As of 2020, CMS has mandated that Skilled Nursing Facilities (SNFs) adopt the new Patient-Driven Payment Model (PDPM), certification surveys. Additionally, SNFs must use the QAPI process. QAPI is the merger of two complementary approaches to quality management, Quality Assurance (QA) and Performance Improvement (PI). QA and PI combine to form QAPI, a comprehensive approach to ensuring high-quality care.
The SNF PPS establishes a Medicare-required PPS assessment schedule. Each required assessment supports reimbursement for a range of days of a Part A covered stay. The schedule includes assessments performed around Days 5, 14, 30, 60, and 90 of the stay
Leadership at SNFs should see that this creates synergies between the Director of Nursing Services (DNS) as the clinical nurse leader and the Nurse Assessment Coordinator (NAC) who impacts reimbursement.
Management best practices in adopting PDMP and QAPI should include:
- Identification of collaboration and synergies between DNS and NAC
- Describe SNF PPS assessments and why collaboration is two-way
- Understand Medicare-required Skilled Nursing Facility Prospective Payment System (SNF PPS) assessments topics:
- Minimum Data Set (MDS) 3.0 background
- Assessments overview
- Factors affecting the assessment schedule
- Assessment results reporting
- Delineate the realities of reimbursement for the facility’s cash flow and the impact on the nursing budget
- Understand how the survey, PDPM, and QAPI are dependent upon the relationship and collaboration between the DNS and the NAC and ultimately impact the SNF PPS.