PDPM Every Penny Counts - SimpleLTC

[Pages:30]Trends, challenges and solutions in Texas skilled nursing

SEP 15-16, 2020

SESSION 9

PDPM ? Every Penny Counts

Don't Leave Them On the Ground

SUSAN KRALL , PT, RAC-CT CSO, QRM (QUALITY REHAB MANAGEMENT)

Texas LTC Virtual Symposium: CEU Disclosure to Participants

Conflicts of Interest: The planning committee members and presenters/authors/content reviewers of this CNE activity have disclosed no relevant financial relationships related to the planning or implementation of this CNE activity.

Explanation: A conflict of interest occurs when an individual has an opportunity to affect or impact educational content with which he or she may have a commercial interest or a potentially biasing relationship of a financial nature. All planners and presenters/authors/content reviewers must disclose the presence or absence of a conflict of interest relative to this activity. All potential conflicts are resolved prior to the planning, implementation, or evaluation of the continuing nursing education activity. All activity planning committee members and presenters/authors/content reviewers have submitted Conflict of Interest Disclosure forms.

Selman-Holman & Associates, A Briggs Healthcare Company, is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.

Penny for your thoughts...

Do you know your trending PDPM revenue by Component (PT/OT, ST,

Nursing, NTA)?

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Agenda

PDPM Reimbursement Model - Refresher PDPM Calculator with FY 2021 Updates Impacting Reimbursement Drivers by Component Revealing Data Trends Key Component Drivers Top 5 Opportunities Risk Mitigation

Are you ready to start finding pennies?

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PDPM Reimbursement Model - Refresher

Intent: Focus care delivery on, and reimburse providers for patient-specific active conditions, co-morbidities and level of care needs. Desired Result: Patient-specific knowledge and individualized care delivery driving improved overall outcomes.

MDS

Initial Medicare Assessment 7-Day lookback window Optional Interim Payment Assessment (IPA) Interrupted Stay 161 Questions on MDS Determine Case Mix Group by Component Case Mix Group (CMG)> Case Mix Index (CMI) (No PDPM MDS item changes for 2021)

Reimbursement

CMI is Multiplied by CMS' Component Base Rate Base rates are Average Wage Index (AWI) Adjusted Components : PT/OT, ST, Nursing, NTA & Non-Case Mix Daily rate = sum of all components impacted by variable per diem (day of stay)

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PDPM Reimbursement Model Calculator

2021 base rates, eff 10/1/2020

Component

Urban Base Fed Rate *

Non-wage index adjusted

Rural Base Fed Rate *

Non-wage index

adjusted

Case Mix Index (Determined by Case Mix Group Capture)

Special Adjustors

Variable per diem (VPD)

Payment (per diem) URBAN without VPD or AWI impact

PT

$62.04

$70.72

X

1.08 ? 1.92

X

1 through day 20

X

then drops 2% =

every 7 days

$67 - $119.12

OT

$57.75

$64.95

X

1.09 - 1.69

X

X

Same as above =

$62.95 - $97.60

SLP

$23.16

$29.18

X

.68 - 4.21

X

X

=

$15.75 - $97.50

Nursing

$108.16

$103.34

X

.66 - 4.06

X

1.00**

X

= $71.39 - $439.13

NTA

$81.60

$77.96

X

.72 ? 3.24

X

X

3 day 1 ? 3, then drops to 1

=

$58.75 - $264.38

Non-Case Mix Component

$96.85

$98.64

X

X

X

=

$96.85

? AWI applied to labor portion of base rate for 2021 = 71.3%. 2021 Wage Index Analysis ? capped at 5% drop for 2021 Total Payment

$372.69 - $ 1,114.58

** Except when the resident has HIV/AIDS, then variable per diem adjustment equals 1.18 *** Rates are for FY 2021, from SNF PPS final rule

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PDPM Reimbursement Model

Impacting Reimbursement Drivers by Component

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Impacting Reimbursement Drivers

IDT Communication, Collaboration & Documentation (by ARD)

? Initial IDT

PDPM

Component

Review

? Day 1-3

? Restorative ? Determine care

Gathering of GG Nursing

delivery needs

Performance &

Initiation

by Discipline

Patient Specific Goals

? Baseline care plan

? GG 1st 3 days Review and Determine "Usual Performance" & DC goals

? BIMs / CPS and

? PHQ9 Interview completion

PreAdmission

Day 1,

(Day of Admission)

Day 2

Day 3

Day 4

Day 5

? IDT Review of Patient Response to Intervention & progress towards capturing of active conditions, Dx & characteristics

? PDPM Component Review Leading to Accurate Admission Assessment by day 8 (161 items on MDS impact reimbursement)

Day 6

Day 7

Dx capturing of Primary Reason for SNF stay begins preadmission ? continually reassess for accuracy and supportive documentation

Day 8

Don't be a day late and a

dollar short!

Day 9<

? Ongoing Dx Specificity > Clinical Category (68,000 ICD10 codes, 24,000 RTP)

? Gathering of ACTIVE Clinical Conditions and Characteristics - including Pre-Admission ? Consequence of incomplete assessment = default category

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