PDPM Part 6: High Fives, Whys, Collaboration and Communication

Earlier this month, Reliant hosted regional directors for its annual leadership conference in Plano, Tx. The first day, attendees were inspired by Roy Tuscany of the High Fives Foundation. He offered a patient’s perspective for clinicians and presented a call to shift from the “standard protocol” to the “patient protocol.”

Through his personal story and rehabilitation journey he detailed the importance of cultivating hope in our patients and a killer high five. He emphasized it’s not just the control, attitude, and effort of the patient that effects outcomes and recovery, but the clinician’s control, attitude, and effort that ignites success.

Day two opened with keynote Heath Slawner. Heath passionately detailed the importance of claiming and living out purpose. He led the audience through an exercise to evaluate personal reasoning for our daily choices, during which he stated “start with why.” What is your why? Recognizing and embracing the reason we set out to become a clinician, administrator, or other healthcare professional provides perspective. Knowing your company’s why allows for a common culture and approach to executing product delivery.

These speakers offered the perfect complement to the remainder of the conference which focused greatly on planning and preparing for PDPM. This is the sixth installment of the Reliant Reveal PDPM series. Previous articles have focused on the structural frame work of the model, details surrounding function score calculation, strategies for training, and coding success. Within each article, and the education we have created to date, a complementary theme is emerging: the importance of collaboration and communication.

Success under PDPM may be related to contract considerations, amassed resources, and field education; however, longitudinal success- the success that produces outcomes, will be directly impacted by each care professional’s ability to effectively collaborate and communicate for the patient’s care needs.

Facilities should begin moving from the standard protocol of care to an elevated, patient-driven protocol. This protocol will empower the evaluating therapist to collaborate with nursing to ensure comorbidities are accurately and timely identified. Therapists will bring to the table the clinical characteristics to be identified on the MDS, discharge planning notes, and knowledgeable discussions surrounding the clinical reason for admission.

The successful facility under PDPM will have a clearly defined “why” complemented by Reliant’s why: Care Matters. This is the heartbeat of our daily practice, service delivery, communication and collaborative approach to patient care.

Skilled Nursing Facility Open Door Forum Call

CMS held the first skilled nursing facility (SNF) open door forum (ODF) call for this year on February 14, 2019. The call included updates on CMS’ PDPM website, the SNF Quality Reporting Program (QRP), and Payroll-Based Journaling (PBJ).

SNF QRP Update:

  • CMS announced they are contracting with RTI international to develop and maintain additional SNF QRP quality measures.
  • RTI is convening a Technical Expert Panel (TEP) to inform the direction and development of a claims-based measure of healthcare-associated infections in SNF. For information on this project and nomination steps visit the SNF QRP website.

PBJ Update:

  • Fourth quarter (10/1/18-12/31/18) PBJ staffing data will be considered timely if it was submitted by 2/14/19 and will be posted on Nursing Home Compare.

CMS provided separate emails for questions concerning technical aspects and policy related issues.

Patient Driven Payment Model (PDPM) Updated Wepage

CMS provides a Patient Driven Payment Model (PDPM) web page which houses a variety of resources (comorbidity mapping tools), fact sheets, and a training presentation.

During the open door forum, CMS announced updates to the materials found on the PDPM webpage in response to stakeholder feedback including:

  • The training presentation has been replaced with the National Provider Call from December 2018,
  • The classification walk-through document has been updated, and
  • The FAQ document has been updated.

Skilled Nursing Facility Provider Review Reports

Skilled Nursing Facility (SNF) Provider Preview Reports have been updated and are now available. Providers have until March 4, 2019 to review their performance data prior to the April 2019 Nursing Home Compare site refresh, during which this data will be publicly displayed. Corrections to the underlying data will not be permitted during this time; however, providers can request CMS review of their data during the preview period if they believe the quality measure scores that are displayed within their Preview Reports are inaccurate. 

