It’s that time again! 

Time for back to school, meeting new teachers, making new friends and looking forward to adventures ahead.

Adventures, that is, after the dreaded preparation of purchasing and organizing everyone’s school supplies.

This year, my 11-year-old daughter joyfully completed the task. She printed five total school supply lists, she logged onto the Target website, and she systematically went through every list and marked off items as they entered her virtual shopping cart. 

This year, we have two middle schoolers, and in my minimum engagement with the process of organizing supplies I noticed the vast difference in what it means to be prepared for a kindergarten kiddo, versus a second- and fourth-grader, versus a sixth- or seventh-grader.

  The younger ones still need Clorox wipes, while the older ones need Kleenex … I guess come cold season the lower school needs more sterilization whereas older kids are more apt to conduct appropriate tissue use.

The younger ones still need washable markers, and crayons of a specific width and color scheme, whereas the older ones have moved on to permanent and non-erasable red, blue and black ink pens. I assume that the older kids are held to a higher standard of accuracy. 

They all need pencils, preferably pre-sharpened.

In a similar sense, providers need to sharpen their understanding around accuracy associated with their respective community needs leading into October.

We all have standard areas that should be perfected. Additionally, we are uniquely different and should all have individualized check lists for success. 

The are must-haves for everyone:

  • An understanding of your current coding trends and how they will crosswalk between RUG-IV and PDPM HIPPS codes.
  • Integration opportunities between therapy and MDS electronic medical records to promote interprofessional coding accuracy. 
  • Updated Medicare Part A meeting structures, including role play for current patients tied to key clinical areas which will impact PDPM success and accuracy.

Additionally, as with our supply checklists, communities need to add an additional level of individualization based on their populations and clinical needs.

For communities with a significant number of individuals with medically complexity:

  • Assess your current practices for coding in Section I: Active Diagnoses of the MDS which will impact your non-therapy ancillary (NTA) case mix.
  • Implement systems within your communities’ primary care physician groups to obtain more thorough medical records outside of the hospital discharge records. Remember: Physicians have new standards associated with the IMPACT Act and the Medicare annual wellness visit. Their input could yield significant gains in your coding accuracy. 
  • Determine nursing and therapy teams’ clinical competencies with completing assessments and treatment for specific diagnostic groups, including their skill set in obtaining baseline accuracy for Section GG: Functional Status in Self-Care and Mobility. Systematic review will ensure that you are not limited in coding volume or accuracy simply due to a lack of evidence-based knowledge for diagnostic categories such as cardiac and respiratory .

For communities seeking to improve return-to-community rates:

  • Assess your current practices for completion of home evaluations and discharge-planning processes.
  • Initiate conversations early in the stay, including all options for discharge to a lesser level of care. 
  • Increase health literacy and teaching/training for individuals on medical conditions and understanding of chronic disease processes. 

For communities pursuing a greater level of collaboration with their therapy partners:

  • Begin with changing the focus on your care meetings. Center conversations around specific clinical diagnostic categories and openly discuss the elements of care tied to each team member. 
  • Consider clinical pathways or road maps versus overly rigid protocols that allow for flexibility and phase level progression based on severity at baseline, prior level of function, and desired discharge location.
  • Build upon these conversations with discussion around MDS accuracy including “usual” for functional status coding, cognitive function, and impacts of complexity and nutritional status. 

How is your list looking?

The countdown is upon us. It’s time to review the items we need, cross off those that we have mastered and look forward to the adventures to come. 

Renee Kinder, MS, CCC-SLP, RAC-CT, is Vice President of Clinical Services for Encore Rehabilitation and 2019 APEX Award of Excellence winner in Writing–Regular Departments & Columns 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).