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Patient Driven Payment Model (PDPM)
Flash Insights Report 2020
Author
Paul Hess
Author
Jennifer Hickenlooper
The new Patient Driven Payment Model (PDPM) proposed by Medicare went into effect in October 2019. Now that the first billing cycle under the model has passed, KLAS reached out to skilled nursing facilities (SNFs) to get early insights into how smoothly the transition went, how helpful their technology (EMR/therapy) vendors have been, and how the change has impacted their bottom line. The feedback came from a total of 48 respondents—11 executives, 20 directors, and 17 managers, analysts, and other healthcare professionals.
Biggest Positive Financial Impact Seen by Large LTC Organizations
Over half of interviewed post–acute care organizations report that PDPM has had a positive financial impact on their organization,† with larger organizations (over 500 beds) being especially likely to report positive financial returns. Smaller organizations (>500 beds) are more likely than larger organizations to say that PDPM has had a negative impact, and a few smaller organizations say it is too soon to determine what the impact will be. Some smaller organizations report being less prepared for the shift. A clinical nurse informaticist at one of these organizations noted that their organization is experiencing “delays in getting bills out the door.”
† This feedback mirrors the findings reported by other groups who have analyzed PDPM’s impact. See Alex Spanko, “Early PDPM Claims Data Reveals Far More Winners Than Losers, ‘Impossible Combinations’ of Conditions,” Skilled Nursing News, November 20, 2019.
Transition to PDPM Mostly Smooth; Majority of LTC EMR Vendors Were Effective in Helping Clients Prepare
In addition to reporting improved financials, a majority of interviewed organizations say the transition to PDPM has gone smoothly. All of the organizations who reported a negative financial impact also reported a difficult or bumpy transition. Feedback regarding any one long-term care (LTC) EMR vendor is too limited to be broken out in detail, but overall, respondents using Netsmart, PointClickCare, or MatrixCare all reported above average guidance and involvement from their vendor.
Regardless of vendor, the issues highlighted by less satisfied organizations include the vendor not fully understanding CMS’s timeline and the vendor being late in delivering needed changes.
Therapy Vendors Seen as Helpful during the Transition
Therapy vendors were more likely than LTC EMR vendors to be described as helpful during the transition to PDPM. All interviewed organizations using Casamba feel that their vendor was supportive during the transition, and over 75% of interviewed Optima customers described their vendor as helpful. Customers of other therapy vendors report receiving a bit less support.
Writer
Elizabeth Pew
Designer
Natalie Jamison
Project Manager
Robert Ellis
This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2024 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.