Replacing RUGs – CMS’ New SNF Payment System & How to Get Ready (a video recording from the 2019 AHCA Convention Intensive)

Recorded On: 10/10/2018

  • Registration Closed

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The Patient-Drive Payment Model (PDPM) is now final with implementation scheduled for October 2019. AHCA’s educational approach to PDPM will be to offer a holistic picture of how PDPM impacts SNFs and will incorporate PDPM interactions with: • Requirements of Participation, • Survey and Licensure, • SNF Re-Hospitalization Measure Value-Based Purchasing, • IMPACT Act Quality Reporting Program, and • Other payers’ (Medicare Advantage and Medicaid) and their probable responses to PDPM. In addition to in-depth training on the PDPM final rule, a member’s only tool kit will be introduced that will contain the core competencies framework and a readiness review tool that will help you track your operational readiness for PDPM. The intensive will also cover data gathered from 12 companies testing impacts of PDPM and provide hospital and discharge pattern data that could be helpful in member markets. Finally, a panel discussion of AHCA members will discuss opportunities and potential pitfalls for SNFs as they consider operational changes necessary to be successful under PDPM. 

Learning Objectives:

  • Discuss how Patient-Driven Payment Model (PDPM) will impact MDS assessments and claim payment components
  • Describe how PDPM will require changes to current SNF operations
  • Explain how facilities are preparing for PDPM implementation

Speakers:

Mike Cheek – Senior Vice President, Reimbursement & Legal Affairs, AHCA/NCAL

Daniel E. Ciolek, PT, MS, PMP – Associate Vice President, Therapy Advocacy, American Health Care Association

Robin L. Hillier, CPA, STNA, LNHA, RAC-MT – Director Reimbursement and Quality Metrics, Welcome Nursing Home

Nate Ovenden, RAC-CT – Senior Medicare & Managed Care Consultant, Good Samaritan Society

Deb Bielek, MS CCC SLP – Therapy Resource Education and Programs, Ensign Services, Inc.

Anne Tumlinson – CEO, Anne Tumlinson Innovations, LLC

Francine Rainer, MA, CCC-SLP – Senior Vice President, Reimbursement, PruittHealth

Session Price: $199 for AHCA members only

CEs Available: Up to 4 NAB approved CEs are available.

  • 2 CEs available after completing Part 1. 
  • 4 CEs are available if you complete recording in its entirety. 

Mike Cheek

Senior Vice President, Reimbursement Policy and Legal Affairs, AHCA

Mike Cheek is the Senior Vice President for Reimbursement Policy and Legal Affairs. Before joining AHCA/NCAL, Mike was the long term care director for the District of Columbia Medicaid agency in the Fenty administration. Before joining AHCA/NCAL, Mike also worked as a consultant at The Lewin Group and Avalere Health with clients such as health plans, post-acute and long term care organizations, pharmaceutical companies, and states. Mike also worked extensively with state agencies. He was the deputy director with the association of state aging agencies and was the lead staff person on eligibility and long term care with the National Association of Medicaid Directors. Mike holds a Bachelor of Science from the College of William and Mary.

Daniel Ciolek, PT, MS, PMP

Associate Vice President, Therapy Services, AHCA

Dan Ciolek is the Associate Vice President of Therapy Advocacy with the American Health Care Association. Mr. Ciolek's clinical and healthcare policy experience spans 30 years. He has practiced as a physical therapist clinician, manager, and business owner in a variety of settings including acute inpatient, inpatient rehabilitation, skilled nursing facility, home health, outpatient, and industrial health. He previously earned the Geriatric Physical Therapy Specialist certification, and is currently a certified Project Management Professional. Before joining AHCA in 2013, Dan served in the Subject Matter Expert and Project Manager capacities in numerous Centers for Medicare and Medicaid contracts. Specific to therapy services, Dan's CMS work has included: national outpatient therapy utilization analysis for PT, OT, and SLP services; medical review; workgroup facilitation; development of policy recommendations; development of Medicare Learning Network and 1-800-Medicare content, and Physician Quality Reporting System reporting enhancements.  Additionally, Dan has contributed to therapy health policy activities at the University, State, Chapter and National levels. These activities included: elected and appointed positions; adjunct faculty/lecturer; author of professional articles; invited speaker; technical expert panelist, and invited contributor of health policy concepts to professional and provider organizations. Dan's advocacy efforts have been recognized through his receipt of two national professional awards for Policy Making and Advocacy for Older Adults. Overall, Dan is recognized as a leading expert in therapy policy and research, including a focus on reimbursement issues. His efforts have contributed directly to numerous Medicare policy changes. 

