Matt Nash, Vice President of Strategic Development on June 5th at the 2018 MARCUM Long Term Care Symposium

Matt Nash, Vice President of Strategic Development on June 5th at the 2018 MARCUM Long Term Care Symposium at Mohegan Sun in CT. Matt will be hosting an educational session discussing the Review of key components proposed under the Patient Driven Payment Model (PDPM), The PDPM Impact, and Strategic Planning and Preparation for PDPM.

Darlene Piraino Guest Speaker at the 2018 AOTA Annual Conference and Expo

April is always a special month at Preferred Therapy Solutions as we recognize the many Occupational Therapy professionals that are devoted to helping people through therapeutic measures to participate in everyday activities. This year we are especially proud of Darlene Piraino, an Occupational Therapist and a Regional Director of Compliance and Education at Preferred Therapy Solutions. Darlene was invited to be a guest speaker at the 2018 AOTA Annual Conference and Expo held in Salt Lake City, Utah On April 20th, 2018. Darlene and her colleague, Pamela Karp, presented to one of the largest gatherings of Occupational Therapy professionals in the world!

Darlene and Pamela hosted an accredited session to over 300 attendees on “Training the Generalist to Evaluate and Treat Common Shoulder Pathologies in the Geriatric Population.” This educational forum is designed to provide the general population of therapists practicing in outpatient, acute, subacute and skilled nursing facility settings the vital comprehensive understanding on the awareness that is often missed when assessing common shoulder pathologies. In many cases not providing accurate assessments are the secondary causes of disability.  Lack of knowledge regarding palpation, special testing, and other diagnostic criteria leaves them at a disadvantage when planning interventions.  This forum provided occupational therapy practitioners with the basic knowledge and skills to quickly and accurately assess common shoulder pathologies and to develop an appropriate plan of care in addressing upper extremity pain and dysfunction in patients with concurrent diagnoses.


For additional information please contact Maria Maggi, Vice President of Compliance:  mmaggi@preftherapy.com

CMS Releases FY 2019 Proposed Rule

Background

On Friday April 27th, the Centers for Medicare and Medicaid Services (CMS) released the proposed rule for the Prospective Payment System & Consolidated Billing for Skilled Nursing Facilities (SNF-PPS) for FY 2019, SNF Value-Based Purchasing Program, and SNF Quality Reporting Program. The proposed rule contains information on payment updates, requirements of the SNF-VBP and SNF-QRP programs, and a new payment model for SNF’s called the Patient Driven Payment Model (PDPM).

What You Need To Know

SNF Payment Update

  • There will be a 2.4% payment update to the SNF market basket, resulting in an estimated increase of $850 million in SNF payments for FY 2019

Patient Driven Payment Model

  • CMS is proposing a new payment model called the Patient Driven Payment Model (PDPM) which would replace the current RUG-based payment model effective 10/1/2019
  • The PDPM builds upon the concepts of RCS-I by using resident characteristics as the basis for case-mix index (CMI) and payment
  • A few of the key concepts under PDPM include:
    • Each therapy discipline (PT, OT, and ST) would have their own CMI and associated payment
    • Nursing categories would be reduced from 43 to 25 by reallocating the way ADL’s are classified
    • Non-therapy ancillaries (NTA’s) would have their own CMI and associated payment
      • The IPA is a new required assessment being proposed as a means to reclassify a patient under the PDPM if certain criteria are met
  • A Variable Per Diem Adjustment would impact the PT, OT and NTA payments
  • Functional and ADL scores would be based on Section GG data rather than Section G

SNF-VBP and SNF-QRP

  • The rule contains proposals on baseline periods, reporting periods and requirements specific to each of these programs
  • Based on the FY 2018 Final Rule, the 2% recoupment with incentive payment based on rehospitalization performance for the SNF-VBP takes effect 10/1/19
  • Based on the FY 2018 final Rule, additional reporting requirements for the SNF-QRP specific to Section GG take effect 10/1/19

Although the PDPM is not scheduled to take effect until 10/1/2019, the next 2 months are a critical time as all comments related to PDPM are due to CMS by June 26th. We fully expect PDPM to become finalized with the release of the FY 2019 Final Rule in July.PTS will be participating in the upcoming SNF Open Door Forum call covering the proposed rule on May 1st.We will also be participating with a trade group collaborative to fully analyze the proposed rule and PDPM in preparation for our submission of comments to CMS.PTS is developing educational materials and hosting a webinar covering all of the details of the FY 2019 Proposed Rule in the coming weeks.PTS will continue to monitor for updates and keep our valued partners informed.


If you have any questions, please contact Matt Nash, Vice President of Strategic Development:  mnash@preftherapy.com