This post ran in the June 14, 2019 edition of LeadingAge Michigan’s The Latest Wrinkle.
Most LeadingAge members are now tired of hearing about PDPM, but the time for implementation is fast approaching. Like many other changes to our major systems, preparation is key. While the new reimbursement model changes have been discussed in detail many times, it is important to remember that there will be nuances to the implementation that could have implications for individual providers.
Although there has been a lot of thinking and preparation, many providers still feel unprepared. Between now and October 1, Therapy Management, Inc. will be working with LeadingAge Michigan to provide insight and information that may help keep the important elements for implementation up front for members.
PDPM will usher in an entirely new framework that will impact much of the daily work for SNF providers. We are providing some tools below that will help gauge your readiness.
Whether your team has been methodically planning and plodding over the past year, or you’ve waited until now, you have four more months to get ready for PDPM. Since time is of the essence, your ability to focus your team’s efforts on top priorities, training, and new modes of collaboration will determine your success.
Here are 10 questions/statements meant to assess your team’s readiness for PDPM.
Your honest answers (YES or NO) will inform you about where time, resources, and training should be spent. If your answer is NO, then what would be your immediate next step toward preparedness?
All team members have attended PDPM training sessions. They understand the focus of the new payment model and how their role will play a part.
2. ICD‐10 DIAGNOSIS CODING:
Our staff is familiar with the 10 primary diagnosis categories and can accurately code the primary diagnosis (does not use return to provider codes) based on hospital/physician documentation (obtains clarification as needed for greater specification).
3. MDS ITEMS:
Our team is competent with coding key MDS items required to accurately reflect what is occurring using input from all disciplines (per RAI manual). This includes section C, D, GG, K.
We have adjusted our Medicare meeting format to focus on validating the acuity of the patient and accuracy of the MDS as a collaborative team.
5. CARE PLANNING:
Our team (including therapy) is care planning to address the primary diagnosis category and the NTA (non‐therapy ancillary) conditions stated on the MDS.
6. RESTORATIVE NURSING:
We have established an effective restorative program and understand when restorative can apply to PDPM reimbursement.
7. INTERDISCIPLINARY CARE:
We have a stellar relationship with our therapy provider and have developed interdisciplinary “care pathways” together for specific conditions.
Our EMR is providing guidance on PDPM. We are using the tools offered in preparation for PDPM and have a clear understanding of how they will support transition before, during, and after the first week of October.
We have completed a crosswalk of recently coded MDS’s in order to assess the financial impact. We are aware of historical RUG utilization per category and nursing days.
10. THERAPY CONTRACT:
We have assessed PDPM pricing options with our therapy provider and understand the methodology/language they have presented and its impact on percentage of cost overall. A plan to analyze post PDPM is in place.
As a bonus, here are some valuable readiness checklists, tools, and materials:
- AANAC ‐ PDPM At‐a‐Glance Tool
- LeadingAge National – Checklist to Prepare for the Patient‐Driven Payment Model
- CMS Grouper Tool (download)
- AADNS – Pathway to PDPM Readiness Tool
In addition, Point Click Care offers four comprehensive checklists for PDPM preparation:
Need help understanding your options on your new therapy contract under PDPM?
Other therapy providers are presenting a plethora of pricing models and asking skilled nursing providers to choose the option that suits them best. However, many of those options are not a win-win-win for SNFs, patients/residents, and contract therapy companies. We’d be happy to talk with you about the pricing model that we believe is most fair, transparent, and appropriate for therapy delivered under PDPM . Call us at 877-TMI-8171 or email us today.