Robin L. Hillier, CPA, STNA, LNHA, RAC-MT

Director Reimbursement and Quality Metrics, Welcome Nursing Home

Robin L. Hillier is a healthcare executive dedicated to post-acute and long term care. She is a Certified Public Accountant, a State Tested Nursing Assistant, a Licensed Nursing Home Administrator, and is Resident Assessment Coordinator Certified and a Master Teacher through the American Association of Nurse Assessment Coordination (AANAC). Throughout her career she has been involved in all aspects of facility operations, including ownership roles. She is currently the Director of Reimbursement and Quality Metrics for Welcome Nursing Home in Oberlin, Ohio, and President of RLH Consulting, which provides operational and reimbursement consulting to providers of skilled nursing, assisted living and intellectual or developmental disabilities. Ms. Hillier served on the Board of Governors and Executive Committee of the American Health Care Association from 2010 through 2017, and currently serves on the Reimbursement Cabinet. She is Past Chair of both the Ohio Health Care Association (OHCA) and its’ Educational Foundation (EFOHCA). She also serves on the AANAC Expert Advisory Panel. Ms. Hillier was a recipient of the 2015 Joe Warner Patient Advocacy award, the 2004 OHCA President’s award, and the 2018 AANAC Contributor of the Year. She is a graduate of both the AHCA Future Leader and Political Ambassador programs and represented AHCA at the 2014 White House Summit on Working Families. 

Nate Ovenden, RAC-CT

Senior Medicare & Managed Care Consultant, Good Samaritan Society

Nate Ovenden, RAC-CT, Senior Medicare & Managed Care Consultant, Good Samaritan Society. Nate has been working in the Medicare compliance and revenue area for Good Samaritan Society (GSS) for seven years. He has provided training and education to the 160 plus Skilled Nursing Facilities owned and operated by GSS. Nate helped develop all RCS-1 & PDPM education materials and has traveled the country providing education on the new payment model. He is currently focusing on developing and implementing the strategic goals related to PDPM. Nate and his team provide four Medicare & Managed Care annual workshops and also travel the country providing regional education on an annual basis. Under the current RUG-IV model, Nate developed an audit tool that has recouped more than $3 million over the last three years. 

Deb Bielek, MS CCC SLP

Therapy Resource Education and Programs, Ensign Services, Inc.

Deb Bielek, MS, CCC-SLP is a Speech-Language Pathologist and serves as the Therapy Education and Programs Resource with Ensign Services, Inc. She has spent most of her career in the post-acute industry, working in various roles as both a clinician and leader. Deb provides program development and education support to greater than 200 post-acute care facilities throughout her organization. In addition to leading education and development, she also serves as a regulatory liaison, representing her organization and providing expertise to various industry panels, clinical and technical work groups and councils throughout the post-acute care industry. She is currently a member of the Therapy Policy Advisory Group and the Reimbursement Committee of the American Health Care Association. She is also a member of the Clinical Focus Workgroup for Optima Healthcare Solutions. One of her areas of specialty is helping teams develop models of care that meet the needs of their individual healthcare communities through the delivery of well-coordinated, patient-centered, outcomes-based care. Deb facilitates discussion and learning with therapy, nursing and operations teams throughout her organization and other industry providers on topics of post-acute regulatory change and implementation strategy, functional outcomes with focus on the shift to value-based payment, and clinical programming to support innovative healthcare models such as managed care, BPCI, and ACO’s. Recent speaking engagements include: Co-Presenter at the Regional Multi-facility Council Meeting for American Health Care Association; Co-Presenter of the Comparison of RUGIV and RCS1 American Health Care Association; IMPACT Act Leads Change for an interdisciplinary continuing education event. 

