Intensive
70th AHCA/NCAL Convention and Expo
Robin Hillier, CPA, STNA, LNHA, RAC-MT
Director Reimbursement and Quality Metrics
Welcome Nursing Home
Disclosure: Nothing to Disclose
Nate Ovenden, RAC-CT
Senior Medicare & Managed Care Consultant
Good Samaritan Society
Disclosure: Nothing to Disclose
Deb Bielek, MS CCC SLP
Therapy Resource Education and Programs
Ensign Services, Inc.
Disclosure: Nothing to Disclose
Mike Cheek
Senior Vice President, Reimbursement & Legal Affairs
AHCA/NCAL
Disclosure: Nothing to Disclose
Daniel Ciolek, PT, MS, PMP
Associate Vice President, Therapy Advocacy
American Health Care Association
Disclosure: Nothing to Disclose
At the time of this program, skilled nursing providers will have had less than two weeks’ experience with the new Medicare Part A SNF prospective payment system (PPS) called the patient driven payment model (PDPM). PDPM is the most significant payment model change since the transition from cost-based reimbursement to the resource utilization groups (RUG) based PPS payment model in 1998. CMS’s priorities with PDPM are twofold: to better align payment with resident care needs as reflected by clinical characteristics, and to make quality and value-based programs the key measures of provider PDPM performance. In this three-hour session, attendees will hear from, and ask questions of, Laurence Wilson, former director of the Chronic Care Policy Group at the CMS Center for Medicare. In that role, Wilson oversaw all SNF and other Medicare-financed post-acute care fee-for-service benefit and payment policies. He directed all phases of the CMS PDPM research, payment model design, and regulatory processes from inception until earlier this year. He will share insights regarding CMS’s motivation to change post-acute care payment models, the process of developing the PDPM and its possible future iterations, and the long-term future of SNF payment policy.
Since CMS finalized its plans over a year ago to implement the PDPM on October 1, 2019, providers have been preparing their clinical and financial operations to successfully transition to the PDPM. During this interactive session, attendees will hear from a panel of SNF operators who will share their experiences in preparing for PDPM implementation and discuss their transitions, highlighting successes, best practices, and lessons learned from strategies that did not go as well as envisioned. Additionally, the panel will discuss how they are monitoring IMPACT Act Quality Reporting Program (QRP) measures, which CMS is using as the primary PDPM monitoring tool, and they will talk about how they see the PDPM evolving in the coming years.