C.A.R.E.

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

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Interview with Mark Parkinson, President and CEO of American Health Care Association (AHCA)

Tom Mack, Senior Vice President of Client Development at Harmony Healthcare International (HHI), interviews Mark Parkinson, President and CEO of American Health Care Association, in the 2018 AHCA Provider Lounge.   Parkinson says there are two key things providers should be focusing on when it comes to reimbursement and regulatory change.  First off, he says facilities need to prepare for Patient Driven Payment Model (PDPM) right now.  He emphasizes that PDPM doesn't just change rates, it's a completely new payment system.  Secondly, Parkinson encourages providers to take risks when it comes to these reimbursement changes.  More and more of his member facilities are developing their own insurance plans known as I-SNPs (Institutional Special Needs Plans).  Parkinson admits that it can be a complicated process, but the 22 facilities that have implemented such plans have seen positive results that not only benefit operators, but residents as well.

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C.A.R.E.

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

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Patient Driven Payment Model (PDPM) is the proposed SNF Payment System that correlates payment to the patients’ conditions and care needs rather than volume of services (Cost Based) provided or resources rendered (PPS RUGs System).

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C.A.R.E.

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

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The Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) released the SNF Proposed Rule for Fiscal Year 2019.  Within the regulation, multiple items addressed including the: 

• Medicare Rate (increase of 2.4%),
• Value Based Purchasing (Hospital Re-Admission Metric with 2% reduction or possible 1% increase), and the
• Quality Reporting Program (No changes, but extended the number of years from one year to two years to calculate the MSPB and Discharge to Community measures). 

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