APRIL 2019
GET FAMILIAR WITH PDPM
April 1 – 6
PDPM OVERVIEW – Understand concept for conversion from RUG-IV
- Schedule training sessions, attend webinars/courses, attend state/national conferences
- Review resources on CMS’s PDPM webpage
April 7 – 13
SNF COVERAGE REQUIREMENTS – Review regulations that are not changing with PDPM
- Medicare Benefit Policy Manual, Chapter 8 – Conditions of coverage, need for daily skilled services
- RAI Manual, Chapter 3, Section O – Therapy services, restorative nursing
- Review definitions of skilled therapy vs. restorative nursing
- Assess current restorative nursing programming
- Download the Restorative Assessment Template
April 14 – 20
DISCUSS PDPM KEY CONCEPTS – Payment based on patient characteristics, therapy service delivery to be outcome-driven, MDS assessment schedule changes
- Five (5) variable case-mix group components (vs. 2 under RUG-IV): nursing, non-therapy ancillary (NTA), PT, OT and ST
- Simplification of MDS assessment schedule: 5-day, PPS Discharge, Interim Payment Assessment (IPA)
- Variable per diem payment adjustment for PT, OT and NTA
- Transition from Section G to Section GG for function scoring
- Download the PDPM Summary Document
- Review the PDPM Per Diem Rates for FY2020
April 21 – 27
FOCUS ON ICD-10 CODING – Review current ICD-10 coding practices on both MDS and the claim and prepare for identifying primary diagnosis for new MDS item I0020B beginning October 1, 2019
- Leverage EMR/billing software to determine ICD-10 codes currently utilized
- Look for unspecified and symptom-based ICD-10 codes as these will likely not map to a PDPM Clinical Category for PT, OT and ST
- To access PDPM ICD-10 Mappings click here and then scroll to the bottom of the page to the last link, PDPM ICD-10 Mappings
- Schedule ICD-10 training for key personnel (e.g., MDS Coordinator, Director of Nursing, Therapy Director)
April 28 – May 4
EVALUATE WHAT YOU HAVE LEARNED – Identify areas of opportunity, focus areas for education and staff training.
- Review PDPM Considerations.
MAY 2019
LOOK AT YOUR DATA
May 5 – 11
OBTAIN PDPM VS. RUG-IV COMPARISON DATA – Determine if current patient population and current practices project better or worse financial performance with PDPM
- Run current, completed MDS assessments through PDPM analytics software, if available, to compare current performance under RUG-IV to PDPM
- Review CMS’s SNF PDPM Provider-Specific Impact File – results listed by CCN (CMS Certification Number)
- Recommend reviewing the Enhanced Provider Specific File spreadsheet
- Note that the information in this Provider File represents FY 2017 data (not current data)
May 12 – 18
ANALYZE DATA FROM A FINANCIAL PERSPECTIVE – Does current RUG category utilization translate to PDPM?
- If PDPM analytics software is available for current data, start with an overall picture
- Financial results of current assessments under RUG-IV and PDPM
- Financial performance of rehab stays under PDPM, particularly Rehab Ultra High and Rehab Very High
- Current ADL score (end split) vs. PDPM function score
- If using CMS’s Provider-Specific Impact File, review overall performance
- Facility financial performance under RUG-IV vs. PDPM
- Comparison of therapy and nursing financial performance under RUG-IV vs. PDPM
May 19 – 25
ANALYZE DATA FROM A CLINICAL PERSPECTIVE – Does RUG-IV clinical data accurately reflect the clinical needs of your patients under PDPM?
- Percentage of rehab vs. non-rehab RUG under RUG-IV
- Distribution (percentage) of nursing and therapy PDPM case-mix groups (CMGs)
- What percentage of current patients are in Medical Management for PT and OT (TI – TL)?
- What percentage of current patients are in SA and SD (2 lowest CMGs) for SLP?
May 26 – June 1
DRILL DOWN INTO THE MDS ITSELF – Are the items that impact payment under PDPM completed accurately?
