Consonus PDPM Update Based on CMS Final Rule Release

On July 31, The Center for Medicare and Medicaid Services issued final details of the Patient Driven Payment Model (PDPM). As expected, there were no significant changes, and the PDPM will go into effect October 1, 2019.

CMS is suggesting that the Patient Driven Payment Model will transform the current payment structure from a therapy-driven model, where the quantity of minutes drives payment, to one that has more emphasis on nursing and improved reimbursement for medically complex patients.

However, despite not having a baseline or ceiling for Therapy minutes, CMS clearly communicated they do not expect the quantity of minutes delivered to change significantly.

This leaves providers asking the following questions:

  1. How many minutes should we deliver under the new payment system?
  2. How do we protect our clinical outcomes and the overall patient experience?

Consonus has positioned itself as an industry leader by tracking patient outcomes and understanding the different delivery models effective for Medicare versus Managed Care patients.

With 60% of our patients enrolled in managed care models, we have become experts in the delivery of effective yet efficient services. We have had the opportunity to test systems, delivering more cost effective care, while maintaining optimal outcomes and a positive patient experience.  We call this our Advanced Rehab Model.

While research supports clinical efficacy with various levels of therapy utilization, it has been our experience that there are three core-guiding principles for an organization to be successful.

  1. Rethink Rehab – Beginning with the end in mind. Coordinating a successful discharge prior to admission. Tailoring an individualized therapy plan to prepare for the next level of care.
  2. Data Emphasis – Accessing live data to identify opportunities for improvement. Using actionable insights to affect change at the point of care.
  3. Leadership Investment – Developing leaders who utilize their resources and can affect change through others.

We have adopted this approach by implementing the following changes to our therapy programs:

  • Restructuring rehab gyms following principles from lean management allowing for efficient patient care.
  • Implementing advanced technology for mobile documentation.
  • Investing in a customized clinical documentation library, which requires our clinicians to follow International Clinical Guidelines for Balance, Chronic Conditions and Cognitive Disabilities.
  • Implementing alternative modes of treatment (group and concurrent) with positive functional outcomes exceeding national standards.
  • Participating in a quarterly quality improvement process related to clinical and functional outcomes.
  • Adopting data analytics and reporting into core operational procedures.
  • Restructuring our Talent Management department with added personnel and software support.
  • Providing education for Rehab Directors on how to successfully adapt and implement changes related to Section GG and PDPM.

View additional PDPM coverage from Consonus and be sure to check your inbox for the upcoming August Consonus newsletter.