[Music] hello i'm candice gutierrez ceo of integra rehab i'm glenna gilliam reimbursement nurse for paramount healthcare welcome to pdpm for dummies the first of three training modules for paramount healthcare the goal for this training series is to prepare you for the changes coming up in october 1st 2019. we have three series coming out which is the one we're doing today pdpm for dummies which is an overview we have an in-depth training session pdpm bootcamp and an on-site training session pdpm sniper school pdpm for dummies is to understand the basics of the patient-driven payment model i think there's a reason that they have candace and i doing pdpm for dummy very good glenna and let's get started going from the rugs to the pdpm one of the biggest things that i saw in the trainings with cms was that they were not satisfied with the rug4 model of being reimbursed for the amount of minutes therapy was providing versus the clinical characteristics of a patient so they've been developing for years uh this change has been coming we've been seeing it through the different things that we've been asked for with the ggs with the 24-hour care plans there's been a lot of things coming to fruition to come up with this payment a patient driven payment model so therapy minutes are no longer going to be the basis of payment it's going to be fun functional outcomes not only from therapy but for nursing documentation supporting that resident clinical characteristics determine the patient the payment now for many years in in nursing for example wound care the facility didn't get paid anymore or reimbursed anymore for wound care issuing a wound vac that requires close monitoring extra equipment special rentals that we have to achieve we wouldn't get reimbursed anymore for that then we would put in a band-aid on a patient right pdpm changes that right and also with therapy group and concurrent therapy are now going to be capped at a combined 25 percent per discipline and one of the things that cms you know wants to see is the group and current come back because it's also a psychosocial um advantage for the patient and they felt that that was kind of taken away by just being driven by minutes there will be six components required to establish per diem rates and these rates are going to be established by a point system given to nursing pt otst non-therapy ancillaries and a non-case mix that is the flat rate what is going to comprise of nursing nursing categories have been and currently are 44 and they're going to be taken down to 25 much more manageable categories that can comprise all aspects of of bedside nursing care great and pt and ot are going to have 16 clinical categories that they'll be able to follow fall into and st will have 12 categories that they'll fall into there's about 50 non-therapy ancillaries that will also allocate points to be given towards the reimbursement so these categories we're going to go in depth in the pdpm boot camp to train how the clinical categories are scored again the non-case mix is component covers things like room and board capital cost and overhead it does not depend upon the resident characteristics it's going to be based on basically rural or non-rural areas it's a flat rate there's only two two variables there now we're going to cover the strategies for success under pdpm which is going to cover icd-10 code accuracy section gg ppsmds therapy skilled and clinical documentation icd-10 codes have always been very very important but now even more so with with each um each code being assigned a number and the differences in how we uh put them in into our face sheets and into our diagnostic sheets we're working on a smart sheet to to help all of our nursing coordinators identify the more common diagnosis that we see coming into a skilled nursing facility right i think this sheet will help getting the accurate icd-10 code so you get the appropriate points allocated when that mds inji is is strictly about diagnosis and it's going to be again it's going to be imperative that we get those in on admission as quickly as possible the goal is to have everything in within 48 hours and the j section where where we address components of falls and fractures and pain control is going to also be very important for the care of the the patients and for reimbursement and as we have been illustrating throughout this training the section gg is the collaboration between nursing and therapy will be essential for accurate gg function score because that score is going to again add points to the overall reimbursement that is given to the facility based on the ggs again we're going to go in depth of training on here with pdpm boot camp of an actual sheet that's going to walk you through what score to provide for what services that you're seeing on a usual basis therapy's normally been doing the gigi since before october of last year however i know we've been getting requests from nursing to assist in that but it's based on what the nurses are actually seeing not what they're performing in therapy so that's going to be very important for that training for them to be comfortable again we're going to make another smart sheet for them to have like a decision tree of what the patient should fall under i think the gg section was real new to to the nursing component and they have to do it three consecutive days in in a row from date of admission and they were at first very uncomfortable with it and and going to therapy and trying to rely on therapies and what therapy was seen but what nurses see and what therapy sees are two different things i think they've kind of come to realize that nursing does their part therapy does their part and then we can marry the two together to come up with a more accurate description of the needs for the resident right and one of the things we're going to be working on as well is trying to blur that line between therapy and nursing so that we're working together to get those gigi's more accurate on both ends and you know that's going to be part of the training for the patient-driven payment model is making sure that the patient's involved in that training as well pdpm mds assessment there's only only going to be two pdpm mds assessments that are going to be required the five-day assessment that we're used to the information is going to be gathered from the interdisciplinary team to to capture all the optimal information for the resident and for reimbursement the discharge assessment which will include therapy