- Review key sections of the MDS:
- Section I – all checkboxes and I8000A-J
- Section GG
- Section C – BIMS and CPS
- Sections D, E, H, K, M and O (Nursing, NTA and SLP)
JUNE 2019
LOOK AT YOURSELVES
June 2 – 8
ASSESS YOUR PEOPLE – Do you have the right people in the right places? Are your people informed? Access the Role-Based Assessment tool.
- Who is involved in the admissions process? Are they effective?
- Is your MDS Coordinator a strong, clinical evaluator?
- Does your staff understand PDPM and the shift in reimbursement?
- Do your doctors and referring providers understand PDPM and their role?
- Are your therapists involved in a collaborative team effort to ensure accurate diagnosis and MDS coding?
June 9 – 15
ASSESS YOUR PROCESSES – Admissions, MDS coding and completion, standing meetings/patient care conferences, triple check, therapy scheduling, etc.
- Are your processes clearly defined? Are they consistently followed?
- Do your processes need to be improved or is it a “person problem”?
- Do you have the right person in the right role?
June 16 – 22
DEFINE NEW ROLES AND PROCESSES – Identify your desired state with respect to workflow, task/process ownership, communication, timeliness and output
- What and/or who needs to change?
- What skills and characteristics are needed for each role?
- Clearly communicate expectations
June 23 – 29
INITIATE ROLE AND PROCESS CHANGES – Continue education and training with a role-based focus, document processes
- Socialize changes in roles and processes
- Support staff who are changing roles – consider assigning staff mentor
- Establish expectations of collaboration and accountability
- Casamba customers can schedule time for staff to complete the Section GG competency training on your Computer-based Training (CBT) site and use the Casamba Competency Quiz report to track staff performance
June 30 – July 6
EVALUATE WHAT YOU HAVE LEARNED – Identify areas of opportunity, focus areas for education and staff training
JULY 2019
LOOK AT YOUR CONTRACTS
July 7 – 13
REVIEW CUSTOMER CONTRACTS – Assess current contract structure with SNF providers from volume and performance perspective
- What types of contracts do you currently have in place?
- How do you perform under each contract?
- Assess customer/partner relationship – strong (true partner) vs. weak (vendor only)
- Review the PDPM Pricing Model white paper.
July 14 – 20
CONSIDER ALTERNATIVE CONTRACTING ARRANGEMENTS – PDPM and other value-based care payers
- Percentage of therapy CMGs, percentage of all CMGs
- Risk-sharing, performance adjustments
- Time in facility, management
July 21 – 27
SCHEDULE CONTRACT NEGOTIATION MEETINGS – Jointly define the metrics that communicate success with PDPM
- Readmission rates
- DC to community
- Other metrics?
July 28 – August 3
EVALUATE WHAT YOU HAVE LEARNED – Identify areas of opportunity, focus areas for education and staff training
AUGUST 2019
LOOK AT YOUR REFERRAL SOURCE DATA
August 4 – 10
ANALYZE YOUR MARKET SEGMENTATION VARIABLES
- Complete Market Strategy Framework
- Record averages from trailing 12-month period to show the percentage of referrals by:
- Payer mix (Managed Care, Medicare, Medicaid, Hospice)
- Percentage of readmissions – focus on strategies to reduce avoidable readmissions
- Percentage from each hospital referral source
August 11 – 17
FORM JOINT OPERATING COMMITTEES WITH HOSPITALS AND PROVIDER NETWORKS
- Download JOC Sample Letter
- Aligning behaviors with mutual goals and objectives
- Discuss strategies to standardized care. Download Facility Assessment Tool
- Discuss readmissions and how to improve outcomes with complex patients. Casamba customers can refer to the May 8th Casamba Skilled Lunch & Learn on Screening Tools by logging in to the Community.
- Define new processes and expectations. Access Discharge Readiness Checklist and Next Site Of Care questionairre
August 18 – 24
EVALUATE CURRENT PAYER CONTRACTS – Must know all payer contract requirements on admission or could be a financial liability
- How are we performing? Are we ready?
- Are current contracts financially positive for the facility?
- If not, which areas are causing loss?
- How can we improve performance?
- Can contracts be renegotiated?
August 25 – 31
EVALUATE WHAT YOU HAVE LEARNED – Take time to review changes made thus far and assess overall progress
- Are employees gaining competence and confidence in new roles?
