Originally posted by Skilled Nursing News 10/21 – Jack Silverstein

The Patient-Driven Payment Model (PDPM) is now two years old, and the shift in skilled nursing to value-based care continues to grow — and does so while operators still battle COVID-19-driven occupancy woes.

For providers looking to make the new reimbursement model work in their interest, one important consideration is therapy. Summit LTC Management found its solution in Nexus Therapy Management, the Mississippi-based therapy provider with a unique facility-first, non-revenue-sharing model.

“Our clinical outcomes have been great with several success stories, while from a financial perspective, our entire company has lowered its therapy spend by about $1.5 million annually while maintaining our reimbursement rates, compliance, and productivity,” says Summit president Chris Slimmer. Improved outcomes at a lower cost are two of four major benefits Slimmer has seen in the Texas-based Summit’s partnership with Nexus. Here is a look at the four.

Closer clinical alignment between therapy provider and SNF

For a small monthly fee, Nexus Therapy Management offers therapy program management and daily oversight for SNFs. That is a partnership ideal for success under PDPM — yet Nexus was founded prior to the change in payment models. Founder Greg Arnold’s background includes both SNF ownership and Medicare consulting.

“After working extensively in Medicare reimbursement and program management, it was obvious that the pay structure would change,” he says.

In 2013, when a SNF operator asked him to help their operation escape a troubled therapy provider relationship, he projected a future payment model akin to the then-yet-to-launch PDPM. He shifted the paradigm of therapy services in the SNF and focused more intently on quality, outcomes and compliance. And he designed a unique therapy model which does not share the revenue of its SNF partners.

Rather, Nexus removed the incentivized volume-based therapy services, which CMS has long argued against.

“That’s why CMS created PDPM: incentive was in the wrong hands — the therapist’s, not the provider’s,” Arnold says. “For a SNF, we’re an ally and partner in their objectives. They now have therapists integrated into their care teams, and the backing of a rehab provider with strong clinical experience at their disposal to help them accomplish their objectives.”

In short, Nexus offers a closer clinical alignment than most SNFs are accustomed to receiving from their therapy partners.

“Our partnership with Nexus has been very collaborative and aimed at enhancing clinical outcomes while improving customer service,” Slimmer says.

Improved skills and better experience for nurses

To help SNFs succeed in PDPM, Nexus works to leverage the skills of trained therapists to assist nursing objectives and critical MDS capture.

“Our nurses have enjoyed working under Nexus’s management team,” Slimmer says. “The collaboration between nursing and therapy has been simplified.”

“Our therapists now are rededicated to a facility and can reintegrate into the care teams to get a better interdisciplinary approach,” Arnold says. “They generally enjoy the fact that they are still required to meet certain benchmarks, but at the same time can exercise their skills and look at caseloads more objectively.

Better care outcomes

The Nexus pricing model is more in line with PDPM, which helps to manage costs without compromising outcomes. As long-term care providers increasingly move to value-based models, working to become a better partner in the total episode of care, Nexus is a solution.

“It’s amazing what happens when you take money off the table: you can focus on care,” Arnold says. “CMS will continue to shift SNFs toward outcome based reimbursement, which we believe is inevitable. Nexus is already helping our partners to prepare.”

Slimmer has seen it.

“Our primary interest in exploring the Nexus model was to enhance our partnership in therapy to produce better outcomes at a much lower cost,” he says. “Outcomes truly have improved thanks to the resident-centered approach.”

Savings that lead to reinvestment

Because Nexus is not sharing in the SNF’s revenue, partners are seeing more cash at the end of each month, Arnold says. That leads to more reinvestment opportunities, something that has been crucial for Summit LTC.

“Nexus’ model has come at a vital time for our organization,” Slimmer says. “The savings we have achieved together have been critical in our fight against the COVID-19 pandemic. We have been able to invest these savings into acquiring necessary PPE and to fight through labor shortages across the state of Texas.”

“When we present the Nexus Therapy Management model, the first question providers ask is, ‘How is this possible? It sounds too good to be true.’ One hundred percent of our customers have said this in our initial conversation,” Arnold says. “Once we show them our model running in their current therapy program, they are usually stunned and excited.”

Nexus Therapy Management is truly innovative and delivers high quality care at a fraction of the cost. With a full line-up of services a SNF would expect, there is no fall-off in care. In fact, it tends to improve according to their customers.

This article is sponsored by Nexus. To learn more about how Nexus can help your SNF improve outcomes and save money, visit TeamNexus.net.

In this article:
The Patient-Driven Payment Model (PDPM) is now two years old, and the shift in skilled nursing to value-based care continues to grow — and does so while operators still battle COVID-19-driven occupancy woes.