21 Mar-21 Apr-21 May-21 Jun-21 Jul-21

Nursing

$205 $202.92 $201.05

$200 $195 $190

$196.80 $194.92 $193.21 $191.48$190.22

$185

Source: CORE Analytics $180

Jan-21 Feb-21 Mar-21 Apr-21 May-21 Jun-21 Jul-21

Isolation Distortion in the Nursing Component

Isolation v. Special Care High Capture Trended

60% 50% 40% 30%

49.0% 50.6% 51.2% 52.5% 53.7% 54.3% 52.5% 52.2% 51.3% 50.7% 51.2% 50.9% 49.3% 49.3% 48.3% 48.3% 48.5% 48.6% 48.9%

44.6%

40.6%

47.4% 48.8% 48.4%

43.3% 31.0% 39.4%

41.6% 36.3% 37.0% 37.6% 38.0% 39.6% 40.6% 38.8%

42.6% 44.4% 45.4% 46.2% 39.6%

35.4%

33.3% 32.5%

30.1%

20% 10%

0%

0.9%

1.2%

1.4%

1.6%

1.8%

17.3% 17.2%

17.6% 16.8%

10.9%

14.9% 14.1% 11.7% 10.1% 12.4%

13.9% 8.7%

2.8%

5.7%

4.1%

3.2%

2.7%

Source: CORE Analytics

Isolation

Special Care High

Iso + SPH

PT / OT Component

Category Major Joint Rep / Spinal Surg Other Orthopedic Medical Management Non-Ortho Surg & Acute Neuro

PT/OT (by Days) Top 10%

3.2% 22.9% 44.3% 29.5%

Average % 3.6% 21.8% 50.8% 23.8%

24 10-23 6-9 0-5

Range

PT/OT Function (by Days)

Top 10%

Average %

0.4%

0.7%

48.2%

56.5%

28.9%

25.1%

22.5%

17.8%

Source: CORE Analytics, January ? July 2021 Medicare Part A claims

Bottom 10% 1.8% 15.1% 66.4% 16.7%

Bottom 10% 2.2% 58.5% 22.1% 17.2%

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