Welcome to the HealthPRO Heritage Blog

The 2019 RAI Manual is here! The SNF world has been on the edge of their seat in anticipation of how the changes would impact the interdisciplinary team and coding of the MDS assessment.  CMS’ message is clear:  No longer is the manual only for MDS coordinators!  More emphasis on clinical characteristic coding for PDPM case mix group assignment means all disciplines must participate in completion of the MDS. The MDS item sets have been adapted for this shift in the Medicare classification system, requiring significant updates in the go to manual for RAI process.

The Patient-Driven Groupings Model (PDGM) is a game changer, requiring home health providers to explore new business models based on the introduction of new risks and potentially significant financial impacts.

HealthPRO Heritage at Home is leading the industry in readiness for the January 1, 2020 change to the Patient-Driven Groupings Model (PDGM). Success for both our partner agencies and employees will be driven through knowledge and implementation of process and strategy around PDGM.

SNFs have been bombarded with changes to many key performance indicators – such as Quality Measures, Five Star Ratings and the Quality Reporting Program – and will be expected to sustain and even grow quality improvements over time.  Read up on all the new changes here. (And have you heard the latest: CMS recently implemented a process whereby the QM thresholds will increase by 50% of the average rate of improvement in QM scores.)  

Based on these obvious smoke signals from CMS, the industry pundits foresee: Quality Measures just might be CMS’s way of monitoring for appropriate levels of skilled rehabilitation services after the October 1 transition to PDPM.   

In light of this prediction, consider your facility’s QM performance in highly monitored areas – such as skin integrity, falls, ADL performance, weight loss, functional mobility, pain, etc. 

Ask:  Are these areas recurrent concerns for your SNF?  

If so, HealthPRO Heritage advises:

We can all agree: the value of a solid, efficient Restorative Nursing Program for SNFs should not be underestimated!

There’s a lot of BUZZ in the industry about increasing restorative programming in preparation for PDPM. Many SNFs have Restorative Nursing programs. Many do not. Some have a program, but it doesn’t function the way it should.

Here’s the stone cold truth…
Restorative Nursing may (or may not) make sense for your organization. Hear us out. 

Coding will be instrumental to your agency’s success under PDGM. Performing an audit of your coding practices now will provide the opportunity to educate your staff on accurate and cohesive coding guidelines and targeted aspects of the OASIS to ensure you are prioritizing both patient needs and accurate reimbursement. 

Success under PDPM – and beyond! – in large part, boils down to this: A SNF’s ability to build positive, sustainable outcomes. As such, HealthPRO Heritage advises providers to focus on the strategies, processes, and initiatives that will support consistent delivery on exceptional clinical and performance outcomes.  

Accurate OASIS coding has always been important, but with PDGM on the horizon, our ability to master the OASIS will be imperative! After all, accurate OASIS coding will directly impact an agency’s ability to achieve optimal outcomes and support reimbursement in today’s and tomorrow’s world.

Today, CMS published the FY 2020 Skilled Nursing Facility Proposed Payment System (SNF PPS) in the federal register. It contains the SNF PPS payment update is 2.5% for FY 2020, which is an increase in payments of $887 million, compared to FY 2019.  This estimated increase is attributable to a 3.0 percent market basket increase factor with a 0.5 percentage point reduction for multi-factor productivity adjustment.

Implementation of the new case-mix classification model, the Patient Driven Grouping Model (PDGM), on January 1, 2020 will bring BIG changes to the home health profession! HealthPRO Heritage at Home is ready to help you start preparing TODAY for the most dramatic Medicare reimbursement change since PPS.