Out with the old, in with the NEW! We are days away from an industry shift that will change care as we know it. Patient Driven Payment Model (PDPM) will focus on individual patient characteristics and comorbidities in deriving payment. Every patient will be unique and the care provided to patients under PDPM will need to be individualized as well.
In preparation of these changes, we have included need-to-know transition tips for your MDS Coordinators and Dietary team.
- Initial assessment is critical. The initial MDS assessment determines payment for the patient’s entire Part A stay. “Getting it right” will determine how successful each SNF will be under the new payment system.
- Communication with admitting hospital and other admission sources prior to and immediately after admission is an important piece to the PDPM puzzle. In addition, the ongoing assessment and collaboration of the MDS team over days 1-7 will be essential to identifying and documenting all patient deficits.
- ICD-10 coding and documentation education. Your interdisciplinary team should have a plan in place to gather diagnosis data prior to admit, be aware of the wide variety of diagnoses that now impact reimbursement, and have a good flow of communication/ SNF admission processes with Coders and discharge planners at referring hospitals to insure accurate and efficient flow of information needed for admission assessments.
- Interrupted stay: Know the rules. An interrupted stay is defined as: A patient who is discharged from Part A services and subsequently resumes SNF care in the same SNF during the interruption window. CMS defines the interruption window as A 3 day period starting with the calendar day of discharge and including the 2 immediately following calendar days ending at 11:59pm. Establish tools to accurately track discharge admission patterns and ensure that interruption windows are discussed during IDT meetings. Ensure that expectations surrounding required documentation is on point and being followed.
- Accurate input for the MDS initial assessment in Section K will be necessary. Your speech therapist, dietary team, and nursing teams must all be communicating on every aspect of intake, including swallowing medication, overall intake, oral residue and spillage during meals, as well as need for modified diets.
- Monitoring residents during meals during days 1-7 is an essential tip under PDPM. Noted deficits will be a key objective in properly identifying and coding resident deficits.
- Observing and communicating changes in diet modifications for residents, specifically for mechanically altered diets will also play a major role in reimbursement as well as care delivered under PDPM.
How we can help
With October 1st right around the corner, we have spent the better part of 2019 working on our own PDPM transition action items to better assist our SNF partners. Because effective communication and care coordination is a chief component of PDPM, Therapy Center is training our staff to speak your language.
- Developed a pre-admit checklist and admission packet to assist with communication and gathering of all necessary information prior to admission.
- Provided top referring hospitals PDPM preparation in-servicing.
- Identified key personnel who will aid our teams as well as our partner facilities in obtaining comprehensive and accurate ICD-10 diagnoses.
- Prepared our staff to meet with the entire MDS team based on the individual facility’s PDPM meeting schedule, whether that be daily or Day 1, Day 3 and Day 7-8.
- Created and provided MDS teams with education materials and checklists in an effort to keep everyone aware of all sections of the MDS that now impact reimbursement.
- Discussed and planned clinical pathways.
- Shared resources with nursing in order to improve diagnosis specific charting/care planning.
October 1st is just days away. Remember we are all in this together and when in doubt, re-read and share How to handle stress in the ever-changing healthcare industry
Tune into more PDPM articles here on our blog.