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Prepping for PDPM: Strategies for ASAP
Prepping for PDPM: Strategies for ASAP
SpeakersBecky Finni, DHS, OTR/L, RAC-CTSenior SRS Appeals Specialist, RehabCarePresident, Ohio Occupational Therapy [email protected] | [email protected]
Sabrena McCarley M.B.A.-SL, OTR/L, CLIPP, RAC-CT, QCPDirector of Quality, RehabCare [email protected]
Jeremy Furniss, OTD, OTR/L, BCGDirector of Quality, [email protected] | www.aota.org/value
History & Overview of PDPM
OT & PT & PDPM
PDPM vs. RUGS-III
AOTA Resources
How did we get here?
• Countless CMS audits and reviews found that under the current RUG-IV model:– Skilled Nursing Facility (SNF) per diem payments are based almost
exclusively on the amount of therapy received by the resident, regardless of his or her “unique characteristics, needs, or goals.”
– SNF residents with significant variation in nursing needs, costs, or care often receive the same reimbursement for nursing services.
• Final Rule July 30, 2018: – CMS finalized a new case-mix classification model, the Patient Driven
Payment Model (PDPM), that, effective beginning October 1, 2019, will be used under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) for classifying SNF patients in a covered Part A stay.
In short…
This is a BIG change in payment perspective…Fee-for-service (volume, e.g. minutes of therapy) Value-Based (quality, performance)
PDPM in a Nutshell
Calculating Per Diem
PT/OT Components: What to Know
Comprehensive Evaluations & Plans of Care
• ICD-10 selection on OT Evaluation– Primary diagnosis/reason for SNF stay
– Medical diagnosis
– Treatment diagnosis
• Standardized Tests
• Occupational Profile
PT/OT Components: What to Know
Section GG of the MDS
• Outcomes functional reporting for CMS
• Used in SNF, HH, IRF, LTACH (replacing FIM in IRF as of 10/1/2019)
• Scores prior to admission, admission, and discharge
• “Usual performance”
PT/OT Components: What to Know
Functional Treatment Strategies and Interventions• Continued options for modes of delivery:
individual, group, concurrent, co-treatment• Occupation-based will help show our distinct value• Quality of documentation is still a critical piece—
our documentation must clearly articulate what separates occupational therapy interventions from other services being provided
PT/OT Components: What to Know
“I heard cognition can only be provided by SLPs now?”
• BIMS score is used to calculate the SLP case-mix
• This does not mean cognition cannot be addressed as part of the occupational therapy plan of care
• Functional cognition continues to be a focus for OT with SNF patients under PDPM as it is now
Summary: What hasn’t changed…
• Older adult population in the SNF/LTC setting will continue to need high quality therapy services that are evidence-informed and occupation-based.
• CMS requirements for medically necessary skilled services are not changing! Therapy services must be reasonable, medically necessary, and clinically appropriate to meet the resident’s unique and specific needs.
• Occupational therapy’s scope of practice has not changed. OT practitioners can still evaluate and treat for functional cognition, feeding, eating, and swallowing under PDPM.
Summary: What has changed…• No more specific minute utilization requirements
– No longer in constant assessment reference period (No more COTs!)– Minutes will be tracked during the entire stay, but no longer dictate the per diem
rate
• Group and concurrent therapy combined can be up to 25% of treatment over course of the stay
• IDT communication/collaboration/documentation will be critical for success: – ICD-10 coding of reason for skilled stay– Admission/5 day MDS assessment is only required MDS for payment– Section GG to establish PLOF, status on admission, and discharge status for
outcomes reporting
At the end of the day…
• Resources are available for you and your members
• CMS will be monitoring for drastic changes in utilization
• Continued support through both our organizations will help make a smooth transition
VALUE RESOURCES FOR STATE ASSOCIATIONS
CMS Resources
• Patient Driven Payment Model at CMS.gov
• Concurrent and Group Therapy Limit
• PDPM Functional and Cognitive Scoring
• PDPM Presentation
• PDPM FAQs
Resources from AOTA
All resources are linked on www.aota.org/value• AOTA Occupational Profile Template• Section GG Template & Link to CMS Training• SNF, HH, & Medicare OP Evaluation Checklists• PDPM Webinars & CMS Q&A Recordings• Evidence Based Practice Resources• Choosing Wisely• Quality Toolkit
www.aota.org/value
www.aota.org/value
AOTA Occupational Profile Template
• Free for members and nonmembers atwww.aota.org/value
• Part of the OT Evaluation
• Why is it important?
