By Sara Glanz, MS, RD, LD, CNSC
Reimbursement in long-term care is changing … and soon. Beginning on October 1, 2019, the Patient Driven Payment Model (PDPM) will take effect, replacing all existing reimbursement structures for individuals with Medicare or Medicaid. How will PDPM impact dietitians? Let’s explore.
What is PDPM?
PDPM is a new payment structure designed by the Centers for Medicare & Medicaid Services (CMS). Under PDPM, long-term care facilities will receive reimbursement based on services that each resident receives.
Payment is based on services provided by five disciplines: physical therapy, occupational therapy, speech language pathology, nursing, and non-therapy ancillary (NTA). Dietitians are classified in the NTA discipline. PDPM is expected to more accurately reflect acuity level and level of care provided to residents. For dietitians, this means facilities will be reimbursed for services that dietitians are already providing.
Long-term care facilities can receive additional reimbursement for residents with significant comorbidities or those who receive complex treatments and therapies. Think: advanced stage pressure injuries, morbid obesity, diabetes, HIV/AIDS, malnutrition, or parenteral nutrition.
CMS provides a list of NTA comorbidities that may qualify a resident for a higher reimbursement rate. NTA comorbidities are documented in the MDS and require a physician’s diagnosis and accurate ICD-10 code.
The NTA comorbidities are based on a point system. For example, having a diagnosis of HIV/AIDS garners the highest point value at eight. Parenteral nutrition (when used to meet more than half of a patient’s nutritional needs) falls just behind at seven points. Malnutrition, morbid obesity, and tube feeding are each worth one point. The higher the resident’s acuity level, the higher the points, the higher the reimbursement.
The Dietitian’s Role
As we know, dietitians provide highly specialized services to long-term care and skilled nursing residents. PDPM recognizes and rewards those efforts. Dietitians have key roles to play when it comes to PDPM.
- Timely nutrition assessments. To receive maximum reimbursement, facilities must submit completed MDS paperwork with all NTA comorbidities filled in by length of stay day five. This means that dietitians must complete their nutrition assessments relatively quickly, especially if malnutrition is suspected, so that the facility can accurately capture the services each resident is expected to require during their admission.
- Lead the charge on malnutrition care. Although the malnutrition NTA comorbidity requires a physician’s diagnosis and ICD-10 code, the facility’s MDS coordinator or documentation specialist will look to the dietitian to substantiate the diagnosis. Only a dietitian can identify and treat malnutrition. And with an estimated 50% of older adults affected by malnutrition, it cannot be overlooked.
- Expect more specialized nutritional needs. In the past, many skilled nursing facilities did not have the personnel or resources to care for residents who required parenteral nutrition. That may change under PDPM, as parenteral nutrition is worth the second-highest point value. Facilities may ask dietitians to help manage and monitor residents who receive parenteral nutrition. If you need a refresher on parenteral nutrition, watch Dietitians On Demand’s TPN 101 webinar.
Prepare for PDPM now. Talk to your facility’s leadership and find out exactly how you can contribute to a successful implementation.
Sara Glanz, MS, RD, LD, CNSC worked as a traveling dietitian for Dietitians On Demand for two years before joining the team as the corporate dietitian. In this role, she has championed the continuing education program to empower dietitians everywhere to achieve their professional goals.
Dietitians On Demand is a nationwide staffing and recruiting company for registered dietitians, specializing in short-term, temporary and permanent-hire positions in acute care, long term care and food service positions. We’re dedicated to dietitians and helping them enhance their practice and excel in the workplace. Check out our job openings, request your coverage, or visit our store today!
Centers for Medicare & Medicaid Services. Patient Driven Payment Model; Fact Sheet: NTA Comorbidity Score. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/PDPM. Revised February 14, 2019. Accessed July 2, 2019.