The recent overhaul of Medicare Reimbursement has caused nursing facilities to focus on patient characteristics and clinical care needs. This information is valuable, and always has been, for providing high quality care and to develop a plan of care that matches the patient’s needs. Now however, that information, documented comprehensively and precisely, will also drive reimbursement for that care. This change in focus and the need for more patient information has made the first 10 days under PDPM challenging as facilities struggle to get the patient information needed from the medical record and get it in a timely manner. Facilities will need to re-evaluate their screening processes and even communicate with the hospital discharge planners in order to succeed at gathering the information when needed.

Other fallout has occurred for the facilities in as much as CMS had IT issues from the outset and have already made changes to their software. The general sense from feedback is that a few specific PDPM policies are subject to different interpretations and that is leading to confusion.  The Interrupted Stay rule seems unclear to many and also some software features discharge the patient within their system and that necessitates a paperwork response that would not be necessary if the patient returns within the allowed window of time. Software vendors need to amend their coding rules to match CMS guidance and those confused by the wording of the rule should communicate with CMS for clarification.

Speech therapists have noted a problem with the CMI calculation for speech therapy as it relies on a cognitive score from the BIMS, a cognitive assessment that misses certain degrees of cognitive impairment thus calculating a much lower CMI. CMS is aware of this but to date have been unable to change the assessment used to determine cognitive impairment.

Whenever the dust settles and everyone has gotten used to PDPM my hope is that is change in reimbursement and the need to focus on all the patient’s characteristics and clinical care needs will have been good for the patients and the facilities and without serious consequences for any professionals or facilities. While we have always been focused on the patients and their needs now we are learning how to gather all that important patient-specific information in a timely manner, document what it means for clinical care, and bring it all together for the Admission MDS to be completed. Challenging is a good word for all of this and if you are reading this blog you are meeting this challenge and still standing! Congratulations!!