As the SNF sector enters its third year under the Patient-Driven Payment Model (PDPM), data analytics and consulting firms like Zimmet Healthcare Services Group are finding stark differences in reimbursement levels between top-performing operators and those at the bottom of the barrel.
For one, the top 10% of SNF providers have rates $70 over the average, while the bottom 10% of providers are $70 below the average. The difference is buried in nursing and non-therapy ancillary services, according to Zimmet Director of Analytics and Partner Vincent Fedele.
Fedele, Sally Fecto, vice president of clinical reimbursement and COO and Partner Michael Sciacca presented data insight on PDPM trends and benchmarking during a webinar on Wednesday.
While there’s a 27% difference in reimbursement amounts for speech services between top- and bottom-performing facilities, Fedele said there’s “almost no” variability in the [physical therapy (PT) and occupational therapy (OT)] component.
“If you’re looking to assess your performance … those would really be the two things that you would want to measure,” added Fedele, referring to nursing and non-therapy ancillary services.
The majority of varying rates has to do with shorter length of stay and increases in what Fedele called the “acute neuro capture.” — or neurological care received in a high acuity setting.
“Most providers, if they’re looking to assess why they’re in the bottom 10%, it’s never the PT/OT component, it’s always in nursing and then [non-therapy ancillaries] – and to a lesser extent, the speech,” added Fedele.
Increased nursing rates are directly related to Covid spikes, Fedele continued, as SNFs care for residents in isolation; the increased rates capture extensive nursing services.
Specialty care, high acuity nursing services made up 60.1% of nursing categories by day while only 18.8% of the bottom 10% performers recorded that category; the average was 44.4%, according to Zimmet’s data.
The highest nursing category for the lowest performers was received physical function services.
Another factor to consider in the nursing rate: variable per-diem payment adjustments. The shorter the length of stay, the higher the rate.
Top performers are doing better at providing higher acuity nursing care and capitalizing on non-therapy ancillary categories like behavioral health, according to Fecto and Fedele.
Top performers also put time and effort into codifying results from their Patient Health Questionnaire (PHQ-9), which screens residents for the presence and severity of depression.
“If the resident can’t participate or won’t participate, who are we asking, who are we interviewing for those symptoms? Energy, fatigue, decreased appetite, changes in their sleep, all of those things could be related to their acute medical problem – are we capturing it? Sometimes we’ll find that that area might be dashed out, so that interview is not done,” said Fecto. “We just want to make sure that [operators] have a process in place to get that PHQ assessment done.”
There’s one big unknown as Zimmet continues to capture rate behavior in the years ahead, according to Sciacca, what the public health emergency (PHE) will do to rate categories. If the three-day stay waiver goes away with the PHE in January, nursing homes would likely not be picking up a lot of non-acute Covid patients on a Medicare benefit period, he said.
“It’s gonna be interesting to model that out, to see how that trends when we do move away from the public health emergency,” added Sciacca.
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