To say the least, 2020 was a difficult year for skilled nursing providers. Aside from the rapid, ongoing changes necessitated by COVID-19, providers are still reeling from recent, sweeping regulatory changes, including the CMS Patient Driven Payment Model (PDPM).
A year into life under the new model, some skilled nursing facilities are adapting to the new case-mix classification system mu
ch better than others, according to Russ DePriest, vice president and general manager of skilled nursing at PointClickCare.
“Under PDPM, CMS wants you to up your game when it comes to care outcomes, so fewer of your residents end up being readmitted to the hospital,” DePriest said. “As part of the new model, Medicare can withhold as much as two percent of reimbursements if a SNF has high readmission rates.”
The good news: Medicare pays facilities in full when they have low readmission rates, and offers added incentives up to 1.6 percent for exceptional performers. But what contributes to high readmission rates? For starters, a lack of automation, integration, and digitization across the resident journey.
Electronic Health Reporter recently spoke with Russ DePriest and Lauren Talbot, an EHR Consultant for Reliance Healthcare. Here, they discuss PDPM, the pandemic, and how digital transformation is driving outcomes in skilled nursing.
Question 1: Russ, how has the pandemic affected PDPM? And how have providers been leveraging technology to adapt to those changes?
Prior to COVID-19, PDPM was one of the biggest changes the SNF industry had seen to its system of operations. Prior to COVID-19, rather than focus on therapy, the new system incentivized treating the needs of the patient as a whole.
In terms of dealing with a high-needs population, PDPM is arguably better designed for a pandemic than the prior RUG system. Given COVID, where we know patients with co-morbidities are at a higher risk, paying on patient characteristics rather than therapy is beneficial to SNFs. So, although it wasn’t designed in anticipation of a pandemic, the new system is well-matched.
To help us further understand the impact of our technology on skilled nursing providers’ operations, including PDPM, we commissioned Forrester Consulting – part of an independent, objective research firm – to conduct a study and talk to some of our skilled nursing customers. I should note that Reliance Healthcare and Heritage Living were not among those customers.
Some of the interviewed facilities were able to save over $200,000 per year in PDPM-related penalties. This is because our platform enables digital transformation, and allows facilities to trace all treatments and associated results delivered to a resident. As a result, it’s easier for management to standardize and improve their evidence-based care plans, translating into better outcomes for residents. The result: facilities using the PointClickCare platform are better positioned to maintain the low readmission rate necessary to avoid penalties.