Preparing for Medicare Changes

Rhonda DeMeno has been keeping busy for the past few months in anticipation of Tuesday, October 1, 2019. That day will mark the official launch of Medicare’s new Patient-Driven Payment Model (PDPM). As director of clinical reimbursement and regulatory compliance at Lifespace Communities, DeMeno is responsible for ensuring the organization’s seamless adoption of the model.

Announced in 2018 by the Centers for Medicare & Medicaid Services (CMS), PDPM will modernize how Medicare reimburses senior care organizations like Lifespace for health services provided to residents who are Medicare beneficiaries. PDPM’s payments will be based on residents’ diagnoses and needs, rather than on the number of services they receive, effectively shifting Medicare from a volume-based to a value-based system.

The change will result in a significant decrease in the amount of effort and number of resources spent on Medicare-related paperwork and administrative duties. Time that would have traditionally been allocated to those tasks will now be dedicated to providing care. “The added flexibility will surely boost the quality of care we’re able to give,” said DeMeno. “Residents are ultimately why we do what we do, so I see this as one of the greatest benefits.”

With Medicare basing its payments on clinically relevant factors, senior care organizations nationwide must shift their reporting and care practices. “Medicare payments haven’t changed much since the early 2000s, so this is a pretty large undertaking, because it’s a complete revamp of how senior living has operated for 18 years or so,” said DeMeno. “We certainly think it’s a move in the right direction, because the previous system wasn’t as tailored to residents’ clinical needs. We’re working diligently to get everyone up to speed and are looking forward to the positive impact this will have.”

DeMeno has been spearheading PDPM training and education sessions across all 12 Lifespace communities and the home office. With diagnoses at the center of PDPM, the sessions have been especially crucial for MDS (Minimum Data Set) nurses, who conduct federally mandated clinical assessments of residents. Other team members who have actively participated in both in-person and virtual PDPM workshops include directors of nursing, health center administrators, key clinical leadership team members, certified nursing assistants, and social service and dietary service staff. DeMeno has also been visiting each Lifespace community for comprehensive PDPM presentations geared toward team members of all disciplines.

“There’s a lot of excitement across our entire organization about PDPM,” explained DeMeno. “Our team members are very passionate about residents and their work, so we all understand how this is a good thing overall. Of course, there’s a learning curve, but everyone has been very appreciative of the amount of training and preparation we’re undertaking. We’re offering all the resources and support necessary to help everyone adjust smoothly.”

Among these resources is PointClickCare^®, Lifespace’s electronic health record (EHR) system. The organization has integrated aspects of PDPM into PointClickCare to ensure it’s configured appropriately ahead of the Medicare updates. “A major reason why we adopted PointClickCare was to make it easier to navigate the caregiving process for both residents and team members, and this is a perfect example of us doing so,” noted DeMeno, who also shared that Lifespace is in the early stages of developing PDPM education and training materials for physicians. “It’s all a team effort.”

With the October PDPM launch date fast approaching, Dr. Sara Hamm, Lifespace senior vice president of successful aging and health services, expressed confidence the organization will be well-situated for the change under DeMeno’s leadership. “We are very fortunate to have someone with Rhonda’s clinical reimbursement knowledge and expertise on our health services leadership team,” she said. “She is well-equipped to lead our communities through this monumental change in our nation’s Medicare reimbursement methodology. With Rhonda’s support and guidance, I have great confidence that our health center leaders will successfully guide their team members, residents and family members through the upcoming changes.”

DeMeno agreed, “We’re putting in the much-needed work and preparation, and I’m certain it will all pay off.”

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