Feature
The PDPM Paradigm: Go Big or Go Home!
By Hilary Forman, PT, RAC-CT, Chief Clinical Strategies Officer, HealthPRO®
Heritage, Healthcare Reform Consulting, PDPM Consulting, Therapy Management
W
ith less than a year to go, what are you doing NOW to prep for our industry’s biggest
change in 20 years? HealthPRO Heritage’s Chief Clinical Strategies Officer, Hilary
Forman, reports from the frontline. She shares practical advice – as well as an out-of-the-
box vision for What If? – related to the New World of PDPM in response to FAQs RE:
PDPM.
Q: Is PDPM good news or bad news for SNFs?
The PDPM transition is an exciting opportunity for leaders in the SNF industry to set
themselves apart! Those willing to objectively evaluate imminent market shifts – and make
important changes – will reap the rewards. After all, success in the post-PDPM era will be
defined (finally!) by SNFs’ ability to efficiently deliver on high quality, truly resident-centered
care. HealthPRO Heritage recommends executing NOW on dramatic culture, process and
role/responsibilities changes required to position their SNFs to succeed under PDPM.
After all, success in the post-PDPM era
will be defined (finally!) by SNFs’ ability
to efficiently deliver on high quality, truly
resident-centered care.
Q: What’s changing?
The tide is turning! Imagine a world where revenue isn’t based on
managing treatment minutes. Instead, the PDPM system will set
reimbursement based on patients’ clinical profiles, as captured via
several documentation, coding and assessment scoring factors.
This fundamental change will turn a spotlight on all members of the
IDT, but especially nursing and MDS who will be under exponential
pressure to understand nuances of the new system and to document properly, communicate
effectively and code correctly. And in the New World of PDPM, there are huge financial
implications for anything less than thorough and flawless documentation and coding.
Now consider that this pressure on nursing is occurring amidst an almost crippling nursing
shortage in New York! The fact is: Nursing is not accustomed to having their documentation
support the skill that drives reimbursement; we are used to a rehab-driven reimbursement
environment. Now nursing steps into the limelight.
Q: Where does that leave therapy services?
PDPM will require the industry to redefine what to expect from therapy! Contrary to what
some people may think, therapy will continue to be just as integral a player in driving and
protecting revenue as ever before… but in a very different way.
Under PDPM, therapy is – in fact – in an ideal position to offer support that extends far
beyond providing just traditional rehab services. After all, for the last 20 years of RUGS-IV,
therapy has become very skilled at defining the processes to drive reimbursement. The
tables have turned with PDPM, and nursing will rise to the occasion. But what if therapy’s
strengths and skills can be leveraged with nursing in support of their new roles and
responsibilities?
For example, HealthPRO Heritage’s approach will be to lock elbows with nursing to reduce
their burden and support their new role in the driver’s seat. There is an opportunity to
reinforce a truly (much-needed!) collaborative approach to resident care by building/
supporting clinical programs and enhancing nursing care in more skilled ways. Rehab-led
process changes (to help optimize care coordination, documentation and coding practices)
are also tangible examples of what HealthPRO Heritage is referring to as “Complimentary
Rehab Initiatives for Nursing Counterparts.”
(See The PDPM on page 12)
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Adviser a publication of LeadingAge New York | Fall 2018