It’s been a little over two weeks since the new Patient-Driven Payment Model (PDPM) went into effect. And if we’ve learned anything from the months leading up to it, it’s that change is the one constant for healthcare providers. Right now, times are challenging for long-term care organizations. Margins are low, occupancy is down, employee turnover is at an all-time high and most are operating with limited resources. The idea of overhauling a complicated process like a payment model sounds daunting.
However, when we look at the reasons behind the change – to provide better quality care and an overall better resident experience – we see why it’s necessary and how it will improve outcomes in the long run. So, what have we learned since October 1? Let’s recap the big news and talk about where we go from here.
Changes To Staffing
In what some are speculating could be a cost-saving measure under the new Medicare payment model, Skilled Nursing News reports that some providers have begun to make “significant conversions to PRN, or as-needed, status, as well as pressures from leadership to maximize the use of group and concurrent therapy services and boost individual productivity.” Some providers have begun laying off therapists due to the switch to PDPM, which allows up to 25% of therapy to be provided in a group setting. Brian Ellsworth, vice president for public policy and payment transformation for Health Dimensions Group, told McKnight’s Long-Term Care News that he recommending re-examining therapy contracts between SNFs and therapy providers three to six months after phasing in the new model.
Cynthia Morton, executive vice president for the National Association for the Support of Long-Term Care, told McKnight’s “there’s really no reason to panic.” This new process is going through a period of trial and error. Still, therapists continue to voice concern.
Kara Gainer, Director of Regulatory Affairs for the American Physical Therapy Association, warns that these staffing and practice changes could grab the attention of CMS. “I think it’s really short-sighted that these companies are doing this, because they know CMS is watching, and they know if they have a dip in outcomes or dip in utilization, CMS is probably going to audit them,” she told Skilled Nursing News.
CMS’ main concern is whether those making these post-PDPM changes are doing so for the benefit of residents or to increase their profits.
Optimism Manages To Cut Through The Clutter
While there was no shortage of news covering the trials of the switch, there were a handful of positive supporters trying to rally providers around PDPM. In another McKnight’s article, Rosanna L. Benbow refers to PDPM as “utopia” and urges providers to get on board.
“I think if we all truly embrace PDPM for what it is — a quality-driven payment system focusing on clinical acuity — and we incorporate the instructions for assessment, planning implementation and evaluation into our daily process with a focused clinical assessment coordinator, we are truly going to win. Good financials, good outcomes, awesome clinical care plans and clinical care: That all translates into a Utopian outcome, doesn’t it?”
In a recent McKnight’s blog with the headline “Happy PDPM Day!”, Gary Tetz applies a positive attitude to the change and encourages others to join him. “Let’s be honest: Learning how to celebrate a new national holiday like PDPM Day is going to be challenging for a while. But hopefully soon we’ll get the kinks worked out, the fear and uncertainty will fade and the benefits to our patients will become clear.”
Turnover Issues Are Cause For Concern With Regard To PDPM Staff Competencies
A recent McKnight’s webinar covered why staff competency is extremely important for success under the Final Rule. Surveyors on the webinar stressed that the education provided to staff based on the resident population of that specific building is critical in protecting the residents, the employees and the community from any compliance risk, while ensuring quality care is provided at all times.
In order to have strong competencies in PDPM, the speakers said that communities must work on their turnover and retention rates. That means empowering and stabilizing their staff to meet person-centered care requirements and Medicare’s PDPM standards.
In a McKnight’s guest column, Debi Damas raises the point that it’s not just the nurses that need to be ready for the challenge of PDPM, but the nurse aides as well. “Your nurse aides are the nurses’ eyes and ears on the floor. They are the first line of defense when it comes to recognizing change in a resident. Their education needs to be up to snuff,” she explains.
Damas says that recruiting and retaining caregivers is important, but that “managing your entire nurse aide supply chain (including education) is the key in a long-term retention solution.”
“As the LTC industry adjusts to PDPM, organizations should consider creating and managing their own nurse aide pipelines. By doing so, you will be able to fill staff vacancies before they happen, keeping in line with your goal of providing the highest quality of care, while maintaining financial stability. Plan for future shortages now and prevent forthcoming lapses in quality care.”
None of the above can be done without a focus on the culture at your organization. Currently, 65% of nurse aids are looking for a new job. Providers need to take steps to make their communities places where employees want to work and stay long term. That means ensuring you have the building blocks of a great culture: top-notch leaders, career development, work-life balance and perks and benefits that improve quality of life for employees.
Obviously that remains to be seen, but I think Skilled Nursing News puts the past few weeks into perspective nicely: “The bumpy transition period reveals a difficult truth about any new payment model: Every change will have a cascading set of effects, with winners and losers emerging in both the immediate wake and the long term.”
Mark Parkinson told attendees at the NIC conference that we should know the effects of the switch in about five to six weeks. “We’re going to know on the therapy stuff right away because people have to report on their therapy in five days … On the revenue side, by the end of November, we’ll have a pretty decent feel for it.” AHCA has formed a committee dedicated to quickly collecting and analyzing PDPM data and his analysts remain “cautiously optimistic.”
Parkinson’s advises patience during the initial stages and “to not jump to invest or refinance at the first sign of healthy profit margins.”