Prior to the implementation of the Patient-Driven Payment Model (PDPM), and as a result of a national pandemic, post-acute care experienced significant shifts that eroded margins even further than they already were, all while costs skyrocketed. Today, providers have the opportunity to enhance operations under PDPM by accurately capturing every dollar they are entitled to and by providing the highest quality care through their interdisciplinary staff.
By connecting the vision of leadership with the power of clinical best practices, SNF leaders can infuse deep skill development to strengthen interdisciplinary and MDS teams. To assist on that journey, Concept Rehab, a leader in post-acute care therapy for over 40 years, and Engage Consulting, a subsidiary of Concept Rehab, offer expert services that are designed to be responsive to provider needs in targeting clinical and financial goals.
As SNFs look ahead, here are two key changes coming to PDPM in FY 2023 — and three tools operators can use to address them and succeed.
Two key changes to reimbursement under PDPM in FY 2023
On July 29, 2022, Centers for Medicare & Medicaid Services (CMS) issued its FY 2023 SNF PPS Final Rule, spelling out changes SNF providers can expect in the upcoming fiscal year. With the advent of FY 2023 SNF PPS Final Rule, post-acute care providers are already seeing a flurry of changes that started October 1. The most notable result of the final rule are two changes to PDPM reimbursement.
- Parity Adjustment
This has long been referred to as the PDPM parity adjustment, as CMS has repeatedly said that PDPM was not budget-neutral as intended. CMS stated in the final rule for FY 2023 that they intend to take a more cautious approach to mitigate the potential negative impacts on the nursing home industry with this parity adjustment by spreading it across a two-year period. Adjustments to the PDPM rates include:
- 2.3% reduction in FY 2023
- additional 2.3% decrease in FY 2024.
We will see this as adjustments/reductions in the case mix indices for each of the PDPM categories.
- Overall Medicare Payment Increase: more than $900 million
Despite the 2.3% parity adjustment decrease that took effect October 1, CMS noted that “the aggregate impact of the payment policies in this final rule would result in an increase of 2.7%, or approximately $904 million, in Medicare Part A payments to SNFs in FY 2023 compared to FY 2022.”
This comes from adjustments to the FY 2023 Federal Base Rates for urban and rural facilities increasing as compared to the rates for FY 2022. Below is an illustration of what SNF providers can expect for each category to reflect the market basket increase:
Three tools to address PDPM changes in FY 2023
The time is now for SNFs to refine their PDPM strategy for 2023. When CMS brings changes that impact daily operations for providers, Concept Rehab and Engage Consulting responded with comprehensive analysis, and updated their tools to support successful operations under new guidelines.
SNFs seeking success under these changes can benefit from three Concept Rehab – Engage Consulting offerings:
- Their most popular PDPM tools, updated for FY 2023, including the PDPM Analyzer and interdisciplinary quick guides
- Comprehensive analysis of CMS FY 2023 changes
- Service overview that accelerate results for SNFs
Concept Rehab’s proprietary PDPM Analyzer is an innovative interdisciplinary tool that assures accurate and optimal reimbursement while focusing on enhancing quality as well. Its PDPM Quick Guides are discipline-specific, reference coding tools that ensure accurate coding and capture of all patient characteristics to match the level of care being provided with reimbursement.
Engage Consulting, meanwhile, made key updates to all of these tools and Quick Guides that are essential to assist MDS teams and facilities in strategically managing PDPM. SNFs report that these tools have been essential to enhancing the performance of their MDS and interdisciplinary teams when used on a daily basis and infused within the daily operations of their SNF.
Operating under PDPM has shown that having a strong rehab partner who assists with strategy and optimization is essential. As we move through the pandemic and gain a deeper understanding of how to be successful under PDPM, many SNF owners and operators are assessing the strength and value of their current rehab provider.
As many are seeing, the results are worth it.
This article is sponsored by Concept Rehab. For a demonstration on how to utilize these PDPM Quick Guides or PDPM Analyzer to assist with PDPM strategy, please do not hesitate to reach out to [email protected].
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