To view the full memo and data contained within the report click here.

Program for Evaluating Payment Patters Electronic Report (PEPPER)

Clinical Appeals Corner

PEPPER is an educational tool that summarizes provider-specific data statistics for Medicare services that may be at risk for improper payments. Providers can use the data to support internal auditing and monitoring activities. PEPPER provides resources for using the report, including user’s guides, recorded web-based training sessions and a sample PEPPER.

The PEPPER team has recently updated the maps that display the PEPPER retrieval rates by state. See how you compare and download yours today! Visit PEPPER site.

“Protect” Protected Health Information (PHI)

Phishing attacks are non-stop year-round, and attackers take advantage of holidays and other seasonal events, like tax time, to trick you into clicking links to provide User IDs and passwords. When a phishing attempt is successful, the “Bad Actor” obtains your email login information, and can use your email account to obtain data. Do you have resident information such as face sheets in your emails? If so, there is a wealth of PHI that criminals can use to commit fraud and identity theft. Stay vigilant with these tips.

Care Matters Spotlight: A Personal Dedication to Self Restoration

When the director of rehab of our partner facility in Shenandoah, IA shared the success of Mr. Lundgren, one phrase stood out in the telling of the story: “Mr. Lundgren’s personal dedication to self restoration.” That phrase articulates an emotional intelligence that is critical in the rehabilitation process: the patient’s buy-in.

Mr. Lundgren admitted to the facility last year following multiple falls at home resulting in significantly reduced physical function and a severe fear of falling. He and his therapists discussed his personal goals and developed a plan of care to restore his physical function while considering his desire to eventually walk without an assistive device.

Any individual who has been through a traumatic experience, illness, or unexpected outcome can easily conjure up the memory of succumbing to the fear of the condition. Many let the fear take over, causing a crippling effect on both the mind and the body. Mr. Lundgren was very nearly there; however, with the help of his dedicated therapists, nursing, administration, and ancillary staff he claimed a personal dedication to self restoration and persevered in his rehabilitative journey.

Following a combination of personalized and individual treatment sessions, participation in regular group activities, and training with restorative nursing he has been able to achieve complete independence with ADLs, live pain free, has not had a fall in over seven months, but most importantly….. is walking throughout the community without an assistive device.

Congratulations Mr. Lundgren, and thank you for the reminder that when we believe in ourselves we can overcome anything!

2019 Care Matters Award Winners

Our CEO Chris Bird presented the two 2019 Care Matters Awards to two very deserving therapists in the field. Meet them here in these tribute videos.

Diamond Morales has been with Reliant since May 2012 and works in the Cross Pointe Care Center in Dania, Florida. See her story here:

Tammy Alexander has been with Reliant since July 2011 and works in the Trail Lake Community in Fort Worth, Texas.

PDPM Part 5: Quantity to Quality: PDPM Assessment Schedule

Over the years, the burden associated with the current Medicare required assessment schedule has become “just part of the job.” Staffing of the MDS office is largely driven by Medicare part A census because all residents admitting to a facility for a skilled part A stay will receive a 5-day assessment and depending upon their length of stay may also have a 14-day, 30-day, 60-day, and 90-day assessment. Changes in therapy delivery trigger an additional set of required assessments.


CMS has boasted The Patient Driven Payment Model (PDPM) will reduce provider burden by implementing a significantly reduced required assessment schedule outlined as:5-day Scheduled PPS Assessment | Completed days 1-8 | Covers payment for ALL Part A daysPPS Discharge Assessment | Set as Medicare A stay end date. | Does not affect payment.


In addition to all OBRA requirements remaining the same, the Medicare required PPS assessment schedule consists of these two assessments. That’s it. CMS does acknowledge that changes in the resident’s clinical condition may affect resource use; therefore, they have created an optional Medicare assessment: Interim Payment Assessment (IPA) | Date facility chooses | Payment begins same day as ARD.(triggering event)


Read more about the importance of quality in our MDS assessments here.

