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Q&A With Hilary Forman, Chief Clinical
Strategies Officer at HealthPRO ® Heritage
Hilary Forman identifies Opportunities to
Improve Cash Flow (And Outcomes!) Amidst
the Turmoil of the PDPM Transition and
COVID-19
The unique dynamics of the Patient-
Driven Payment Model (PDPM)
– coupled with the crisis response to
COVID-19 – have created a perfect storm
of worry about cash flow challenges. Based
on her perspective as a consultant on health
care redesign and clinical reimbursement and
also a therapy provider, Hilary offers strategic
insights into opportunities that exist for
skilled nursing facilities (SNFs) to leverage
cash flow advantages, balance expenses and
improve the overall bottom line impact of
PDPM and COVID-19.
Q: What interesting trends have been
identified since PDPM – and in light of
COVID-19 – that can inform a go-forward
approach for SNFs looking to optimize
cash flow?
A: Interestingly, SNFs that were wellprepared
for PDPM and became adept at
admitting, documenting and capturing
optimal codes for more complex populations
are also generally better at managing
the challenges presented by COVID-19.
Alternatively, facilities that had not yet
adopted strategies and best practices that
drive clinical outcomes and reimbursement
under PDPM are the ones struggling with
exacerbated cash flow issues that have really
come to light during the COVID-19 crisis.
These providers may want to consider having
an outside Minimum Data Set (MDS)/billing
expert conduct chart audits to identify areas
for improved documentation and coding
practices, because even after eight months,
many SNFs are still leaving revenue on the
table related to suboptimal documentation,
coding and billing processes.
Another opportunity for improving revenue
is related to Centers for Medicare and
Medicaid Services (CMS) changes for skilling
in place and 3-day waivers. Extended through
the 25th of July, SNFs should absolutely
still be utilizing these waivers to capture
opportunity to avoid re-hospitalizations,
provide optimal care and recognize
additional revenue.
Q: Many SNFs were just getting
comfortable with leveraging group and
concurrent therapy in the new world of
PDPM. Just as therapists and patients
were ramping up this treatment approach,
the COVID-19 pandemic derailed the
progress. What is the future of group and
concurrent therapy?
A: The use of group and concurrent therapy
will return slowly. As of June, HealthPRO®
Heritage has begun recommending
the appropriate provision of group and
concurrent therapy with the support of
our physician consultant, Dr. James Avery,
and in accordance with Centers for Disease
Control and Prevention (CDC) and CMS
guidelines. After all, several benefits exist for
those communities that can safely reintegrate
group and concurrent treatments, including
social well-being for residents who have been
isolated/quarantined and the priceless peerto-peer
interaction that improves outcomes.
Obviously, the use of group and concurrent
therapy can help mitigate therapy costs,
too, but it must be provided safely and with
clearly defined benefits.
For those facilities looking to reintegrate
group and concurrent therapy, HealthPRO®
Heritage has harnessed dedicated staffing
(See Q&A With Hilary Forman on page 29)
28 Adviser a publication of LeadingAge New York | Summer 2020