PDPM Driving Efficient Use of Data in Skilled Nursing

In July 2018, CMS finalized a new case-mix classification model, the Patient Driven Payment Model (PDPM), that, effective beginning October 1, 2019, will be used under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) for classifying SNF patients in a covered Part A stay.

This new reimbursement model is requiring coding changes and education and training of staff as well as the need to collect and use data effectively for a skilled nursing facility to accurately get reimbursed.

Long-term care facilities have been slow to adopt electronic health records (EHRs) that benefit different providers along the care continuum. A recent study found that HIE between hospitals and SNFs is underused.

A mixed-methods approach is critical to understanding and explaining variation in implementation and use. Creating value requires hospitals and SNFs to codevelop system design, usage guidelines, and workflows that meaningfully integrate HIE into care delivery.

Consulate Health Care (Consulate), the nation’s sixth-largest nursing home provider, has been working to upgrade its EHR system and use of data. Consulate, with more than 140 facilities across 12 states, is the largest SNF operator in Florida.

Consulate recently announced a partnership with Collective Medical, a provider of software that follows patients from the hospital to the post-acute facility to home. Participating providers in Collective Medical’s network have access to information about individual patients regardless of their location.