Renee Kinder

The Sweet Spot Lexington was a local, friendly, bakery-ice cream parlor in the center of downtown.

In addition to their delicious, classic Blue Bell birthday cake and mint chocolate chip ice cream, they also offered sweet prices for kids’ cones and an opening, welcome environment including roomy booths and board games for families.

My kiddos had grown accustomed to walking up for a student cone in the afternoons and enjoying some downtime prior to homework and after school activities.

That is, until last week … We walked up to find the interior windows covered in newspaper with a “For Lease” sign on the door.

Our Sweet Spot as we knew it is now closed for business.

As a result, we are now on the hunt for a new, similar setting to fill its shoes.

We need to find our new Sweet Spot.

Sound familiar?

I had the great pleasure of attending the NASL winter conference this week in Washington, DC, and there seemed to be a general theme in conversation. Everyone, you see, is looking for what their new sweet spot will be in the coming year.

The sweet spot that balances clinical, quality, value and operations. The sweet spot in MDS coding accuracy for capturing functional status measures, swallow function, cognitive status, and ICD-10 coding for clinical complexities and comorbidities. The sweet spot between skilled nursing/rehab and restorative-based care. And the sweet spot in between clinical reasoning and treatment planning for individuals receiving skilled care under the Patient-Driven Payment Model.

Enter the discussion, John Kane of the Centers for Medicare & Medicaid Services, who served a vital role in answering our questions and speaking reason to the creation and intent of PDPM.

He is the voice on the monthly Open-Door Forum conference calls.

He is the architect of PDPM

And on Tuesday of this week, we had the pleasure of hearing him speak first hand.

Those of us in attendance would have to agree that CMS has found their “sweet spot” in John and his role as Technical Advisor/SNF Payment Team Lead at CMS.

A background in philosophy?

A prior employee of a skilled nursing facility?

An individual who has experienced the need to place a loved one in the care of a skilled nursing facility?

We all knew he was smart. We all knew he had a skill set in data analytics.

What we all experienced this week was the softer, person-centered, and dry-humor side that makes up John Kane.

The Sweet Spot … aka, the perfect balance of goodness and discipline.

He talked about PDPM starting as “data and a dream.” He reassured us all that CMS is working to find a balance between payment and quality. And he gave us a solid overview of what is and what is not changing under PDPM, allowing us to understand how we can prepare and find our sweet spot leading into October.

Change will occur in areas of payment classification, emphasis on care, payment/quality alignment, PPS assessments, and medical review/data monitoring.

Change will not occur in areas of denial notice policies, ABNs, NOMNCs, therapy evaluations, student supervision, and the basic administrative process under SNF PPS.

Additionally, Kane clarified that PDPM does not change coverage criteria, it does not change patient needs, and that, in short, it increases the need to focus on holistic care and complete documentation that support all aspects of patients care.

We all left his session feeling energized about getting back to our clinical roots, working together across teams more effectively, and feeling empowered to found our balance in the coming months.

My family’s search for an afterschool ice cream parlor however … is not going so well. The gelato spot comes with a hefty price tag and melts quickly, resulting in sticky, whiny children. The yummy French pot-style location is not walkable, and the healthy options are well … not so sweet.

We have realized, however, that Kroger does carry the same sweet versions of birthday cake and mint ice cream, allowing us to reclaim cozy afternoons at home, get back to our roots, sneak extra scoops of goodness, and realize that, that is the sweetest sweet spot of all!

Renee Kinder, MS, CCC-SLP, RAC-CT, is Vice President of Clinical Services for Encore Rehabilitation and is the Silver Award winner in the 2018 American Society of Business Publishing Editors competition for the Upper Midwest Region in the Service/How To Blogs category. Additionally, she serves as Gerontology Professional Development Manager for the American Speech Language Hearing Association’s (ASHA) gerontology special interest group, is a member of the University of Kentucky College of Medicine community faculty, and is an advisor to the American Medical Association’s Relative Value Update Committee (RUC) Health Care Professionals Advisory Committee (HCPAC).