The Quest for Quality: Red Flags in Skilled Therapy and the Changes Required by the Planned Transition to the New Patient Driven Payment Model (PDPM)

Date: May 1, 2019

Time: 07:00PM - 08:30PM

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This presentation, using case examples, will focus on two major issues facing skilled nursing facility care: the risks and opportunities created by the combination of the current Resource Utilization Groups (RUGS) reimbursement system and the federal government’s increasing use of “Big Data” to identify potential outliers using a set of metrics; and the changes involved with the soon-to-be-implemented Patient Driven Payment Model (PDPM).

Learning Objectives:

  • Explain the concepts of medical necessity, false claims and worthless care in relation to the quality of care in the skilled nursing facility setting, and how to apply these concepts
  • Describe the processes The Centers for Medicare & Medicaid Services (CMS) and other governmental entities use to evaluate medical necessity, potentially false claims and potentially worthless care in post-acute care
  • Discuss how post-acute long-term care providers and medical directors may be asked to participate productively in these processes to provide clinical insight and interpretation to both resolve concerns and proactively minimize risk going forward
  • Define the soon-to-be-implemented Patient Driven Payment Model (PDPM) and improve participants’ readiness to respond to this new reimbursement system for skilled care in skilled nursing facilities

Credit Information:

1.50- CMD Management
1.50- MOC
1.50- CME

Disclosure Information:

Speakers are required to provide verbal disclosure prior to each talk. If the learner perceives any bias toward a commercial product or service, please report this to the Society’s staff. According to the Society and ACCME policy, all those in a position to control content are required to disclose any relevant financial relationships.

The following AMDA Education Committee members have financial relationships to report: John Loome – Genesis HealthCare: Full-Time Employee; Diane Sanders-Cepeda, DO, CMD – UHG-Optum: Full-Time Employee; all others have no financial relationships to disclose.

Online Education Subcommittees have no financial relationships to disclose.

The speakers have no financial relationships to disclose.

AMDA staff have no financial relationships to disclose.