Patient Driven Payment Model (PDPM)
The new Medicare Patient Driven Payment Model (PDPM) begins October 1, 2019. For Skilled Nursing Facility (SNF) providers, this will warrant not only significant operational changes but also a change of thinking as the new PDPM removes therapy minutes as a determinant of payment and strengthens the relationship between payment and clinical characteristics to promote payment accuracy and provide the resources necessary for SNFs to meet the care needs of a diverse range of residents. PDPM will usher in a new paradigm in our approach to care delivery for these patients. Understanding how the six components (PT, OT, ST, NTA, Nursing, Non-Case Mix) incentivize SNFs to reimagine care delivery is critical for operational decisions in the new landscape. The winners in this payment system will be those that carefully assess their unique mission and vision for providing SNF care and begin taking steps to fulfill that vision. Additionally, PDPM requires a greater understanding of how to identify the medical complexity of our residents and ensure that complexity has been captured within the Minimum Data Set (MDS). The identification of medical complexity will require SNFs to have a keen understanding of ICD-10 codes.
This seminar is for SNF administrators, DONs, MDSCs, therapists, IDT members involved in making skilled admission decisions, determining care paths for SNF stays, and consultants involved with caring for those on an Medicare Part A stay.
· Review the six components of the Patient Driven Payment System
· Explain the variable per diem adjustment schedule
· Review the PPS MDS schedule
· Explain Use of the Interim Payment Assessment
· Explain how a function score is calculated
· Review the ?interrupted stay policy?
Judy Wilhide Brandt, RN, BA, CPC, QCP, RAC-MT, DNS-CT, Principal, Wilhide Consulting, Inc., Virginia Beach, VA Judy Wilhide Brandt has more than 25 years experience in positions of increasing responsibility in nursing facilities as a nurse manager, executive, state surveyor, RAI manager for Virginia, and consultant. She is a master teacher for AANAC and a national expert on matters relating to the MDS and the prospective payment system. She is a certified professional coder in a unique position to explain ICD-10 coding for a skilled nursing facility under PDPM. She is the national LeadingAge MDS Expert and principal of Wilhide Consulting based in Virginia Beach, VA, serving clients nationwide.
Continuing Education Units
Nursing Facility Administrators - Louisiana Board of Examiners for Nursing Facility Administrators has approved 4.0 credit hours.