CMS must consider wider impact of pandemic before playing with PDPM rates: analysis – News

The Centers for Medicare & Medicaid Services must consider the wide impact of the COVID-19 pandemic on the skilled nursing patient population and the resulting effect on Medicare payments for SNF care before playing with rates from PDPM, says a new analysis from Avalere Health.

the report, released Monday, assessed the overall impact of the coronavirus pandemic on patients using federal data to analyze how changes to patient care and operations may have affected Medicare payments for SNF care for residents COVID and not COVID.

It comes in response to the recent proposal by federal officials to adjust parity rates after skilled nursing facilities raised $ 1.7 billion, or 5%, more than expected in Medicare payments over the course of the first year of the patient-centric payment model. The model was supposed to be budget neutral, but it was launched just months before the start of the pandemic and healthcare costs have skyrocketed.

The study found that there was a higher proportion of SNF residents diagnosed with respiratory illnesses throughout fiscal year 2020 compared to 2019 and 2018. The analysis also noted that CMS advice on COVID-19 diagnostic coding was not available for SNFs until March 2020, but data shows respiratory diagnoses were “significantly higher in all of fiscal 2020” compared to previous years.

“While several factors may contribute to higher rates of respiratory disease, it is conceivable that this large increase was due in part to cases of COVID-19 before CMS instituted a formal COVID-19 diagnostic code and to undiagnosed cases throughout the year. Avalere Health authors Fred Bentley, Melissa Morley, Emily Gillen and Heather Flynn wrote. “This finding suggests that the CMS claims-based approach using the COVID-19 diagnostic code may not have adequately captured COVID-19 case volumes during the pandemic.”

Analysts also looked at changes in acuity of beneficiaries treated in SNFs during the pandemic by investigating changes in case distribution indices across the five components of SNF care for COVID and non-COVID residents.

“While there was no change in the MIC for OT, PT or NTA, the results indicate that speech therapy and nursing MICs increased in April 2020 for COVID-19 and non-COVID patients. 19, and MICs remained high for the remainder of fiscal 2020 compared to the pre-pandemic period, ”the authors explained.

Melissa Morley

They added that the increase in the MIC for non-COVID residents suggests that the effects of the pandemic have spread to the entire SNF population and not just those with a diagnosis of COVID-19.

“Our results indicate that it is difficult to disentangle the impacts of the transition to the new payment system and the impacts of the COVID-19 pandemic,” Morley said. McKnight Long Term Care News Tuesday.

She stressed the importance of “considering the impact of the pandemic on the non-COVID patient population as CMS assesses the transition to PDPM”.

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