Nursing: How much do my key players need to know about PDPM? 

 

Nursing will be a viable, primary skilled service under PDPM

When it comes to skilled nursing, SNFs can provide direct skilled nursing services, such as wound care, intravenous feeding, IV medications, etc  or skilled-management nursing services, including management and evaluation of a patient care plan, observation and assessment of a patient’s condition, and teaching and training activities.

With the shift of caring for more medically complex patients, PDPM will demand an increase in the improvement and specialization of nursing skills. The Nursing PDPM reimbursement component will rely heavily on quality nursing clinical documentation that demonstrates and supports the need for skilled nursing services.  Demonstrating good clinical outcomes and maximizing the NTA and Nursing component will require nursing to sharpen their clinical documentation skills.  Clinical education will be needed in order to impact nursing and NTA case mix and clinical outcomes.

 

Restorative nursing

Restorative programs can be used to keep residents at their optimal levels using compensatory strategies, therapeutic exercises, and implementing components that residents learned in their therapy programming as well as assisting with prevention of contractures and wounds. Patient are less likely to have a re-hospitalization within 30 days of discharge if a strong combination of therapy and restorative are utilized.  Restorative nursing will undergo changes under PDPM.  Historically Restorative programs were developed at the end of therapy; under PDPM we will need to adjust our thinking and develop Restorative programs at the onset of skilled admission.  Therapy will continue to play an integral role in Restorative but now Nursing will need to be active in program development as well.  Since Restorative is a nursing program, it has been placed inside of the nursing CMI component.  Our therapy team is also committed to Day 1 assessment and conversation to insure that Restorative is initiated promptly to be captured in the 7 day look back if it is appropriate on admit.

 

Assessment and documentation are critical

Nursing staff will need to sharpen their assessment skills as well as documentation skills. Both are vitally needed to capture the characteristics of residents who will require a skilled level of care and then to also record the skilled services that are being delivered to meet those needs. Accurate documentation also supports MDS coding under PDPM.

 

How we plan to help

At Therapy Center, we are actively training our staff to speak your language.  We are prepared to meet with the entire MDS team based on your facility PDPM meeting plan, whether that be daily or Day 1, Day 3 and Day 7-8. We have also provided our MDS teams with materials to keep everyone aware of all sections of the MDS that now impact the reimbursement.  We are actively talking about clinical pathways and sharing resources with nursing to improve diagnosis specific charting/care planning.

 

October 1st is only a few weeks away. Tune into more PDPM articles here on our blog.


Resource Articles:
https://www.aadns-ltc.org/Resources/Nursing-Leadership/Details/post/pdpm-prep-brush-up-on-skilled-nursing-services/2019-01-16
https://www.mcknights.com/print-news/pdpm-will-reduce-clinical-requirements-but-demands-more-attention-to-detail/
https://www.wipfli.com/insights/blogs/health-care-perspectives-blog/how-pdpm-affects-skilled-nursing-facility
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