Beginning on 10-1-2019, with the implementation of PDPM, interdisciplinary data collection between therapy and nursing, and accuracy for entry in our current (i.e.Prior to 10-1-2018) Section GG items sets will be crucial.
Why you ask?
Because the data entered within the MDS will help to determine the case-mix for therapy teams which will then be collectively added to the case mix from Nursing and Non-Therapy Ancillary to create an overall HIPPS Code, or Health Insurance Prospective Payment System code.
The key areas impacting PT and OT elements within the HIPPS for PDPM are as follows:
- GG0130A1 Eating
- GG0130B1 Oral Hygiene
- GG0130C1 Toileting Hygiene
- GG0170B1 Sit to Lying
- GG0170C1 Lying to Sitting on Side of Bed
- GG0170D1 Sit to Stand
- GG0170E1 Chair/Bed-to-Chair
- GG0170F1 Toilet Transfer
- GG0170J1 Walk 50 Feet with Two Turns
- GG0170K1 Walk 150 Feet
Additionally, we have updated Section GG items sets being added to the MDS 10-1-2018. These areas are of equal importance as they will have an impact on our communities QRP ratings.
What can we do to ensure accuracy, consistency, and equal focus on the current and new Section GG items?
Let’s consider a case study.
Picture it…. 10-1-2018
An individual, Mr. Jones, who has suffered the new onset of a cerebrovascular event enters your community.
Care planning is initiated and data collection begins for MDS accuracy including the new and improved additions to Section GG for Self-Care and Mobility.
We are in a period of data collection from 10-1-2018 to 12-31-2018 for SNF QRP. We know that the following areas must have 100% of data for 80% of assessments.
- Drug Regimen Review
- Changes in skin integrity post-acute care: pressure ulcer/injury
- Change in Self Care Score
- Change in Mobility Score
- Discharge Self Care Score
- Discharge Mobility Score
10-1-2018, the 3-day window for data collection begins for Mr. Jones.
Self-Care Items Sets are as follows (current plain text, new bold, PDPM/HIPPS related underlined)
- GG0130A. Eating: The ability to use suitable utensils to bring food and/or liquid to the mouth and swallow food and/or liquid once the meal is placed before the resident.
- GG0130B. Oral hygiene: The ability to use suitable items to clean teeth. Dentures (if applicable): The ability to insert and remove dentures into and from the mouth, and manage denture soaking and rinsing with use of equipment.
- GG0130C.Toilet hygiene: The ability to maintain perineal hygiene, adjust clothes before and after voiding or having a bowel movement. If managing an ostomy, include wiping the opening but not managing equipment.
- GG0130E. Shower/bathe self: The ability to bathe self, including washing, rinsing, and drying self (excludes washing of back and hair). Does not include transferring in/out of tub/shower.
- GG0130F. Upper body dressing: The ability to dress and undress above the waist; including fasteners, if applicable.
- GG0130G. Lower body dressing: The ability to dress and undress below the waist, including fasteners; does not include footwear.
- GG0130H. Putting on/taking off footwear: The ability to put on and take off socks and shoes or other footwear that is appropriate for safe mobility; including fasteners, if applicable.
Mobility Items Sets are as follows (current plain text, new bold, PDPM/HIPPS related underlined)
- GG0170A. Roll left and right: The ability to roll from lying on back to left and right side, and roll back to back on the bed.
- GG0170B. Sit to lying: The ability to move from sitting on side of bed to lying flat on the bed.
- GG0170C. Lying to sitting on side of bed: The ability to move from lying on the back to sitting on the side of the bed with feet flat on the floor, no back support.
- GG0170D. Sit to stand: The ability to come to a standing position from a position of sitting in a chair, wheelchair or on the side of the bed.
- GG0170E. Chair/bed-to-chair transfer: The ability to transfer to and from a chair (or wheelchair).
- GG0170F.Toilet transfer: The ability to get on and off a toilet or commode.
- GG0170G. Car transfer: The ability to transfer in and out of a car or van on the passenger side. Does not include the ability to open/close door or fasten seat belt.
- GG0170I. Walk 10 feet: Once standing, the ability to walk at least 10 feet (3 meters) in room, corridor, or similar space.
- GG0170J. Walk 50 feet with two turns: Once standing, the ability to walk 50 feet and make two turns.
- GG0170K. Walk 150 feet: Once standing, the ability to walk at least150 feet (45 meters) in corridor or similar space.
- GG0170L. Walking 10 feet on uneven surfaces: The ability to walk 10 feet on uneven or sloping surfaces (indoor or outdoor), such as turf or gravel.
- GG0170M. 1 step (curb): The ability to step over a curb and/or up and down one step
- GG0170N. 4 steps: The ability to go up and down four steps with or without a rail.
- GG0170P. 12 steps: The ability to go up and down 12 steps with or without a rail.
- GG0170O. Picking up object: The ability to bend/stoop from a standing position to pick up a small object, such as a spoon, from the floor
What is the data impact?
10-1-2018, the data impact is for entry of content period, to meet the requirements for QRP.
10-1-2019, with the move from volume to value, with the move from minutes to patient characteristics, the data impact is for your HIPPS code.
And the HIPPS codes don’t lie.
Or do they?
Remember, case-mix reimbursement accuracy for PDPM will be impacted by inconsistencies across team members when coding “usual” per the RAI definition.
This could result in a variety of case-mix recommendations impacting the final HIPPS code.
In the end, what is in the MDS for individuals following 10-1-2019 should tell the true story.
Renee Kinder, MS, CCC-SLP, RAC-CT, is Director of Clinical Education 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).