OA-3 - The Great Transition: PDPM and the Medicaid Experience

The modern Skilled Nursing Facility bears little resemblance to “nursing homes” of the past. Sadly, payment systems have not kept pace. We’ve seen three iterations of Medicare’s Prospective Payment System since 1999, with all providers bound to the same national model. Medicaid is state specific. Without the vast resources of CMS and the federal government, many state rate setting departments lack the resources to effectuate a comprehensive payment system update – they’ve put it off so long that rates are effectively arbitrary in some markets. Now they have no choice – if case-mix adjustment is part of the rate setting equation, PDPM is the catalyst, and if your state isn’t equipped to manage the change, you’ll be dealing with a new private contractor’s unfamiliar ideas and standards.

PDPM is a “revenue delivery system”, it has nothing to do with funding. All things being equal, PDPM amounts to a redistribution of scarce Medicaid dollars among providers. SNFs that boasted high CMIs distorted by Rehab RUGs often find they haven’t accurately captured the clinical issues that now drive payment. This presents a major problem with only one solution: The key to a successful transition is preparation.

This session is presented by experts who have guided Skilled Nursing Facilities through dozens of payment system transitions. Speakers will share insights and review operational strategies that ensure your facility enjoys a “soft landing” and avoids “rate shock” that destabilizes the healthcare continuum. You'll gain access to PDPM capture patterns and benchmarks from providers in states that have already made the transition. These lessons will prove invaluable as you benchmark performance against competitors.

Additionally, we’ll explore innovative technologies designed to enhance compliant clinical-reimbursement management, ensuring your facility is prepared, even if your state is not.