Food (and Reimbursement) on the Table Under PDPM

The implementation of PDPM in October is fast approachingand as we await the proposed rule, skilled nursing facility owners andoperators are diligently preparing.  Oneinteresting bit of datum that I have been following closely surrounds the complexityof reimbursements associated with altered diets & swallowing problems inthe SLP (Speech) Component.

Just to recap, under the Patient Driven Payment Model the newly developed SLP component has 12 distinct levels of reimbursement (see below).  These levels are the result of answering five questions, and these questions are grouped into two separate (and differently weighted) groups.  The second group has much more to do with eating chewing and swallowing. 

The SLP Component Under PDPM

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Group One:

1. Does patient’s primary diagnosis fall under acuteneurologic or non-neurologic?

2. Is there an SLP related comorbidity?

3. Is there a moderate to severe cognitive impairment?   

Group Two:

4. Is there a swallowing disorder? 

5. Is the resident on an altered diet?

The answer to these questions will place the resident intoone of 12 categories, SA-SL.  If youguessed the “S” stands for super, you would be right. (Yes, it stands for speechbut give that one to us)!

My main emphasis for this article is to demonstrate theimportance of evaluating new residents for appropriate diets.  Let’s illustrate with two different examples:

Resident A is medical management (non-neurologic) with nospeech co-morbidities, is cognitively intact, has no swallowing issues, and ison a regular diet.  Resident A will fallinto the SA category.  A SNF in LongIsland, NY for example will receive $18.12 per day in the SLP category for eachday of the Med A stay.

Resident B, on the other hand, is evaluated by a highlyqualified SLP who can clearly document a swallowing dysfunction andconsequently the need for an altered diet to ensure safe PO intake. Resident Bwill then fall into the SC category and the facility will receive $70.86 perday in the SLP category for each day of the Med A stay. A difference of $52.74per day. 

Over the course of that 30 day stay, the difference of$1,582.20 is significant.  The differencebetween a highly skilled speech department and one that is less that proficientcould be “make or break” under the PDPM.

In the next few months, we will focus on ensuring residents are getting the best care possible from speech. We will also discuss accuracy of coding & the importance of strong supportive documentation. The importance of having coding & documentation that can survive future audits must not be forgotten in the PDPM transition.

Want to dive deeper on the Speech Component? Do you have ideas or questions? I'd love to talk. Please feel free to comment in the box below.