PDPM: New Reimbursement Model is Driving Disruption

There have been recent media reports of layoffs and pay cuts among the ranks of those working in the nation’s skilled nursing facilities (SNFs) as a result of the new Medicare reimbursement model from the Centers for Medicare & Medicaid Services (CMS): the Patient-Driven Payment Model.

Reporting on these new changes during this edition of Monitor Mondays will be Toby S. Edelman, senior policy attorney for the Center for Medicare Advocacy. The new PDPM system reverses the financial incentives that existed for 20 years. Instead of paying more money for more minutes of therapy that a resident at a SNF receives, the new system pays less for residents who receive therapy. Ms. Edelman will discuss how the reimbursement system has changed, and what residents and their families can do to try to ensure that patients continue to receive medically necessary therapy.

Other segments to be featured on the broadcast include the following:

• RAC Report: Healthcare attorney Knicole Emanuel reports on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.
  
  
• Washington Report: President Donald Trump’s recent executive order tweaking the Medicare system continues to roil healthcare stakeholders. Reporting on the ongoing fallout is Matthew Albright, chief legislative affairs officer for Zelis Healthcare and former CMS official.
  
  
• Monday Focus: New York attorney and RACmonitor investigative reporter Ed Roche returns to the broadcast to report on the use of artificial intelligence in Medicare audits, as announced in the President’s executive order.
  
  
• Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his trademark segment, in which he reports on problematic issues facing providers. HHS Proposes Stark Law Anti-Kickback Statue Reforms
  
  
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.   Medical Conservative