Well my friends, it is time to seriously review your Patient-Driven Payment Model (PDPM) transition strategy.  October 1st  is just around the corner.  Over the past nine months, at Functional Pathways, we have had a robust educational campaign to prepare and position our staff and clients to be ready to thrive under the PDPM system. From on-site intensive management training, component calculations, Clinical Pathways, and client webinars, we have been working diligently to prepare for this major transition in the Medicare Part A payment model.

Some final transition thoughts for your consideration:

  1. Have you fine-tuned your Pre-Admission and Post-Admission Meetings?
  2. Are you receiving all necessary clinical documentation from the hospital?
  3. Is your nursing and therapy documentation reflective of skilled care to paint a picture of the resident’s condition to support the PDPM clinical categories?
  4. How effective is your IDT in identifying the Primary Reason for the SNF admission?
  5. What opportunities exist for capturing the entire clinical characteristics of the resident?
  6. How effective is your Medicare Meeting?
  7. How efficient and effective is your Triple Check process?
  8. Do you have an effective Restorative Nursing Program?
  9. Does your Therapy Department have Clinical Pathways to focus on functional rehabilitation?
  10. Are you ready to complete Interim Payment Assessment when transitioning residents who span from RUG-IV to PDPM?
  11. What is your plan for effectively tracking Interrupted Stays?

These are just some things to be thinking about.  But most importantly, we have to be ready to ensure the transition from RUG-IV to PDPM is seamless and portrays the entire clinical picture of each Medicare Part A resident.

What should you be working on the week before October 1st?

  1. Develop a list of Medicare Part A residents who will be transitioning from RUG-IV to PDPM (skilled in September and will continue to be skilled October 1st and beyond).
  2. The residents on this list must have an IPA ARD set no later than October 7th, 2019.
  3. Provide the resident list to the IDT to ensure they are aware of the requirements for the “transition” IPA in order to complete their sections of the MDS IPA item sets.
  4. Utilize a transition checklist to ensure you are capturing all clinical characteristics on the IPA that are documented in the resident’s medical record. If you are a Functional Pathways’ client partner, our checklist is available on our client portal.
  5. Finalize your Pre- and Post-Admission Meeting process.
  6. Finalize the IDT process for determining the primary reason for the SNF admission; ensure all IDT Department heads are aware of the process; finalize how you will be communicating with the IDT on what the primary reason for the SNF admission ICD-10-CM code is.
  7. Finalize new RUG-IV Medicare Part A resident’s 5-day MDS.
  8. Discuss with your Director of Rehab (DOR) their plan for managing the group and concurrent minutes.

What should you do on October 1st?

  1. Finalize/confirm the list of residents who are transitioning from RUG-IV to PDPM with the IDT.
  2. Utilizing your transition list of residents, open your “transitional” IPA assessment and set the ARD. *Remember: must be set no later than October 7th (can set the ARD 10/1/19-10/7/19).
  3. Ensure all item sets for the IPA are completed as usual.
  4. Confirm the BIMS score.
  5. Confirm the PHQ-9 score.
  6. Confirm the accuracy of capturing SLP related co-morbidities.
  7. Confirm accuracy of nursing criteria for the nursing component.

Most importantly, try not to panic! Panicking will produce a feeling of being overwhelmed and mistakes will happen. You got this and we, your therapy partner, are here to help and support you!

Functional Pathways Resources available:

  • Your Functional Pathways Director of Rehab;
  • Your Functional Pathways Area Director of Operations;
  • Your Functional Pathways Regional Vice President of Operations;
  • Derhonda Thomas, Functional Pathways’ Vice President of Operations: dthomas@fprehab.com;
  • Melissa Ward, Functional Pathways’ Vice President of Clinical and Regulatory Affairs: mward@fprehab.com;
  • Karen Welsh, Functional Pathways’ Director of Clinical Outcomes: kwelsh@fprehab.com;
  • Gina Tomcsik, Functional Pathways’ Director of Compliance and Regulatory Strategy: gtomcsik@fprehab.com;
  • Beth Reigart and Jennifer Callahan, Functional Pathways’ Clinical Outcomes Specialists: breigart@fprehab.com; jcallahan@fprehab.com
  • Functional Pathways’ PDPM Academy (Client Portal): com/pdpm-academy
  • PDPM@fprehab.com inbox

Let’s get excited about PDPM!  It’s been a long 20 years! But now, we are no longer at the mercy of RUG levels!

Gina Tomcsik
Director of Compliance and Regulatory Strategy