– Care and services that are based on the client’s perspectives and goals contributes to the patient experience
– Sets the stage to identify occupations that have meaning for clients
www.aota.org/value
AOTA Occupational Profile Template is FREE for anyone to
download
• www.aota.org/value
• Skilled Nursing & Med B Outpatient
• Occupational Profile
• Core Areas to AddressAnalysis of OccupationalPerformance
Evaluation Checklists
www.aota.org/value
All Evaluation Checklists are FREE
for anyone to download
Webinars & Education available atwww.aota.org/value
• Payment Shift from Volume to Value**
• CE Article: OTPF: A Foundation for Documentation
Volume to Value
• Policy & Quality Requirements of PDPM in SNFs
• PDPM as an Opportunity to Improve the Value of OT
• How OT Practitioners Can Prepare for the new SNF Payment Model**
• PDPM: Occupational Therapy Professionals' Opportunity to Improve Quality of Care
• Skilled Nursing Facilities 101: Documentation, Reimbursement, and Ethics in Practice, 2nd Edition
• CMS Answers Questions & Staff Busts Myths of PDPM & Home Health’s PDGM
SNF PDPM
• Overview of The Quality Payment Program: Are you Ready to Succeed in 2019?
• Medicare Quality Payment Program Part 1: Demonstrate High Quality OT through MIPS
• Medicare Quality Payment Program Part 2: Using MIPS in Practice to Distinguish the Value of OT
Other Programs
Most webinars are FREE for AOTA Members and
available for purchase for non-members
** only available to AOTA members
One Day Conferences
On-Demand: Purchase the entire conference or
individual sessions at store.aota.org
November 19: Silver Spring, MD & Live Streamhttps://www.aota.org/Conference-Events/PDGM
www.aota.org/value
Quality Toolkit is only available to AOTA Members
The Quality Toolkit lists standardized tools that are used by members across the country to address core areas.
Shirley Ryan Ability Lab
A link is provided at the top of the Quality Toolkit on www.aota.org/value
www.aota.org/value
Section GG Template is
FREE for anyone to download
www.aota.org/value
www.aota.org/value
Sharing with your members
• Investment in clinical tools & education
• Please share widely!
• Provide links to the resources on aota.org rather than sending as attachments
• Number of downloads and clicks is the only way to gauge interest which informs development of future resources
ONLY IF NEEDED FOR QUESTIONS
Checklist: Occupational Profile Reason for OT Services
Successful Occupations
Interests & Values
Occupational History
Performance Patterns
Habits Routines Roles Rituals
Environment Supports & Barriers (Physical, Social)
Context Supports & Barriers (Cultural, Personal, Temporal, Virtual)
Client’s Priorities & Desired Outcomes
We recommend starting with the AOTA Occupational Profile
Template (www.aota.org/profile). The checklist includes the categories as reminders.
ADLs Addressed Priority
IADLs Addressed Priority
Functional Cognition Addressed Priority
Vision Addressed Priority
Psychosocial/Behavioral Skills Addressed Priority
Fear of Falling Addressed Priority
Habits, Routines, Roles Addressed Priority
Safety Screen Addressed Priority
Checklist:Analysis of Occupational Performance
Aim for 100%
Unique for ea. Client