Anne Tumlinson

CEO, Anne Tumlinson Innovations, LLC

Anne Tumlinson is the founder of Anne Tumlinson Innovations and Daughterhood with 25 years of research and consulting experience in post-acute and long-term care financing and delivery. Anne’s work helps organizations respond successfully to payment and delivery reform, and develops innovative ideas and strategies for public policy change – especially important as we prepare the country for demographic shifts. Anne has testified before the House Energy and Commerce Committee and Senate Aging Committee, and appeared before the Congressional Long-Term Care Commission, and the Bipartisan Policy Center. Her testimony has consistently emphasized that the under-financing of long-term care is an economic problem for families and caregivers, and stifles innovation needed to help them. In support of this work, Anne researches, writes and speaks about innovation in aging services, contributing to Health Affairs and McKnight’s Long Term Care News. Anne has also created a consumer website, Daughterhood.org, to generate and improve information for caregivers navigating the health and elder care systems. Daughterhood is a nationwide community of caregivers who educate and inform others. Anne served previously as a Senior Vice President at Avalere Health, where she founded and led Avalere’s post-acute and long-term care consulting practice for 14 years. She created, developed and launched a data-based provider navigation tool for post-acute care placement and led many analytic and modeling projects for a wide variety of clients. Prior to that, she led Medicaid program oversight at the federal Office of Management and Budget.

Francine Rainer, MA, CCC-SLP

Senior Vice President, Reimbursement

Francine Rainer, MA, CCC-SLP is the Senior Vice President of PruittHealth. She has served in the Post-Acute Care industry for 19 years. Fran began her career as a speech-language pathologist, where she enjoyed enhancing the lives of our most vulnerable citizens. Fran spent more than 10 years as a clinician while managing teams of therapists. In 2008 Fran joined PruittHealth as the Post-Acute Care Coordinator. In that role, she worked to develop clinical and rehabilitation programs to support PruittHealth’s expanding model of care. Fran supported and coordinated training for more than 80 skilled nursing facilities across the southeast in comprehensive programming for aquatic therapy, balance re-training, respiratory programs, pain management, infusion therapy, cardiac rehabilitation, and restorative nursing programs. In 2011 Fran matriculated into clinical reimbursement. As the SVP of Reimbursement Fran and her team of reimbursement consultant support and train skilled nursing facilities related to the RAI process including reimbursement and regulatory requirements. She developed an onboarding/ training manual for the MDS coordinator that lead to improvement in retention in that role. Fran served as the project lead for a successful transition from ICD-9 to ICD-10. In the role of SVP of Reimbursement, Fran assists PruittHealth to be positioned to be prepared for CMS initiatives such as the requirements of participation (ROP), value-based purchasing (VBP) and the SNF Quality Reporting Program (QRP). 

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PDPM ACADEMY is Both In-Person Training and Continuing Updates and Support

Provider members of AHCA and the STATE AFFILIATE who register for the PDPM ACADEMY will have access to:

  • PDPM 101 workshop webinar
  • One-day, in-person training workshop in your state
  • Monthly workshop webinars on key topics and emerging PDPM issues
  • “How To” webinars on implementing additional tools developed by AHCA

At the in-person workshop, participants will go in-depth with hands on experiential learning by:

  1. Aligning buildings and companies to transition to PDPM using AHCA’s PDPM Readiness Tools© and the related core competencies;
  2. Classifying residents in case mix groups;
  3. Assessing market position in a PDPM environment; and
  4. Using organizational, business, and management tools to reconfigure business planning.
  • CEs if you attend the optional PDPM 101 workshop webinar
  • CEs if you do not attend the PDPM 101 workshop webinar

Who should register:

To be successful with PDPM, Administrators, MDS/billing staff, nurses/DONs, and therapists must be included in the training and education process.

To Register: Contact your local State Affiliate

Components visible upon registration.
NCAL AHCA