Blue Sky Therapy Blog

5 Key Takeaways 90 Days Post-PDPM

Now that it has been over 90 days since the implementation of PDPM, there are several takeaways from the transition that have emerged:

1. Obtaining Positive Patient Outcomes Is More Important Than Ever

  • To be successful, it is essential that the entire care team is on the same page and working together to positively impact quality measures and reduce hospital readmissions.
  • Also, the overall patient experience, patient engagement and patient satisfaction should be tracked internally.
  • Finally, it is necessary to have a therapy partner who provides strategies, processes, and initiatives that support consistent service delivery to achieve exceptional clinical outcomes. Check out one of our case studies on one of our partners outcomes here!

2. Importance of Diagnosis Coding on the MDS

  • The ICD-10 code – rather than minutes – is the primary driver for reimbursement.
  • ICD-10 coding must be detailed and capture all the patient’s conditions and services - this is where your IDT team is crucial. Read more from this Skilled Nursing News article here.
  • The implementation period has shown how important it is that each member of the interdisciplinary team knows which of the 180 MDS sections map to their responsibilities, that each team member is trained appropriately, and that they have any tools necessary to ensure the primary diagnosis code is supported.
  • All IDT members should be included in this process: social workers, dietitians, nursing, physical, occupational, and speech therapists, etc.

3. Importance of Clinical Documentation by the Interdisciplinary Team to Support the MDS

  • IDT members should be discussing the results of their evaluations and identifying any other issues or concerns.
  • For example, therapy team members need to come to IDT meetings with their thoughts on the primary diagnosis or other secondaries diagnoses. This includes Section GG documentation. Therapy members should be reporting on: What the plan of care is for the patient? What is the anticipated length of stay? Also, therapists need to be on target with the key components such as payer, diagnosis, and the therapy components that the patient is mapping to on the MDS.
  • For example, nursing team members should be discussing nursing qualifiers and their input in Section GG. Section GG is a collaborative section and there are a lot of items in the section that nursing and therapy both need to talk about in order to capture the correct function score for the patient. Sometimes patients perform better for nursing than they do for therapy and that information should all be captured in the documentation.
  • These meetings and documentation updates will ensure clean claim processing and consistency throughout your facility with your documentation.

4. Understanding Your Payer Mix

  • While PDPM is a major reimbursement shift, the rise of Medicare replacement plans is also bringing challenges for providers.
  • The first question that the admission coordinator should find out is whether the patient has Medicare or a Medicare Advantage plan. And then they should find out, if it is Medicare Advantage, how are they going to pay? What information is going to be required to pay? How often do they require that information? And when will there been a need to have to authorize continued care?
  • Also, while most Medicare Advantage plans are not requiring the PDPM updates, they may be paying according to the new CMS guidelines. It is essential that questions are being asked of payers as to how they will pay and if there have been any changes in reporting requirements under PDPM.

5. Tracking and Reporting Outcomes

  • Medicare is still going to be looking at overall minutes but they are also ensuring the patient’s outcome is positive. Medicare wants to make sure that therapy was delivered both effectively and efficiently.
  • The other focus for therapy is whether service delivery was appropriate for that patient. Did the documentation support that service delivery and, as always, does it reflect a skilled need?
  • Group and concurrent therapy are new modes of treatment Medicare has made available with the implementation of PDPM. It has great benefits for patient’s but there is a need to make sure the criteria for group and concurrent is being met and that it is utilized appropriately and based on what the patient’s need is.
  • Blue Sky has been collecting outcomes since 2014. We have a lot of data behind what we do. The service delivery should be variable. It is now a patient-driven system. There are no longer arbitrary thresholds that the therapists have to hit.


Schedule a Blue Sky Discovery call today to see how we can help support these 5 key takeaways 90 days post-PDPM implementation!


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