A new person-centered reimbursement model is coming to SNFs, and you need to be on the ground floor for change.
The Patient Driven Payment Model (PDPM) is the new Medicare payment rule for skilled nursing facilities, replacing the current reimbursement system (called RUG-IV). PDPM represents a significant change and goes into effect on October 1st. While patients’ therapy minutes currently drive payment for SNFs, PDPM provides reimbursement based on the complexity of individual patients’ care needs as detailed in the primary and secondary diagnoses. Under this new system, HR takes on a heightened role in helping to ensure the organization’s success.
Why the change? The Centers for Medicare & Medicaid Services (CMS) designed the new system to focus more on person-centered care needs and goals and direct more Medicare spending to high-acuity patients. Agency officials also anticipate that PDPM will reduce fraud by associating therapy payments with patient needs and not minutes of therapy.
CMS has created a special website for PDPM, with facts sheets, frequently asked questions, and other resources. In the meantime, here are some steps you can take to support your organization’s efforts to gear up for this new reimbursement system:
· Work with administrative and clinical leaders to determine additional staffing needs for PDPM. For instance, you might need to hire more nurses or caregivers or Minimum Data Sets (MDS) coordinators. You will want to get a head start on hiring, as these employees should be up to speed by the October 1st PDPM start date.
· Consider how therapy needs might change. While therapy minutes will no longer drive reimbursement, this doesn’t mean that your organization can cut back on therapy staff. Analyze data regarding the number of patients coming to your facility for rehab in the past year, for instance, and use this to project the volume of therapy services moving forward.
· Work with facility leaders to help identify training needs and arrange schedules so that employees can participate in special training and education programs related to PDPM.
· Help staff deal with stress. Implementing a new reimbursement system is bound to be challenging and stressful for everyone. Make sure employees know how to seek help if they are feeling burned out or overwhelmed as PDPM goes into effect.
· Be a positive role model for change. Recognize employees who take on new roles or are instrumental in helping to implement PDPM. Celebrate successes (such as a citation-free survey) with workers. Arrange special food or treats for training sessions. Encourage managers and thought leaders to model positivity for their teams.
PDPM is a major change, and there will be challenges, frustrations, and missteps. HR can help keep employees focused on doing what is right for patients and being effective and confident in their jobs. Promote a culture where employees feel safe expressing fears, concerns, uncertainties and the need for help, support, and additional training.