- Is additional staff training on PDPM necessary? ICD-10 coding, Section GG
- Have you completed contract negotiations?
SEPTEMBER 2019
OPTIMIZE YOUR SYSTEMS AND PROCESSES
September 1 – 7
ASSESS MARKET DEFINITION – Determine where you fit in the market and where you want to be
- Analyze strength of clinical programs offered
- Identify opportunities to strengthen your position in the market and/or services offered
- Develop a clinical grid to assist admission coordinators to more readily accept referrals
- Create messaging/branding campaigns
September 9 – 14
OPTIMIZE THERAPY PROCESSES – Discharge readiness, group therapy, clinical pathways
- Shift paradigm from complete resolution of all problems/deficits to readiness for next level of care. Start to evaluate the planned and actual discharge location
- Hand off to next level of care professionals is successful (e.g., home health, outpatient)
- Transition to restorative should be seamless
September 15 – 21
OPTIMIZE NURSING PROCESSES – Restorative nursing, interdisciplinary meetings, MDS coding
- Restorative nursing and therapy becoming more efficient with integration – For example, therapy in the morning, restorative in the afternoon (skilled treatment in the morning, strengthening in the afternoon)
- Restorative documentation to support daily program delivery
- Emphasize importance of restorative programming and consistent RNA staffing
September 22 – 28
OPTIMIZE DISCHARGE PLANNING – Downstream communication, caregiver training, manage readmission risk
- Referrals to next level of care (HH, OP)
- Ensure caregiver training is comprehensive and complete – from a therapy (function) and nursing (medical management) perspective
- Be able to accept calls/questions from patient and/or caregiver after discharge
- Consider follow-up contact/communication after patient has transitioned home at 24 hours, 72 hours, 1 week and 4 weeks
- Review CMS’s Care Coordination Toolkit
September 29 – October 5
EVALUATE YOUR PERFORMANCE AND MANAGE THE TRANSITION
OCTOBER 2019
FINALLY WE BEGIN!
October 1 – 5
GO LIVE!
- Create list of patients under a Medicare Part A payer admitted prior to 10/01/2019 and remaining on therapy caseload after October 1st
- Check to ensure an ARD is set for the transitional IPA between 10/1 and 10/7/2019 for each patient admitted to the SNF under Medicare Part A prior to October 1, 2019
- The ARD MUST be set on or before October 7th, 2019
- For patients admitted on 10/01/2019 or after, initiate care under PDPM and set the ARD for 5-day MDS on days 1 – 8
- Review all ICD-10 coding, comorbidities, swallowing issues, cognition, and other MDS items impacting payment
October 6 - 12
- Perform a triple check of ICD-10 coding (on the MDS and the claim), physician orders and certification, and MDS items, including a review of medical record documentation to support each item:
- Mechanically Altered Diet - Restorative Nursing Programs
- SLP Comorbidities - Shortness of Breath
- Cognition - Skin Integrity
- Depression - Special Treatments, Procedures, and Programs
- Function - Surgery Prior to Admission
- Active Diagnoses - Swallowing Disorder
October 13 - 19
- Do you know how the MDS impacts reimbursement?
- 161 items in 11 Sections of the MDS impact reimbursement under PDPM:
- B: Hearing, Speech, Vision
- C: Cognitive Patterns
- GG: Functional Abilities
- H: Bladder and Bowel
- I: Active Diagnosis
- 161 items in 11 Sections of the MDS impact reimbursement under PDPM:
October 20 - 26
- Reassess your Interdisciplinary Processes and meetings
- Daily Stand-Up
- Are you receiving timely and accurate information from your referral sources?
- Are you using a pre-admission screening tool effectively?
- What information is still lacking?
- Weekly Medicare Meeting
- Does the team successfully identify and document changes in the patient’s condition?
- Daily Stand-Up
October 27 - 31
EVALUATE PROGRESS
NOVEMBER 2019
- Billing time for first month of residents under Part A payer and under the new PDPM process.
- Review the HIPPS codes and CMG percentages
- Do you have contract structures that are financially successful?
- Which areas need improvement?
- Identify relevant outcomes to measure success under PDPM.
