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PDPM: Redefining Care Transitions


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PDPM: Redefining Care Transitions

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PDPM: Redefining Care Transitions

  1. 1. Executive Education Series PDPM: Redefining Care Transitions – Patient Management from Pre-Admission to Post- Discharge June 11, 2019
  2. 2. Presented by Caryn Enderle, MA,CCC/SLP Director of Business Development “Success under PDPM will be measured by how effectively we manage care.”
  3. 3. VBP • Links payments to performance • High consumer value • Capitate costs • Clinically effective - Outcomes • SNFPPR - Penalties PDPM • Affects 10 – 15% of the average SNF total income • Other payor sources likely to follow in PDPM footsteps • Patient characteristics – outcomes – value over volume = VBP
  4. 4. PDPM & Care Transitions October 1 = PDPM Coding = Payment PROCESS = Success! NursingAdmissions TherapyMDS = Dietary MDS Social Services
  5. 5. Care Transitions - Definition “The movement of patients between one care setting or one provider to another” American Society on Aging “A set of actions designated to ensure the coordination and continuity of health care as patients transfer between locations and encompasses both the sending and receiving aspects of the transfer” The American Geriatric Society 80% of serious medical errors occur during a transition of care 45-56% of medication errors occur during a care transition
  6. 6. Effective Care Transitions Characteristics - • Involves the entire continuum • Patient & caregiver engagement • Risk assessment • Standardized procedure • Timely follow-up • Root cause analysis for all readmissions
  7. 7. Care Transition Goals Goals - • Smooth and painless for the resident/caregivers • Capture comprehensive/accurate data and transfer all information with the patient • Accurate reimbursement • Mitigate risk of readmission • Condense length of stay with appropriate care pathway • Prepare only for next care setting • Assure success post-discharge
  8. 8. • Pre-admission screening • Identifies all patient needs • SNF capable of meeting needs • Effectively and cost efficiently • Desired outcomes • SNF hand-off • Gathering data for PDPM Standardized Procedure • Discharge planning at admission • Discharge planning daily • Downstream partners included • Plan for f/u • Evaluate outcomes – clinical & financial • Implement change
  9. 9. Patient choice Match needs? Enough information? Right information? SNF preparation Care Navigator Physical transition Caregiver considerations Care Ambassador Medication reconciliation Timely assessments Mitigate risk of readmissions Patient Considerations Next level care collaboration Preferred providers Primary care f/u Pt. engagement/education Community services Follow-up – Readmissions?
  10. 10. Information Transfer • ICD-10 Diagnosis – Primary reason for SNF stay • Clinical Category ICD-10 maps to • Prior Surgery • Prior Hospital Stay • Prior Living Setting • Anticipated Discharge Setting/Barriers • GG Functional Scoring – PT, OT, Nursing • Speech Related Comorbidities, Cognitive • Presence of Mechanically Altered Diet – Even Trials • Swallowing Disorder • BIMS/CPS • PQH9 Depression Score • Presence of 2 or More Restorative Programs • Non-Therapy Ancillary Components – ALL! PDPM Data Points
  11. 11. Consequences of Incomplete/Inaccurate Data • Default Category – Return to sender • Less than optimal reimbursement • Paying for expensive treatments that you’re not getting reimbursed for • Missed opportunity for IPA for rate change
  12. 12. PDPM Crosswalk Tool Information Transfer
  13. 13. Care Transitions & Reimbursement
  14. 14. Reimbursement Analysis Admission Considerations • Optimal diagnosis • Captures all complexities • Accounted for all comorbidities • Was GG accurate Weekly UR Considerations • Is ICD-10 still best fit • Was speech involved at admission or later • Swallowing/diet issues identified at admission • Any significant change that warrants a clinical category change • Change in functional scores for OT/PT or Nursing • Is an IPA indicated • Any NTA identified after admission assessment Discharge Considerations • Would a different ICD-10 been a better representation of the patient • Could we have gathered data more efficiently • Was an IPA warranted • Did GG score represent patient accurately • What could we do different next time • Would we admit a similar patient
  15. 15. LOS & Readmissions Length of Stay Readmissions ¼SNF stays results in readmission
  16. 16. Transitions & Readmission Cutting Readmissions! Risk Assessment Care Pathways Patient/Caregiver Engagement Disease Management Staff Skill Set Collaborate Downstream Follow-Up Plan
  17. 17. Cutting Readmissions PAC Transition Assessment - PACTA
  18. 18. Cutting Readmissions Risk Based Diagnosis Specific Care Pathway
  19. 19. Next Level of Care Preferred Providers Part of D/C Planning Community Services Process for Follow-Up Information Transfer Collaborate
  20. 20. Pitfalls of Ineffective Transition Communication Breakdown Pt. Education Breakdown Lacking Accountability Medical Errors Re- Hospitalization Duplication
  21. 21. Transition Success Impacts Quality • SNF QRP • SNF Value Based Purchasing • Nursing Home Compare Star Rating
  22. 22. Quality Impacts Reimbursement • Penalties • Referral sources • Census • Quality measures realign payment incentives and quality incentives
  23. 23. Nursing Documentation & Care Transitions Under PDPM, skilling requirements are not changing. • Requires skilled nursing or rehabilitation services • Requires these on a daily basis • Can only be provided in a SNF • Services are reasonable and necessary PDPM strengthens importance of documenting all aspects of care patient receives
  24. 24. PDPM Care Transition Checklist • Develop Your Process • Designate Roles • Practice Data Gathering • Evaluate Outcomes • Root Cause for Better Outcomes
  25. 25. Final Thoughts • PDPM is only one pillar of payment • Other payors will take their cues from PDPM • RUGs will eventually be retired • Don’t lose focus on other priorities
  26. 26. SNF Solution Center
  27. 27. Nursing Documentation Under PDPM Join us for the next webinar in our Executive Education Series Presented by ; Tammy Cassidy, RN,BSN,LNHA,RAC-CT, T.L. Cassidy & Associates Jennifer Napier, RN, RAC-CT, QCP, Concept Rehab July, 2019
  28. 28. Thank you! Caryn Enderle, MA,CCC,SLP Director of Business Development 614-570-2404