How PDPM is Bringing Nurses Back to Skilled Nursing

July 15, 2019 Melissa Bagnoli

With the onset of the Patient-Driven Payment Model (PDPM) just months away, Skilled Nursing providers are gearing up for the changes.

While the process of change will require a lot of time and resources from a management standpoint, operators agree that there is one key worker demographic that will benefit from PDPM: nurses.

PDPM takes effects on October 1 and represents one of the most significant shifts in Medicare payment in years. The new reimbursement system will no longer be driven by minutes of therapy, but by the care and needs of the patients. While payment will still take the form of a per diem rate, it will be determined by five rate components based on characteristic of patients:

  • Physical therapy (PT)
  • Occupational therapy (OT)
  • Speech language pathology (SLP)
  • Nursing
  • Non-therapy ancillaries

When PDPM takes effect, the care nurses provide will stay the same, but the way they document and capture all aspects of it will change.

“I think nurses are going to be given the opportunity to get credit for their assessment skills, the assessment of all the different conditions that will have an impact on length of stay, case management of a patient in Medicare and outcomes,” says Judi Kulus, Chief Nursing Executive at Lantis Enterprises. “Both in terms of looking at the trajectory of case management from admission to discharge and looking holistically at the patient.”

PDPM is enabling nurses to get back to their core skill sets, allowing them to focus on care for residents or patients rather than spending more time on administrative tasks. By placing the patient at the center of the payment model, nurses are able to focus on what they were trained to do – provide care. Providers can help their nurses thrive under the new PDPM system by monitoring and educating them.

Some key steps to help ensure nurses are ready for the changes include:

  • Regular meetings with members of the interdisciplinary team
  • Assessing how nurses evaluate the patient needs so they have high-quality notes
  • Using the analytic and predictive capabilities of the electronic health record (EHR) to identify any weak links in documentation

“I think one thing that’s going to be highlighted in PDPM is the admission process. We’re working on an enhanced admissions screening tool to capture the resident’s status prior to admission so that we can have a smooth transition from the hospital into our care system,” says Kulus.

While PDPM is a complex system, the care nurses provide will remain a top priority, and the definition of a skilled patient will not change under the payment model.

To learn more about PDPM will affect nurses and how to prepare them for the changes check out our white paper: “How PDPM is Bringing Nurses Back to Skilled Nursing,” developed in collaboration with Skilled Nursing News.


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