RevCycle Intelligence: Patient-Driven Payment Model Reimbursement Exceeds CMS Prediction

“Initial analysis of the Patient-Driven Payment Model (PDPM) shows success in the model’s rollout, exceeding the Centers for Medicare and Medicaid’s (CMS’s) predictions.”

“The model, introduced in October of 2019, recently completed its first billing cycle. Analysis by Z-CORE Analytics, LLC (CORE), an analytics group founded by Zimmet Healthcare Services Group, LLC, estimated that the PDMP per diem rate was 5 percent above CMS’s predictions.”

“The report analyzed three months of claims data from over 1,000 skilled nursing facilities (SNFs) across 38 states in CORE’s database. While not a statistically valid sample of all SNFs across the country, the analysis provides insight into a subset of SNFs until more robust data allows for further analysis.”

“A majority (91.5 percent) of facilities had a higher PDPM rate than they would have achieved under the previous payment structure, Resource Utilization Group (RUG).”

“A recent KLAS report also indicated that large, long-term care organizations saw the biggest financial impact on the payment model change. Bigger skilled nursing facilities are more likely to feel the impact of this change.”

“The KLAS report also showed a majority of long-term care EHR vendors were effective at helping their clients prepare for PDPM, but therapy vendors were more likely than EHR vendors to be seen by their provider partners as helpful…”

“Understanding which factors drive reimbursement rates will allow SNFs to deploy strategies that ensure they are compensated appropriately for the care they deliver. Providers will understand where in their systems and workflow they should be investing time and resources in order for their care to reflect the best practices and most up-to-date reimbursement models…” Read the full article here.

Source: Patient-Driven Payment Model Reimbursement Exceeds CMS Prediction – By Emily Sokol, February 20, 2020. RevCycle Intelligence.

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