Recalibrating PDPM after COVID-19

Written By Maureen McCarthy, RN, BS, RAC-MT, QCP-MT, DNS-MT, RAC-MTA

Confusion, new directives every hour, residents desperate for help, family, and hope. Your clinical awareness is sharp, on high alert, mindful of any shift in condition. Your all-consuming focus is the health of the patients in your care.

In March 2020, this was the scene in the Long-Term Care landscape. In the blink of an eye, staff intent on treating patients during the pandemic lost the time once dedicated to PDPM initiatives. Fast forward to October 2020, Long-Term Care heroes have helped define “essential”. Our SNF saviors have come out the other side, with techniques and processes to endure the COVID-19 pandemic; and ready to set their sights on the PDPM game once again.

COVID-19 has interrupted any type of ‘normal’ PDPM trends or benchmarks that would have been established over the past year. Currently, most patients fall into the “medical management” category due to the mass amount of acute infection admissions for COVID-19. Once SNFs begin resetting post-pandemic, and normal admissions, discharges and surgeries resume; a new normal PDPM revenue and Case Mix will establish itself. Providers will need to analyze this new normal for important trends, and what components build your PDPM makeup. How many are ortho, post-surgical, medical management or neurological? What diagnoses and resident characteristics are most common? How much rehab is provided?

Many states have also begun collecting PDPM data; to potentially change their state case mix systems. As this makes up a large portion of the SNF census, providers will want to maintain their strongest PDPM metrics to obtain an appropriate case mix weight.

Recalibrating for PDPM also requires an honest assessment of your team’s practices, and opportunities for efficiently optimizing PDPM based on resident’s needs. Utilizing your existing Morning Report, Medicare and Triple Check meetings is an effective way to address PDPM triggers, identify opportunities for additional assessments such as the Interim Payment Assessment (IPA), and manage projected revenue.

Incorporating tools into your existing practices is an important step in operationalizing PDPM fundamentals. PDPM Prodigy, proudly released by Celtic Consulting, is a PDPM calculator designed by industry experts to streamline PDPM strategies and trends. PDPM Prodigy allows users to determine the financial impact that subtle clinical changes can have on your average daily rate. Simply click on the condition, and the dollar impact will be immediately shown on both a daily, and per episode basis. PDPM Prodigy will also allow you to access reports that can identify the average Case Mix Index for each of the PDPM components (PT/OT/ST/Nursing/NTA). From there, you can monitor changes over time and compare to industry standards.

MDS Coordinators, Rehab, Admissions, Clinical Nurse Evaluators, and Case Managers enjoy PDPM Prodigy because of its intuitive design which equates changes in HIPPS codes and Case Mix Groups to dollars, allowing users to make educated choices in the moment. Administrators and Executives appreciate that PDPM Prodigy creates accurate predictions compared to actual revenue, measures your facility against benchmarks, and exports precise reports to focus on areas of opportunity.

Celtic Consulting is committed to the Long-Term Care Industry. Founded in Connecticut, it serves hundreds of clients as subject matter experts across the country, and sought by several National, Regional and State Professional Associations for thought leadership. At its core, Celtic provides Reimbursement and Regulatory advisory services, Clinical Performance and Enhancement services, PDPM/PPS/MDS/CMI Service, Payroll-Based Journal (PBJ) Reporting guidance, 5-Star Improvement Programs (QAPI),  Independent Review Organization (IRO) Audits, Clinical Care Management, Revenue Integrity Audits, Compliance Solutions including Medicare Compliance Auditing, and Litigation Support.

Currently, PDPM Prodigy is being offered to new users at a special introductory rate of $30 month/user for the first six months with promo code ACHCA30. Visit www.pdpmprodigy.com for more information. When every penny counts, don’t leave your PDPM money on the table.

About the Author

Maureen McCarthy is the President and CEO of Celtic Consulting (www.celticconsulting.org), nationally recognized as a luminary amongst long term care operators and clinicians for Reimbursement and Regulatory matters, Audits, and Analysis, Enhancing Operational Efficiency and Education and Litigation Support. Maureen combines her clinical expertise in long-term care and her regulatory acumen to assist clients with developing and executing, sustainable remediation plans. She is a registered nurse with over two decades of work experience, including direct patient care, MDS Coordinator, Director of Nursing, and Rehab Director, and Medicare biller. 

About Lance Leifert