The Patient Driven Payment Model is coming, and your staff has lots of questions and concerns. But instead of panicking, you can put them in control and increase their confidence to tackle this change.
Specifically, you can make sure that your information technology platforms have the capabilities to support their efforts to comply with PDPM while helping to avoid errors or missing pieces. Increasing their confidence in the technology they’re using will help boost their job satisfaction — even in the face of big change — and prevent turnover (which can be especially devastating when you are adapting to a new payment system).
Don’t wait until PDPM goes into effect to looks for gaps or other issues with your technology. According to one source, the software reviews site G2 Crowd, 24% of workers across industries have actually thought about leaving their jobs over “bad” technology. A recent survey by Deloitte showed that bad technology equals poor employee experience for one in five workers.
At the same time, a 2018 Black Book survey showed that nearly half of nurses surveyed said their EHR had disruptive flaws and glitches. While this last number is down from 85% in 2016, it still suggests that patient-care technology needs to be a priority for health care organizations.
By understanding what PDPM will require of your EHRs and other technology and how this impacts your clinical teams and staff, you can help ensure the accuracy, confidence, efficiency, and multi-directional communication to thrive under this new payment system.
Federal regulations require that nursing facilities include copies of practitioner notes (encounters) in the official medical record. The majority of PALTC medical practices already use their own EHRs. Encounter notes from any modern physician EHR always include a problem list (diagnoses). Your practitioners already use ICD-10 codes on every encounter (i.e., visit) they have with your residents. A physician, NP, or PA can’t receive any third-party insurance payment without submitting a claim that includes one or more ICD-10 codes.
However, very few PALTC medical groups are selecting ICD-10s with PDPM in mind. The medical staff serving nursing facilities are paid by Medicare Part B – not Part A. For Part B payments, the encounter is ‘coded’ around the primary medical issues the practitioner treated. The encounter note(s) may include ICD-10 codes that are important for PDPM rate determination, but that is fortuitous, not planned. It’s essential to help practitioners “think PDPM” and code accordingly.
There are five months remaining until PDPM is a reality. Use them wisely. It’s time for SNF leaders to sit down with the medical groups covering their facilities and start forging a collaboration. But don’t forget your own interdisciplinary teams as well. Technology is an indispensable tool in helping coordinate patient care across organizations; and the right technology goes a long way toward maximizing staff satisfaction and confidence, as well as contributing to quality outcomes. And all of this ultimately will have a positive impact on the bottom line and census over time.
Moving into PDPM, your system will need:
- The ability for team leaders to stay on top of data, including analyzing recent admissions to determine PDPM’s impact, tracking/understanding staffing levels, knowing lengths of stay, tracking 5-star quality measures, and knowing ED admissions and 30-day readmission numbers.
- The ability to identify your facility’s strengths and weaknesses so that you can change or revise processes as necessary.
- Easily identify, manage, and track diagnoses in a way that promotes effective documentation, thus driving PDPM payments.
- Dashboards and other tools to give your team access to easily available, accurate, and real-time snapshots of what is happening facility-wide and with each individual patient at any given time.
- EHR technology this is designed specifically for LTPAC, including the move to PDPM and what implications this will have for the documentation, use, and sharing of data.
- An interoperable platform that links practitioners with facilities and others in a shared care model.
- An analytics tool.
- An ability to estimate, assess, and track frailty and frailty risk.
The status quo is not enough, but it is a starting point.
You can no longer count on the MDS to give you the information you need. This form may be standardized, but the assessment itself is not a standardized assessment tool. In its native form, the MDS doesn’t forecast anything about the resident’s needs, but it is the only standard available across all SNFs and other facilities.
You need technology that can take the information available in the MDS and expand on it to ensure accurate diagnoses and identify appropriate resource needs. You also need the ability to communicate appropriate information throughout the care continuum without time delays, gaps in information, or interoperability issues.
With the right EHRs and other technology, along with a culture that encourages change management and recognizes the value of learning new processes, you can have a team that embraces PDPM, instead of dreading it. As a result, you’ll have a strong, consistent workforce that will enable you to thrive under this new payment model.
Rod Baird is the president of Geriatric Practice Management.
