BEYOND PDPM: NURSING IN A QUALITY-DRIVEN WORLD - TECHNOLOGY AND THE NEW FACE OF NURSING - MCKNIGHT'S LONG-TERM CARE NEWS
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SPECIAL MARKETING SECTION
Beyond PDPM:
Nursing in a
Quality-Driven World
Technology and the New Face of Nursing
A SUPPLEMENT TO
Page 3
The Art of Nursing Returns
Page 4
IN PARTNERSHIP WITH
PDPM and Beyond: Are You Ready?
Page 6
IS PROUD TO SPONSOR THE
CONGRATULATIONS TO
THE 2019 WINNERS!
Lifetime Achievement Award
Lynne Katzmann
Hall of Honor
Lori Alford Kim Estes Elliott Alla Onitskansky
Avanti Senior Living, Conroe, TX Brookdale Senior Living, Nashville, TN Genesis Rehab, Lyndhurst, OH
Brenda Bacon Kimberly D. Green Tammy Jo Painter
Brandywine Senior Living, Mt. Laurel, NJ Diakonos Group, Edmund, OK American Medical Facilities Management,
Winsome Bent Stephanie Harris Charleston, WV
The Bristal Assisted Living, North Hills, NY Arrow Senior Living, St. Charles, MO Jolene Roberts
Crystal Bowens Andrea Leebron-Clay Hillcrest Health Services, Bellevue, NE
CB Strategies and Solutions, Demorest, GA Nightingale Healthcare, Seattle Kathryn Roberts
Pilar Carvajal Mary Leary Ecumen, Minneapolis
Innovation Senior Management, Miami Katie Smith Sloan
Mather LifeWays, Evanston, IL
Leslie Cunningham Campbell Barb Masella LeadingAge, Washington, DC
Diversicare, Brentwood, TN Lizzy Straus
HCF Management, Lima, OH
Jamie Dlatt CareOne, Fort Lee, NJ
Legacy Healthcare, Chicago
Rising Stars
Sarah Belmont Felichia Fields Tabassum Majid
Brookdale Senior Living, Nashville, TN St. Catherine’s Village, Madison, MS Integrace Institute, Eldersburg, MD
Vanessa Brookes Scarlet Star Gardner Jennifer Maina
Friendly Senior Living, Rochester, NY Willow Ridge Rehabilitation, Rutherfordton, NC Larksfield Place, Wichita, KS
Jennifer Cisneros Jessica Garvin Rachel Monger
The Williamsport Home, Williamsport, PA Gregston’s Nursing & Rehab and West Wind LeadingAge Kansas, Topeka, KS
Kristy Ruppe Craddock Assisted Living, Marlow, OK Rebecca Scott Rawn
Commonwealth Senior Living, Charlottesville, Bre Grubbs Extendicare, Markham, Ontario
VA Leisure Care, Seattle Berenice Galvez Soto
Kari Dick Katie Jayne HealthPro Heritage, Broadview, IL
Touchmark, Fargo, ND Bishop Gadsden, Charleston, SC Christine Ulbricht
Erin Donaldson Natalie Law University of Massachusetts Medical School,
Life Care Services, St. Charles, IL Life Care Centers of America, Life Care Center Worcester, MA
Debora Erksa of Stonegate, Parker, CO Shamim Wu
Ohio Living Breckenridge Village, Meg (Margaret) Lutze Eclipse Senior Living, Lake Oswego, OR
Willoughby, OH Good Shepherd Community Care, Newton, MA
JOIN US AT THE AWARDS CEREMONY MAY 16 IN CHICAGO!
Visit https://womenofdistinction.splashthat.com/ for more information
SPECIAL MARKETING SECTION
BEYOND PDPM 3
professional challenge.
“You will need nurses who
are on top of their game,” War-
wick says. “If you want to test
your skills, this is a place where
you can do that.”
A more ethnically varied can-
didate pool also could help pro-
viders better relate to diverse
resident populations.
The 2017 National Nursing
Workforce Study found about
30% of Hispanic/Latino and
nearly 25% of Asian nurses are
under age 35. Given the right
tools, they could bring longevity
to this high-turnover field.
Technology can be a critical
tool in helping front-line staff
Tech and the New
handle the push toward quality
transformation and its impact
on daily tasks such as docu-
mentation.
Face of Nursing
Paul Wray, RN, has been
working with PointClickCare
to make sure Touchstone Com-
munities’ products include
clear algorithms to expedite
S
killed nursing’s regulatory and clinical chang- PointClickCare. “People often smart decision making.
relate to elderly patients but Mentoring, shadowing and
es aren’t happening in a vacuum. Even as the may not know until they are in training both from in-house
that setting for the first time.” staff and trusted vendors can
industry approaches implementation of the Patient- PDPM’s emphasis on car- give nurses more confidence.
