Sights and Sounds from “Peace Love and Reimbursement.”
Last week’s Zimmet Healthcare Services Group Annual Conference in Atlantic City was an thrilling experience. Over 1,200 people gathered at the Borgata Resort and Casino to learn and network as one of the most important industry changes is now looming just over one year away.Since the FY 2019 CMS Final Rule has been finalized, it means the Patient Driven Payment Model (PDPM) is coming and SNF stakeholders must adapt. Attending my first ever Zimmet conference, I frequently found myself in the fascinating roles of spectator and listener. Here’s some of what I observed:1. I think we all knew that the days of being reimbursed based on the delivery of therapy minutes were numbered. It was useful for a while, but its time to move on.2. Years ago, I was taught that nursing was the foundation of Skilled Care. The industry got away from that, so we all need to get back to it.3. Hospital based SNFs could be making a comeback. We will see.4. Like any other change, PDPM represents an opportunity. It appears to be an opportunity to improve the delivery of patient care by really focusing on the clinical condition of the patient.5. Different states seem to be shifting their methodology / approach when it comes to Case Mix. Is this in response to the perceived “gaming of the system” by providers??6. “Speech is Boss!!” I heard that loud and clear. Speech Therapy Service will have an enhanced role under PDPM. All patients will need to be evaluated in time for the 5-day MDS. To quote Mike Sciacca, “Speech is Boss!” Thank you, Mike Sciacca!7. Lots of great discussion about data and where it comes from. Keep a close eye on your source.8. PDPM is 14 months away. Having been around the block once or twice, I wouldn’t just look at a numerical analysis of how your RUG scores would translate into PDPM. I recommend having a trained clinical eye get into the medical records of your current Medicare patients and seeing what they would look like under PDPM. Remember, the volume of therapy minutes will have zero impact on reimbursement under PDPM.• Would there be a reimbursement difference?• What would be the impact of changes in the Functional / ADL Score?• Does the nursing documentation support skilled care?Lots of exciting stuff. We'd love to hear your thoughts in the comment box below.Would you like to talk about how Language Fundamentals can provide the best Speech Therapy available to your SNF? Let's talk.