Improving Financial Outcomes with PDPM Coach

The Challenge

Sun Mar Healthcare, a skilled nursing management company serving locations across the state of California, maintains a high standard of resident care and quality outcomes.

Previously, Sun Mar relied on manual spreadsheets to record data, which led to gaps in submissions for Patient-Driven Payment Model (PDPM) reimbursement.

Accurately capturing services or treatments was often challenging, especially across Sun Mar’s interdisciplinary team (IDT), requiring detailed information from multiple team members.

“You can’t just assume one person can capture everything. It has to be an IDT approach,” explained Joanne Lao-Calabia, Director of Clinical Reimbursement at Sun Mar Healthcare.

Sun Mar was already using another PointClickCare product when they were introduced to PDPM Coach and learned it could simplify their IDT’s approach to collecting reimbursement data. By allowing staff to interactively input details related to care and services rendered, they could increase their efficiency and improve financial outcomes.

The Solution

PointClickCare’s PDPM Coach optimizes reimbursement workflows for skilled nursing organizations, giving them accurate guidance for submissions. It also provides a simple and intuitive way to complete the 5-Day Admission Minimum Data Set (MDS), further enhancing efficiency and increasing reimbursement.

With PDPM Coach, staff can accurately forecast and track PDPM reimbursement by resident. MDS decision support guides MDS submissions, allowing clear visibility into revenue capture and case mix index.

By proactively minimizing risk, reducing audits, and easing administrative burden, PDPM Coach supports skilled nursing organizations in driving better revenue management.

The Outcome

After implementing PDPM Coach, Sun Mar’s IDT was able to increase their efficiency in submissions and make better informed decisions when submitting data. “Now they are seeing the value of their work,” noted Lao-Calabia. “Some people just didn’t know how much work has to be put in in order to get the reimbursement that’s needed.”

By capturing the data needed to drive accurate reimbursements, Sun Mar saw a 6% increase in its Case Mix Index (CMI) and a 20% increase in per patient day (PPD) revenue generated.
Also, rather than manually transferring information to the MDS, Sun Mar was able to rely on PDPM Coach to automate that process. “It’s more efficient and now I’m assured that my assessment is more accurate,” explained Lao-Calabia.

Learn More

If you’re interested in implementing PDPM Coach to help your organization achieve results like those experienced by Sun Mar Healthcare, click here for more details.