Skilled nursing facilities reported higher payments than expected for Medicare reimbursement for last year. Skilled Nursing News states the federal government will be assessing these payment claims. Operators should be prepared for these surveys by ensuring thorough reports and documentations.
The Centers for Medicare and Medicaid Services (CMS) announced they will be bringing change to the current Patient Driven Payment Model (PDPM). Under the current system, it is reported that skilled nursing facilities received an unintentional $1.7 billion in the year 2020.
CMS claims that the PDPM is the main driver of changes. However, Bill Goulding of PACS Consulting argues that the COVID-19 pandemic is also to blame. Earlier in the pandemic when it was difficult to have residents test and qualify as COVID-19 patients, those with symptoms were classified as “special care high.” This led to an increase in the number of residents in isolation.
While assessing the data from October 2019 to February 2020 and from April 2020 to March 2021, Bell notes that physical therapy and occupational therapy were working with lower-case mix residents while nursing and speech therapy were working with higher-case mix residents. Those receiving speech services in the higher case mix lead to a $4 per day increase while nursing services contributed to a $33 per day increase. The average minutes of therapy that residents received decreased from 91 minutes to 62 minutes. He also notes that CMS should take into account that now payments are made for “patient characteristics” and not PT and OT therapy minutes. For this reason, he believes that parity adjustments are necessary.
Bill also argues that as per CMS claims there have not been any changes in outcomes or quality measures which include falls and rehospitalizations. However, it is to be noted that these outcomes are not impacted by therapy.
CMS will also be assessing speech therapy and how it impacts patient care. They will specifically look for documentation from physicians that state speech services rendered were necessary for the residents.