minutes and gg reported on the discharge assessment yeah that's one of the things that at the cms training is that they are still going to be tracking the therapy minutes change in how therapy is being provided is just going to be categorized differently as far as on the mds but the minutes are still going to be tracked pdpm mds is going to have an optional assessment it's going to be called ipa for interim payment assessment and that can there's no set schedule for that that is going to be at the discretion of the interdisciplinary team and whether the patient is improving or declining it's going to be very important and for for all aspects of the team to contribute and when we do the pdpm meeting every morning format's going to change from the pps meeting that we know now but um still tracking days tracking potential discharge dates and tracking uh improvement or decline of of any given resident yes and these uh improvement or declines would you know possibly trigger an ipa uh to happen and one of the things again that the cms kept getting questions on was during the training was well what if this what if that about a patient and the answer stayed the same it is optional so you don't have to do it if it declines you can do it if it increases your reimbursement it's optional they just kept saying optional so that's something that i think would be very advantageous to be tracking is any um significant changes that are happening um this is where you know the whole team can get involved during a morning meeting if we see something changing then we can maybe look at okay would it ipa be appropriate i just wanted to emphasize the five-day mds assessment and its importance what hasn't changed is that we have between day one and day eight to set that assessment but it's going to be critical for any department that has a portion of the mds to do or any of the uda assessments to do that they get them in in time in a timely fashion because this is the assessment it is the only assessment that that we have to set our our revenue rate and everything is going to be based off of it so we cannot afford to be late everybody has to be working and together as an as an idt to get this set or to make it successful i had an interesting story with the cms training that i did um i guess the sections if it was late went into what triple a days be under current system under pdpm it's going to go under a zzzzzzzz code and he says the cms coordinator basically said you're going to get that default code because that means you were asleep at the wheel you only had you only had one time to do this assessment right for eight days so you know just i emphasize with glenna get it in on time i think we have the first five days of interdisciplinary collaboration to be able to make sure we have that set with the clinical documentation it's going to be important to make sure that um everything is accurate with therapy with nursing in in the sections one of the conditions of coverage is still the need for daily skilled services and that documentation so under that they also discuss the therapy services and the restorative nursing this is where restorative nursing is going to come back into play they've always been in play but we never been really reimbursed for it pdpm is going to now allocate points if restorative nursing is in the skilled services with the patient uh with therapy involved as well so i think this can also be very advantageous for a patient who is like non-weight-bearing and restorative therapy can go in there and do active or passive range of motion until they get the weight-bearing status released to as warranted some of the things that haven't haven't changed in in the medicare pdpm module is that you still have to have a need for a skilled stay such with therapy with with nursing those those regulations have are remaining the same and this is a great opportunity for our restorative nursing program to to come to light pdpm is going to require a lot of preparation and we want to cover a few more areas that preparation i think would be advantageous for facilities to look at and i know that paramount is working with their emr provider to make sure that they're getting selecting diagnosis is in the right mds category identifying tracking non-therapy ancillary conditions in the mds tracking cognitive and speech comorbidities also documentation the medical records the pre-admission screenings are going to be very important i mean they are important now but we're having to look at what we can capture maybe 90 days before the admission um whether it be a surgery whether it be other treatments that they got that we can take credit for supporting their need for skilled nursing yeah this is a this is a part that's really kind of exciting because we do not have to rely solely on the diagnosis of what took the patient to the er and ultimately to have an inpatient acute care stay we can also look at chronic conditions that they have like you know cvas diabetes and such that's great the trainings on the icd-10 codes and the gg trainings that are going to be done in the pdpm boot camp and the clinical competencies are going to put all the therapists and nurses on their to require their clinical practices to be at the top of their license and this is one thing that excites cms is that this way that they feel that the reimbursement is going to be allocated for the patient outcomes versus the quantity of therapy getting given to the patients so again for sniffs to succeed under this is also going to help them succeed in their qrs scores in their five-star ratings and those are going to be something again we're going to be going over in our further trainings of how they all marry each other so that we get not only a great reimbursement but we also get that rewarded in your qrs scores and hopefully in your five star ratings we're going to reemphasize what does not change under pdpm this is important when you bring in a skilled patient that we make sure that we're checking the three midnight stays the medical necessity that the facility is able to be able to provide services to the patient under nursing or therapy skilled needs i think they feel that the non-therapy ancillaries will be looked at but if it still doesn't have the skilled need of therapy or nursing they may have that non-therapy ancillary but it's still not scalable so that's real important that cms wanted everybody to know that it didn't open gates of what is skilled um that doesn't change you just get