Patient Driven Payment Model (PDPM) Frequently Asked Questions

CMS provides a Patient Driven Payment Model (PDPM) web page which houses a variety of resources (comorbidity mapping tools), fact sheets, and a training presentation. An additional resource is the 37 page PDPM Frequently Asked Questions document.
This document covers 14 PDPM topics and answers 92 questions as of 1/28/2019. On the December provider call, stakeholders requested revision dates be provided for reviewers to identify the most recent document update and CMS indicated this would be implemented.
As we progress toward PDPM’s implementation date, be sure to reference CMS’ website frequently to ensure up to date information and clarification.

Dream Big and Set Goals

Kathleen Savina admitted to our partner facility in Maryland in early January. She was evaluated by therapy following a hospitalization for pneumonia which greatly impacted her functional ability. The rehab team quickly learned Ms. Savina was an inspiration with a determined plan to return home soon.
Although Ms. Savina has required the use of oxygen, she hasn’t let this slow her down or limit her goals. Last year, she completed a 5K while carrying her oxygen in a back pack. In contrast, earlier this month, due to the recent illness, she was only walking 10 feet. Some individuals may have struggled with this significant change, but her therapists say she is such a motivated individual both in and out of the rehab gym.
As she progressed in her therapy, her spirits remained high and her plans to return home became a reality. Her unwavering determination is a testament to goal setting and discipline.
Congratulations Ms. Savina! We are proud to be a part of your journey!

THE CLIENT CONNECTION: A COLLABORATIVE APPROACH TO QUALITY OUTCOMES

Every month on the third Thursday, Reliant’s Clinical Services offers a webinar to our partners on relevant topics within our industry.
January’s training An Overview of PDPM provided participants with the big picture of PDPM. In the coming months, we will be offering “deep dives” into various components of PDPM.
Join us in February to brush up on the long term care survey process and requirements of participation:Survey Preparedness: Ready, Set, Go! 

Targeted Prove and Educate Trends

As we move into 2019, our focus is honed on the new payment model going into effect in October, PDPM. However, CMS continues to review current trends and initiate audits without a break in sight. With the continuation of Targeted Probe and Education (TPE) audits on the rise, strong supporting documentation, accurate billing practices and managing patient stays appropriately must be the focus of our treatment each and every day.
Read article here .

CMS Chief Indicates New Set of Quality Measures in the Future

This week, Baltimore hosted CMS’ Quality Conference. McKnight’s Long Term Care News featured a recap of CMS administrator, Seema Verma’s “fiery speech” in which she indicated the Patient Driven Payment Model is the first step to move SNFs toward an “outcomes-based system.” She acknowledged continued focus on meaningful measures and offered insight into the future for CMS’s new app eMedicare and quality measure ratings.
Read full McKnight’s article .

Draft of the 2019 MDS Item Sets Posted

A new DRAFT version of the 2019 MDS item sets (v1.17.0) , which is scheduled to take effect on October 1, 2019, was posted earlier this month to the MDS technical information webpage .
The files are located in the Downloads section at the bottom of the webpage (see MDS 3.0 Item Sets v1.17.0 (DRAFT) for October 1, 2019 Release [ZIP, 3MB] ). 
This early draft is promising of more information to come. Reliant is monitoring CMS’ updates and postings for more information regarding October 2019 MDS and RAI changes.

New Medicare Card Mailing Complete

CMS has finished mailing the new Medicare cards to beneficiaries across the United States.
CMS states Medicare fee-for-service health care providers submitted 58% of claims with new Medicare Beneficiary Identifiers (MBIs) indicating some success with integration. They encourage providers to utilize the new MBIs for all Medicare transactions even though the former Social Security Number-based health insurance claim numbers are permissible during the transition period.
Old cards may be used through December 2019. If a Medicare beneficiary states they have not yet received a new card, instructions are providedhere .