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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