If you have a medical facility to run, then you have most definitely already heard of PDPM that has been introduced by the Centers for Medicare and Medicaid (CMS). Of course, there is a great chance that you are not entirely familiar with this concept, meaning that you might not understand how it really works. There is nothing wrong about that, but the truth is that you will absolutely need to learn more about this in order to run your practice the right way.
While it is impossible for you not to have heard of this concept already if you’re in the healthcare industry, it is actually quite possible for you to be a bit confused about what it actually is and why you should even care about it. Well, those are certainly some rather important questions right there, and we are now going to address them. In the rest of the article, we will shed some light on PDPM in general, and help you figure out why it is so important.
In other words, I will tell you more about what PDPM is, as well as what the advantages of it are. After that, we will talk about why you should actually care about this concept, i.e. how it can affect your business. And, since achieving a high PDPM functional score is of utmost importance, we will also talk about how to succeed in doing that. Let us do this one thing at a time.
What Is PDPM?
Since we are taking it one thing at a time, it is not surprising that we are going to begin with the very basics and clearly explain this concept before going any further. So, the Patient Driven Payment Model, or PDPM for short, is a Medicare payment rule designed and proposed for nursing facilities. It represents a whole new method of calculating reimbursement.
Instead of therapy minutes being the payment basis, PDPM actually relies on resident classifications and the actual anticipated resource needs during the patient’s stay. This may sound a bit complicated when you first hear about it, but it is actually all quite simple. Basically, under the PDPM, all residents are assigned a case-mix classification which drives the daily reimbursement rate for that specific individual.
So, this concept assesses every resident individually, while taking into consideration the opinions of the entire team consisting of dieticians, nurses, social workers, as well as the billing department.
What Are Its Advantages?
You now most likely have a better idea about how all of this works, you are wondering what the advantages of it really are. Plenty nursing facilities are still struggling to understand this particular model, but things tend to get a lot clearer once they get familiar with the actual advantages of this particular system. Of course, those advantages are clearly visible after you get the hang of it all and start implementing this model perfectly.
First things first, the fact that this model is patient oriented is definitely a great benefit. Due to this fact, care coordinators and nurses have to carefully consider and assess the quality of care delivered to each resident. As a result, the quality of care will actually be improved. PDPM helps you make sure that therapy is neither over-delivered nor under-delivered. So, you won’t have to worry about neglect, among other things.
Another great benefit that you absolutely need to know about is the fact that this particular model decreases the staffing needs. This is especially important nowadays, given that the healthcare industry is certainly experiencing a staffing crisis. So, if you have felt this crisis in your particular facility, you can rest assured that PDPM will reduce the need for more therapists, as well as relieve staffing stress, which is definitely extremely important.
It is also extremely important to mention that this model will actually help improve financial stability of your nursing facility. Once the facility is adequately reimbursed, you will be able to free up the resources in your own budget and reallocate those resources into other important areas. So, you have the opportunity to make significant savings and improve your profit margin.
Read more on this concept here: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/PDPM
Why Should You Care?
I suppose that the answer to the question of why you should care is already quite clear to you, if you’ve been reading everything carefully. Basically, you should care because of the fact that you will get to improve the quality of medical care in your nursing facility, as well as because you will get to increase your overall financial stability. These are definitely quite important aspects of the entire operation process in your facility, and I have no doubts that you get how PDPM can help.
How To Achieve A High Score?
If you want to improve the accuracy of PDPM reimbursements and actually achieve a high score when calculating it, then you will need to think carefully about how to actually improve the entire situation and make things better during the calculation process.
The best thing to do when trying to achieve something like this is actually get a proactive PDPM pre-submission audit. These audits will help you identify any potential MDS errors, as well as missed coding opportunities, which will help improve your score. Of course, you will need to find highly experienced and reputable professionals to do the audit for you perfectly.
