Harmony Healthcare Blog

Patient Driven Payment Model: Bootcamp #1 Questions & Answer

Posted by The Harmony Team on Thu, Jun 20, 2019


Edited by Kris Mastrangelo

C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory/Rehab • Education/Efficiency


Ask An Expert sign with clouds and sky background-1Question and Answer with Joyce Sadewicz, VP of HarmonyHelp and Pam Duchene, VP of Education & Training Harmony Healthcare International (HHI)

  1. Please address the need for restorative nursing when PDPM is launched.

    See blog dated 6.4.19
    Restorative Nursing: Crucial for Patient Quality, Critical for PDPM
  1. If a patient is admitted late Friday evening and is not seen by PT and OT until Monday but Nursing sets the transfers/ADL assist Friday - how will this affect our initial 1-3-day rate?

    The rate will not change.
  1. Is your rate calculator based on the Proposed 2020 Rule or the Final 2019 Rule?

    The Proposed 2020 Rule. It includes the 2.5% increase.
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  2. Do you know if a hospital swing bed program will also fall under PDPM?

    Swing beds in most hospitals will be affected by PDPM.  The exception is critical access hospitals which will remain cost based for their swing beds.

    Final Rule:

    “Accordingly, all non-CAH swing-bed rural hospitals have now come under the SNF PPS. Therefore, all rates and wage indexes outlined in earlier sections of this final rule for the SNF PPS also apply to all non-CAH swing- bed rural hospitals. ….The latest changes in the MDS for swing-bed rural hospitals appear on the SNF PPS website at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/index.html
  1. If the definition of group is expanded to include 2 to 6 individuals, how will the minutes be calculated on the MDS? Will they be divided by the actual number of participants or by 6? Just curious how this will impact the 25% threshold.

    CMS will determine compliance with this limit by using a ratio of group and concurrent minutes versus the total therapy minutes provided per patient by discipline.  Once reported on the MDS in full for each patient, the grouper software will calculate the percentage of group minutes combined with the concurrent minutes provided to the patient by discipline as a percentage of all therapy minutes provided to the patient by discipline.  The calculation would be the sum of the group and concurrent minutes by discipline divided by the sum of individual, concurrent and group minutes by discipline.  If the result is 0.25 or less, then the discipline is compliant with the group and concurrent limit.  If the result is greater than 0.25 then the discipline is non-compliant with the limit for that patient. 
  1. Should an IPA be done only if the payment is going to go up or should it be done if the payment will go down as well?

    The IPA is an optional assessment.  It can be completed in either scenario, however, as this is optional you would not choose to do one if your payment would go down.
  1. How would we know if someone went to the hospital but did not come back to us as an admission and d/c back home, would this still affect us?

    Yes, this would affect you.

    You will only become aware through the Value-Based Purchasing Program or the Quality Reporting Program which reports through CASPER.  The information is delayed.

    Current reports reflect the period 10/1/15 through 9/30/17.  Best practices include placing calls to the residents following discharge. A Case Manager or Nurse calls the resident 3-7 days after discharge to see how they are doing (and documents this call in the medical record).  During the call, the Nurse reinforces that if the Resident needs to return, they can come right back to the SNF.

    Such a system is not perfect, but it is effective in reinforcing that the Resident doesn't have to go to the ED for care.
  1. Can you please repeat the website for the PDPM calculator?

    The pdpm-calc is a phenomenal navigation tool that allows you to quickly and efficiently enter in the 5 PDPM components and immediately see the per day rates, running revenue and average rate for days 1 through 100. Mobile App being launched next week!! 

    Currently available by clicking below:

PDPM Calculator

 Join us the for PDPM Webinar 6.21.19 at 1:00 EST. Click Here to Register.

Harmony Healthcare International (HHI) is available to assist with any questions or concerns that you may have.  You can contact us by clicking here.  Looking to train your staff?  Join us in person at one of our our upcoming Competency/Certification Courses.  Click here to see the dates and locations. 


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Tags: Patient-Driven Payment Model, PDPM

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