PDPM Expertise at Synergy Care
Synergy Care is Ready to Support your PDPM Needs
For more than 40 years, Synergy Care has advised and supported long-term care and skilled nursing facilities, using our rich experience to cultivate patient well-being, as well as promote the financial stability of the facilities we serve.
Focusing on quality care isn’t new to us. It’s always been our priority, which is why we view the shift to PDPM as an exciting opportunity.
What is PDPM?
The Patient Driven Payment Model (PDPM) is a quality-based reimbursement structure introduced by the Centers for Medicare & Medicaid Services (CMS) that replaces the existing RUG-IV payment system for therapy reimbursement in skilled nursing facilities.
Effective October 1, 2019, the new model moves away from reimbursement based on therapy minutes and instead considers a patient’s clinical characteristics and illness severity. A resident’s total payment rate is determined by adding together various components to produce a daily reimbursement rate.
Like other CMS payment model changes, Medicare PDPM reflects a shift toward value-based care. To be successful with this model, providers need to root their therapy decisions in robust patient assessments and plans of care, which take into account the patient’s current condition and treatment requirements, as well as evidence-based recommendations.
How will the PDPM model affect your organization?
Although PDPM represents a change in how reimbursement occurs, the overall requirements for Medicare-reimbursed skilled nursing won’t change that much. The most significant difference is that therapy decisions will depend on a patient’s clinical characteristics as well as evidence-based recommendations, rather than a suggested number of minutes. Defensible plans of care that clearly communicate the reasons for therapy decisions will be critical to making the transition.
Creating a PDPM Plan for your Organization
To get ready for the new PDPM model, skilled nursing facilities need to develop a strategy for making the switch. Here are some key considerations to keep in mind during the planning process:
Top-quality therapy remains important.
There is a common misperception that the start of PDPM will prompt a significant drop in the amount of therapy skilled nursing facilities provide. However, therapy is a fundamental component of skilled nursing care, and the change in the reimbursement method will not alter that. A high-quality therapy program can be a differentiator for your facility and help you stand out in your community as an organization committed to excellence.
Precise coding is essential.
Due to PDPM’s emphasis on quality, it is crucial to thoroughly and accurately code patient care and therapy to reflect the patient’s clinical characteristics, illness severity, therapeutic interventions, and clinical outcomes. Knowing how to code for specific clinical deliverables can ensure your organization receives optimal reimbursement and timely cash flow.
Robust training should underpin the work.
Facilities must provide comprehensive training on the new rule’s nuances and the staff’s role in ensuring compliance. This education should cover how to fully assess a patient, develop a plan of care, determine therapy needs, and accurately code the individual’s condition and care.
Synergy Care’s Patient Focus Enhances PDPM Expertise
We are ahead of the curve in preparing for the PDPM model, and our commitment to thorough patient assessment, plan of care development, therapy, and coding will ensure your organization optimizes reimbursement under the new model while improving patient outcomes and satisfaction.
Some specific advantages we offer include:
- Synergy Care has developed a start to finish PDPM Impact Program, which can be personalized for each patient and includes critical components for success:
- Forms, tools, and processes for collaborative assessment and expert implementation
- MedBridge software to enhance knowledge on continuing education, patient education and home exercise programs
- PDPM Screen and Safety Score to evaluate the level of discharge readiness for safe and effective transition of care
- Synergy Care’s standard of care uses evidence-based clinical pathways based on resident characteristics for the most appropriate and effective care, with emphasis on the identification of early exacerbation of a condition to reduce hospital readmission.
- We offer clinical coding support with accurate supporting documentation and expert planning from pre-admit to post-discharge, including section GG coding support tools, baseline testing, BIMS, and depression scale.
- Synergy Care has RAC certified managers to provide training and clinical support for the most accurate coding possible.
- Our experienced healthcare professionals provide a level of therapy that is unsurpassed in the marketplace.
- As a company, we prioritize continuous improvement, raising the bar for our staff and our clients’ staff by providing comprehensive MedBridge educational opportunities – an all-in-one solution for continuing education, including live webinars, certification prep, and compliance.
- We stay abreast of the ever-changing regulatory environment, so you can be confident that your facility will remain in compliance as the healthcare landscape evolves.
Our Synergy Care team partners with clients and serves as an extension of their teams. We work hard to build lasting, productive relationships based on integrity, experience, and above all, a passionate commitment to patient care.
To learn how we can help you prepare for PDPM, please email pdpmquestions@synergycare.com.