Five Months to Patient-Driven Payment Model – Is your Skilled Nursing Facility Ready?

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Five Months to Patient-Driven Payment Model – Is your Skilled Nursing Facility Ready?

In October 2019, the new Patient Driven Payment Model goes into effect, with an entirely new method for determining Skilled Nursing Facility reimbursement. At Vohra Wound Care, we have been working with our Physicians and Facilities to help them prepare. With expert assistance from Gravity Healthcare Consulting, we have established that wound care is a “hidden gem” in helping facilities ensure that PDPM becomes a clinical and revenue improvement opportunity.


While PDPM is intended by CMS to be “revenue neutral”, their own internal studies have shown a significant alteration in who is likely to see revenue changes as a result, with large, urban skilled nursing facilities at particular risk compared to current payment methodology. Many consultants summed up these changes as, “while CMS has touted PDPM as a “revenue neutral” payment shift, for most providers, PDPM equals a reimbursement reduction, unless significant changes are enacted”.


So, what kind of changes can your facility make to be prepared for PDPM? There are three stages to being fully prepared:


  1. Education around PDPM especially in the Non-Therapy Ancillary (NTA) and Nursing (N) areas


  2. Effective clinical treatment options that meet the new guidelines, with a focus on early diagnosis and documentation (within 8 days of admission)


  3. Detailed documentation of treatment is paramount as there is an expectation of increased auditing especially in the early stages of the program


  4. At Vohra, our specialist Wound Care Physicians provide consistent weekly physician-led beside care, document wounds in a proprietary wound-centered electronic health record and have a dedication to in-services education that will improve your wound care program. We can help your team understand how proper, dedicated wound care helps your patients heal better, (demonstrated improved wound healing time by 21 days and Medicare expenses cut by almost 50%).  We can also help you make changes to ensure you properly code and document care that can ensure accurate case-mix adjustments.  Proper documentation, care, and coding can affect reimbursement by as much as 30%!

To learn more about what Vohra can do to support your transition to PDPM, please contact us at facilities@vohraphysicians.com or call us on 305-866-7123

Author: Janet S. Mackenzie, MD, ABPS, CWSP, AAGP

Janet S Mackenzie MD, ABPS, CWSP, AAGP is the Chief Medical Officer at Vohra Wound Physicians. She has been with the company since 2013 and has almost 30 years of wound care experience as both a plastic surgeon and a wound care specialist. After obtaining a Master’s degree in Education, she obtained her Medical Degree from the University of Pennsylvania Perelman School of Medicine. She trained in general surgery at Dartmouth Hitchcock Medical Center and plastic surgery at McGill University. She is board certified by the American Board of Plastic Surgery, the American Board of Wound Management, and the American Board of General Medicine, and is a Certified Wound Specialist Physician (CWSP).

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