points for having those non-therapy ancillaries or nursing services that weren't getting reimbursed in the past to recap alignment of nursing and therapy clinical documentation and coding will be critical to support the skill clinical care provided and reimbursed one of the things glenna that i think that is exciting about this is it focuses on the patient and not on the quantity of therapy provided and i think you know instead of you know attempting to calculate the minutes and putting them in a rug level we can really sit down with the patient and say okay what is your what is your need and if therapy is not the the you know top provider for this patient then nursing gets in and you know therapy can assist you know in the back until maybe they get stronger or more uh stabilized and then therapy can get in i think you know obviously it's going to open the door for you know higher acuity patients for the facilities but i think if we again bring um the therapist and the um nurses up to their license of care i think you know it's going to be a good thing yeah i do too i i think for several years now we've seen where um skilled nursing facilities have accepted higher acuity patients and and at the beginning we were a little bit leery of that with the traits and thinking about tpm or tpn and now we're thinking of of ng tubes more advanced wound care we're not sending patients out to wound care centers like we used to treating them more in-house so we just have to to get on board with that that's where our education and training is for and now we get the opportunity to use it i think it's a real good chance opportunity for social worker and st to work together for cognition and and to work for ultimately uh planning a discharge for the patient in a safe environment whether it be to go to an assisted living or back home or into a long-term care facility and explore what their options are right and one of the things that's going to be you know it's not only getting the interdisciplinary team you know within the facility it's an interdisciplinary team within the community being from the hospital to home we're that stepping stone so going from the hospital making sure that they're educated with pdpm of what we're requiring upon admission and the documentation that we need i've talked to many of the case managers in the hospitals and they're excited about this collaboration because they're hoping that you know us doing the right thing and partnering with good home health agencies that we can keep the patient from that 30-day re-uh and that's one of the things that i think we want to be working on i know paramount's the navigator of making sure that we partner with home health agencies that will collaborate and even come to the care plan meetings before discharge we have a great model here in el paso doing that to where the patient goes home and if the patient is not quite ready they can come back to the nursing facility before they go the 30 days you know back to the hospital so there's you know working uh i think one of the things we did leave off uh here that i want to emphasize it'll be something that we're training them on uh individually is the medical director the medical director is going to be very key player in this pdpm and making sure that we need the diagnosis that we uh if we don't see that you know we get and making sure that they understand the pdpm model as well which we are doing training for our medical directors and um medical staff that is not you know part of the nursing staff yeah it will be a a lot of training for all of our departments and like you said including the physicians that come into the facilities and i think a very strong misconception early on with pdpm is that we would need less therapists or we would need less mds coordinators and that really is simply not true because if if if we start focusing on that type of reduction we're going to miss our reimbursement we're going to miss assessments we're going to miss opportunities for the for the residents right one of the things that cms was illustrating too is that wasn't their intention at all in coming up with this payment model one of the things is would be the mds coordinator would be more out with the patient care instead of doing assessments every seven days or 14 days or 30 days and the therapists would be actually doing the one-on-one training and not counting the minutes seeing what their clinical outcomes were going to be which are you know i think going to be advantageous or you know for all parties involved i think back in the day when i when i did i was mds coordinator at a facility and i'd come set in your gym and watch the therapists interact with the patients and and um do eyes on observations i think i got in their way a little bit but didn't mean to no and but that's going to be the way it is so that you can get an accurate uh assessment of the patient for their outcome status exactly so it's exciting and change is not always bad in this case i think it's real good it's good for our our staff and it's good for the for the residents right the one thing that doesn't change is change i heard that before as well and so i think if we just embrace it with um knowing that there's a lot of opportunities in this change for not only the residents but also the staff i think we will successfully be able to do this transition with little bumps in the road and we have a frequently asked questions section if you have any questions regarding what we covered or you feel that you weren't clear on please you can set your questions to integra rehab inc dot com forward slash pdpmf and if i can't answer them or glenna can't answer them we will go ahead and submit it to cms who gave us a contact there to be able to answer any questions and if you have any questions or recommendations for the what you want to see on the the boot camp pdpm training please submit those as well and just to recap what uh the bootcamp pdpm is going to cover is the training for the ggs for nursing and therapy and that's going to be pretty significant hands-on training and then clinical categories for each ptot st and nursing and how those points are allocated the non-therapy classifications where we can also obtain some further points towards the reimbursement i think that concludes our training session okay thank you we'll see you at camp thank you [Music] [Laughter] [Music] [Laughter] [Music] [Music] [Music] [Laughter] [Music] [Laughter] [Music] [Laughter] [Music] [Laughter] [Music] you