Welcome to the HealthPRO® Heritage Blog

G vs GG: Yes, One Letter Makes All the Difference!

Posted on: January 2, 2019

MDS coding experts must remain vigilant! Beware coding pitfalls when it comes to Section G versus Section GG.

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Tags: Section GG

Final Rule Released: Game On

Posted on: August 1, 2018

Final Rule Indicates PDPM Transition is “A Go!”
No Significant Changes

According to CMS’ Final Rule released July 31, PDPM (Patient-Driven Payment Model) will replace the current RUG-IV system – as originally proposed – on October 1, 2019.

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Tags: Patient-Driven Payment Model, PDPM, Section GG, Payment Reform, CMS Update 2018

Are You Ready for the Upcoming October MDS Changes?

Posted on: May 30, 2018

CMS recently announced the proposed Patient-Driven Payment Model (PDPM) and it was a flurry of, “what happened to the RCS-1 proposal?” Add this to ongoing MDS RAI Manual updates and CMS appears to be in lockstep with refining the way it collects and analyzes clinical data through the completion of the MDS assessment, and how this will implicate provider reimbursement.

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Tags: PDPM, Patient-Driven Payment Model, Section GG, MDS Changes, CMS Update 2018

April Advisor Newsletter

Posted on: April 6, 2018

Define Your Value Proposition

If you are a Life Plan or Senior Living Community, the time is now for you to understand your value proposition.

Life Plan and Senior Living Communities are in a unique position to be THE strategic solution to a growing marketplace need. Hospitals are seeking partners to lower overall cost, and Seniors don’t always want to go to Skilled Nursing Care. Your community can be the cornerstone of a win-win-win strategy to support patients and a network of care providers in your area.

First, ask whether your Life Plan/Senior Living Community is prepared to leverage these newly identified opportunities.

Readiness Checklist Requirements:

  1. Are you a medical model in AL/IL/PCH?
  2. Can the nursing care at your community adequately support residents with higher acuity needs? Can you take those higher acuity needs?
  3. Have you established a network of preferred home health partners to strategically optimize clinical/financial outcomes?
  4. Do you have a rehab provider that offers strategic operational/marketing support along with the full continuum of therapy services (including outpatient services and collaborations with home health)?

If the answer is “YES” to these four (4) “Readiness Checklist Requirements” then your community is an opportune position.

For those Life Plan Communities and Senior Living Communities that answer “NO” to these important questions, HealthPRO® Heritage offers the following preliminary ideas to spark your imagination.

Enhance your value proposition for the hospital partners in your network
Establish a direct admit program in a skilled nursing facility (SNF). In this scenario, your community is a next step for Seniors who experience a non-emergent issues at home. Example: Seniors who fail to take medications, experience a fall, etc. Rather than visiting the ER, your community can offer this alternative solution if you work closely with local MDs/ERs/managed care organizations to get this program off the ground. 

Leverage personal care (PC) or assisted living (AL) capabilities by offering a short-stay program
Provide well-coordinated care between your nursing staff, home health and potential outpatient services in scenarios where there isn’t a qualifying 3-night stay, such as a patient undergoing hip replacement who lives home alone.

This innovative program offers a less expensive option for those private pay patients who prefer your community to a SNF stay. Consider the trend of a growing market for short-stay programs that offer a private room, around-the-clock nursing and on-site outpatient therapy until ready to return home independently. Your community should be taking advantage of this census-stabilizing opportunity! 

Care ReDesign initiatives to ensure an operational/strategic foundation is in place

  1. Process for consistent communication with your hospital partners and managed care organizations
  2. Review your clinical capabilities, and define admission criteria
  3. A well-defined communication pathway for your team re: new admissions
  4. Rigor around nursing assessment at time of admission
  5. Readmission mitigation strategies (e.g.: risk assessment and clinical rounding)
  6. Clarity re: expectations for home health and outpatient care
  7. Advanced discharge planning process
  8. Enlist the support of a forward-thinking rehab provider to serve as “the glue” in building cross-continuum services

The safe, efficient transition for seniors between levels of care is akin to a new frontier in quality care delivery, and Life Plan Communities and Senior Living Communities are well-positioned to be in the driver’s seat to offer optimal solutions. The steps outlined above provide a glimpse at a well-thought out approach to building and sustaining your value proposition with far-reaching implications. Fortify your census, grow your network and position your community for success!

Contact HealthPRO® Heritage to optimize the value propositions of your Life Plan or Senior Living Community! 



Survey Tip of the Month

Surveyors will look for triggers on and off-site;  observations may focus on altered diet, wounds and weight loss. Observations will include:

  • Are residents getting the supervision that they need during meals (especially residents who eat in their rooms and trigger for one of the areas listed above)?
  • Is feeding equipment present and utilized properly?
  • If feeding assistants are part of the facility culture, what are the policies and are they being adhered to?
  • What is the policy for food storage (especially food that is brought in by families)? Are families educated regarding the policy?
  • Positioning during meal times will be a focus during observations on all units.

Three Easy Steps in Response to More MDS Changes

EDUCATE
Make Sure Your MDS Team is Up-To-Date. On October 1, 2018 new version of the Data Specifications for the MDS RAI Manual Version 1.16.0 goes into effect. Three types of updates are outlined in the most recent draft version (released January 2018): 

  • technical corrections/revisions addressing grammar or punctuation,
  • items modified for clarification, and
  • new/modified items addressing the SNF Quality Reporting Program.

Also note that several changes specific to Section GG admission and discharge reporting intervals are included.

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Tags: CMS Update 2018, MDS Changes, Section GG, Life Plan Community, Senior Living Community