Harmony Healthcare Blog

Transition to Patient Driven Payment Model (PDPM): Nurse Leader Strategies

Posted by Pam Duchene on Fri, May 10, 2019


Edited by Kris Mastrangelo

C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory/Rehab • Education/Efficiency


Conceptual image of electric bulb with business sketchesWhen you think of October, you may think about cooler weather, brightly colored leaves, crisp apples and stocking up on candy for Halloween.  Unless of course, you are working in post-acute or sub-acute care, in which case, you are probably contemplating the massive change involved in conversion from RUGS to PDPM.  During a recent MDS Competency course, several nurse leaders from New England took time to share their strategies for preparing for the Patient Driven Payment Model.  Following are some of their thoughts.  

  1. Strategy 1:  Review and consider increasing care capacity and complexity.  In particular, consider adding administration of TPN and key IV push medications such as Furosemide (Lasix) and Solu-Medrol.  
    • Rationale:  Adding the capacity to administer such medications will positively impact the Non-Therapy Ancillary (NTA) Component points.  
    • Impact:  Total Parenteral Nutrition (7 points); IV medications (5 points) 
  2. Strategy 2:  Partner with local acute care hospitals for support of cardiovascular care.  Consider adding remote telemetry monitoring through the acute care hospital.  
    • Rationale:  Creating a strong partnership will reduce the need for transfer.  This takes care of the “what if” type of scenario.
    • Impact:  Reduction in Hospital Readmissions 
  3. Strategy 3:  Review the projected MDS assessment schedule for all residents for August, September and October.  Make adjustments in the schedule to plan for the intensity of the conversion period. 
    • Rationale:  All Medicare A resident inpatients will require an Interim Payment Assessment between October 1, 2019 and October 7, 2019.  Keeping that week as open as possible will create available time for completion of the additional assessments.  
    • Impact:  Stress reduction! 

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  4. Strategy 4:  Engage physicians in conversation today regarding the need to review diagnosis coding.  Discuss and demonstrate the impact of appropriate ICD-10 Coding with the physicians.  Solicit their partnership in this endeavor.  
    • Rationale:  The ICD-10 Coding must be physician endorsed, if not physician generated.  Working with them to gain buy-in may reduce frustration and provide appropriate reimbursement.
    • Impact:  Reduce the risk of “Return to Provider” coding. 
  5. Strategy 5:  Nursing is the cornerstone for care.  It is, after all, a nursing home.  Engage the nurses in refreshing skilled nursing documentation.  Provide education on the upcoming changes.  Frame the change in a positive manner to reinforce that this change recognizes key areas that increase nursing time. 
    • Rationale:  Getting the nurses on board with the change will provide a smooth transition.
    • Impact:  Partnering with the nurses will reduce resistance to change.  

There are just a few months left to prepare for the transition to PDPM.  Using the above strategies may facility a smooth transition since planning often helps to reduce stress and anticipate the unexpected.  Nurses are pretty good at doing just that.  Many thanks to the nursing leaders who made time to share their thoughts and strategies.  As one of the leaders noted, if this doesn’t work, it has definitely renewed her love of the cart!

Harmony Healthcare International (HHI) is available to assist with any questions or concerns that you may have.  You can contact us by clicking here.  Looking to train your staff?  Join us in person at one of our our upcoming Competency/Certification Courses.  Click here to see the dates and locations. 

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Tags: Patient-Driven Payment Model

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