The Centers for Medicare & Medicaid Services (CMS) will begin using the PDPM, which focuses on the patient’s condition and resulting care needs rather than on the amount of care provided, to determine Medicare payment. Significant changes will affect skilled nursing facility payment systems beginning in FY 2020, which begins Oct. 1, 2019, and home health agencies in calendar year 2020.

A recent column in McKnight's Long-Term Care News, No PDPM panic when you’re in sync,” can help you prepare. Author Rod Baird is the president of Geriatric Practice Management.

Thorough and early preparation can increase your staff members’ confidence in the technology—and perhaps your staff retention. Baird shared a noteworthy statistic from software reviews site G2 Crowd: 24% of workers across industries have thought about leaving their jobs over “bad” technology.

Baird’s first tip is to make sure that your information technology platforms have the capabilities to support staff efforts to comply with PDPM while helping to avoid errors or missing pieces. The second is to look for gaps or other issues with your technology now, before PDPM goes into effect.

Next, look at your billing system. Baird suggested organizations select ICD-10s with PDPM in mind for every encounter or visit. Including the codes in the practitioner notes that go into the official medical records will satisfy both third-party insurance and Medicare Part B.

Collaborate with medical groups covering your facilities and your interdisciplinary teams. Look for technology that can expand on MDS information to ensure accurate diagnoses and identify appropriate resource needs. Secure the ability to communicate appropriate information throughout the care continuum without time delays, gaps in information, or interoperability issues.

Baird provided this list of items that your system will need to move into PDPM:

  • The ability for team leaders to stay on top of data, including analyzing recent admissions to determine PDPM’s impact, tracking/understanding staffing levels, knowing lengths of stay, tracking five-star quality measures, and knowing ED admissions and 30-day readmission numbers.
  • The ability to identify your facility’s strengths and weaknesses so that you can change or revise processes as necessary.
  • Easily identify, manage, and track diagnoses in a way that promotes effective documentation, thus driving PDPM payments.
  • Dashboards and other tools to give your team access to easily available, accurate, and real-time snapshots of what is happening facility-wide and with each individual patient at any given time.
  • EHR technology designed specifically for long-term and post-acute care, including the move to PDPM and what implications this will have for the documentation, use, and sharing of data.
  • An interoperable platform that links practitioners with facilities and others in a shared care model.
  • An analytics tool.
  • An ability to estimate, assess, and track frailty and frailty risk.

Concerned About PDPM?

Check out the handouts from the session focusing on Person-Centered Payment Models & Supporting IT Tools panel presented at the Collaborative Care Summit, check out relevant resources from LeadingAge Gold Partner PointClickCare, or explore related materials on the LeadingAge Learning Hub.