What’s new in long-term care: Value-based Care and PDPM

Big changes are coming to skilled nursing facilities (SNFs). Value-based care and the Patient Driven Payment Model (PDPM) are poised to change reimbursement for SNFs, and dietitians are taking center stage.

Value-based care

The value-based care model is driven by the Centers for Medicare and Medicaid Services’ (CMS) goal of moving away from a fee-for-service reimbursement model. In addition to the clinical services provided, a value-based care model looks at quality of care. For SNFs, the primary quality measure is the number of hospital readmissions within 30 days of admission to the SNF. CMS believes that high quality clinical care at SNFs prevents residents from being readmitted back to the hospital. When quality standards are met, CMS pays SNFs financial incentives.

Registered dietitians have an opportunity to help contribute directly to a SNF’s bottom line by providing nutrition interventions that keep residents from being readmitted back to the hospital. Dehydration is a frequently cited reason for hospital readmission, and dietitians have key roles in identifying, correcting, and even preventing dehydration, which can substantially decrease the number of patients requiring readmission to the hospital.

Likewise, early assessment and management of nutritional problems can promote residents’ overall healing and progress. Prompt medical nutrition therapy to help manage comorbidities can also reduce risk of readmission.

PDPM

Registered dietitians will also have important roles to play under the new PDPM. Historically, SNFs have been reimbursed by CMS primarily based on services provided by physical and occupational therapy and nursing. Private insurance companies tend to mimic Medicare/Medicaid, so the private sector operated the same way. Under PDPM, a SNF’s reimbursement is based on five case-mix components; one of the case-mix components is called non-therapy ancillary and includes nutrition services and diagnoses, such as enteral and parenteral nutrition, morbid obesity, and malnutrition. Each of these active comorbidities will be assigned a point value. The higher a resident’s score, the more CMS will reimburse a SNF for the resident’s care.

The dietitian’s essential role

For the first time, the nutrition care and interventions registered dietitians have always provided will help bring revenue into the facility. Although much attention has been focused on registered dietitians’ financial impact and influence on malnutrition in acute care, this will be the first time direct correlation will be seen in SNFs. The registered dietitian’s role as the nutrition expert will now help to increase the facility’s revenue, in addition to providing the highest quality care to skilled nursing residents.

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References

The Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program, (2019, May 9). Retrieved from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/SNF-VBP/SNF-VBP-Page.html

Centers for Medicare & Medicaid Services. SNF PPS: Patient Driven Payment Model. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/MLN_CalL_PDPM_Presentation_508.pdf. Accessed July 2, 2019.

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.