The old way of doing things just won’t fly under the new reimbursement system. Don’t forget staff as you dive in.
The Patient Driven Payment Model (PDPM) is here, and even well-prepared organizations are uncertain about precisely what the future will hold for this new system of reimbursement for nursing home care. To gain some insights on staffing in the world of PDPM, InFront talked to Melanie Tribe-Scott and Gloria Brent from MDS Consultants during last week’s 2019 LTC Summit in Asheville, NC. They stress the need to focus on training and education about data collection, assessments, documentation, and how to communicate with patients and other team members; and they remind everyone that they need innovative thinking to succeed in this new payment paradigm.
Before hiring new staff, particularly for Minimum Data Sets (MDS) assessments or ICD-10 coding, make sure your current staff has the training and education they need to effectively comply with all aspects of PDPM. It’s not enough to assume that people have the necessary knowledge. As Brent said, “If you don’t have expertise, you don’t know what you don’t know.” Make sure everyone gets hands-on training and that they have opportunities for additional education or retraining. They need to be comfortable seeking this training without fear of being judged or penalized.
Some additional thoughts from Brent and Tribe-Scott on this issue:
- PDPM won’t change budgeting for staff, but staff may need to move into new roles. For instance, fewer staff members may be needed in therapy and some may move into admissions, where more assistance is likely to be needed.
- Shorter lengths of stay (LOS) won’t mean less time spent collecting and documenting the MDS data. The only facilities that are likely to see any MDS relief are those with longer LOS. However, the key to PDPM is appropriate LOS based on the resident’s clinical condition.
- MDS staff will need more formal training regarding assessments. Self-training is not enough.
- Consider bringing in an outside consultant to conduct audits that can help identify gaps in knowledge or areas where more staff is needed.
- You need to have a triple check process on billing. This is more important under PDPM than ever before.
- Identify and watch for red flags that can suggest problems. For instance, look at the numbers of MDS assessments in progress and those not being completed in a timely manner. You also can look at CASPER (Certification and Survey Provider Enhanced Reporting system) reports for problems with MDS completions or submissions. These issues could suggest that staff is overwhelmed and needs additional support or training.
- Don’t expect PDPM to change everything. Issues you had with assessments, documentation, communication, and other problems prior to PDPM will still be there. At the same time, don’t expect the reports, forms, etc. that you used under the previous reimbursement system (RUG-IV) to work with PDPM. For instance, PDPM will require greater involvement of and communication with physicians and other practitioners. Ensure that nurses and other staff know how to contact and work with these individuals.
- It is important to model optimism. While adjusting to PDPM will be stressful and not without its glitches, it is important for team leaders to be positive and encouraging with staff. Tribe-Scott suggested, “Focus on the fact that we will finally be reimbursed for all of the nursing resources we expend on patient care. It makes sense to have a person-centered payment model to support the type of care we provide.”
Of course, you’re not in this alone. The Centers for Medicare & Medicaid Services (CMS) has numerous resources, as do organizations such as American Health Care Association, LeadingAge, the Society for Post-Acute and Long-Term Care Medicine (AMDA), and the American Association of Nurse Assessment Coordination.