Driven Payment Model and adopts technology to ing for medically complex “Clinically, I see quality trans-
residents jibes the industry formation as a positive change
keep up with new demands, the very face of nursing trend toward treating patients for nursing,” Wray says. “There’s
with some acute needs in the going to be an increased focus
is changing. skilled nursing setting. This on making sure all nurses have
Today’s nurses are more attract and retain highly skilled presents a grand opportunity the right tools to get it right the
e t h n i c a l l y d i ve r s e , m o r e nurses with the right competen- to recruit nurses looking for a first time.” ■
highly educated, and ready to cies and bedside manner.
embrace software and services “Long-term care does a really
PROVIDE SUPPORT: A 2018 all-nurses salary
that keep their patients healthy bad job of marketing itself to
survey showed nearly 3% of LTC nurses said
in any setting. workers and potential work- they were leaving due to job dissatisfaction.
The question for many long- ers,” says Jayne Warwick, RN, Just over 1% said pay was the reason.
term care providers is how to HBScN, a marketing director at
SPECIAL MARKETING SECTION
4 BEYOND PDPM 3
The Art
of Nursing
Returns
A
s far as conversation starters go, the Patient- all the right-brain soft skills,” Kellie Youngman, RN, RAC-CT,
Jackson says. “For too many director of clinical reimburse-
Driven Payment Model is full of possibilities. years, nurses haven’t lasted all ment for Elderwood, which
But if the rollout goes according to plan this October, that long on the floor. The poli- operates skilled nursing facili-
cies, the repetitive procedures, ties in several Northeast states
what might really get nurses buzzing is the prospect of they weigh down on you. We and provides a range of servic-
have conditioned our nurses es for seniors.
more meaningful communication and higher-quality
to think more about the reim- “The PDPM model really
relationships with the residents in their care. bursement than the care.” focuses providers on, and really
highlights the need for, qual-
Call it a return to the art of our best nurses.” WELCOME OVERHAUL ity care and outcomes for our
nursing. Technology that helps nurs- PDPM is the latest step in a oftentimes medically complex
“It’s a great opportunity to ing staff move quickly but larger push toward quality residents. Because it digs so
focus on resident-centered thoroughly through assess- transformation that puts the deeply into a resident’s clinical
care, that cyclical process we ments and charting also will focus back on the resident and makeup, nurses as PPS coor-
learned back in nursing school,” free nurses to do more of what his or her specific needs, rather dinators are going to be very
says Melissa Jackson, RN, they enjoy: spending time at a than the modalities of care and busy, but in a different way.”
CEAL, director of customer resident’s bedside. reimbursement mechanisms. Youngman was part of an
engagement marketing for “When I think about the craft “It is a complete overhaul advisory panel that helped
PointClickCare. “Technology of nursing, I think about the call- from what we have used over PointClickCare identify major
will provide the insights that will ing: the intuitive response we the last 20 years, but from my areas of concern where leaders
allow all nurses to perform like have to others, the compassion, perspective, I welcome it,” says thought technology changes
SPECIAL MARKETING SECTION
BEYOND PDPM 5
might help improve perfor- serving residents with more
mance. The three main targets? acute needs, such as IV lines
Clinical category mapping for or respiratory services.
ICD -10 codes, Section GG “It can be tough to stay on
coding and Interim Payment top of best practices,” says
Assessment triggers. Jayne Warwick, RN, HBScN,
Youngman says her com- director of market insights for
pany has already incorporated PointClickCare. “Our technol-
several technology changes ogy has bridged a gap we prob-
that should assist nursing ably didn’t understand we had
staff as they transition over to 10 to 15 years ago.”
the new care-delivery model. Even the best technology
Among the new PDPM features can’t remove the need for
are screens listing each resi- critical thinking, but it can
dent’s projected PDPM case- allow caregivers to make more
mix score, along with their RUG Efficient use of technology will give nurses more time for critical think- informed decisions. And with
score and upgrades for Section ing and personal interaction with patients, which will improve care. less time spent on MDS forms,
I to cover primary diagnosis nurses will have more time to
selection. working closely with their The more you can do that, the talk with residents, their fami-
“If, then” logic also will be EHR and analytics vendors to more you standardize and the lies and their previous provid-
a part of the solution, helping identify staff competencies, less burnout there is. The sci- ers to get a complete picture
staff become aware of poten- training needs and specific ence can support the art.” of their needs.
tial trouble spots. For instance, strategies that will influence That, after all, is a driving
after entering information care and shape good financial BUILDS CONFIDENCE force behind the change to
about a resident recovering practices, she says. The best software also will be PDPM.
from stroke, the system might But increasingly, nurses embedded with the most-up- Nurses may be best able to
notice that a diagnosis of dys- should be able to focus on the to-date research for nursing identify when residents need
phagia has not been coded and patient’s needs before they staff and other decision-mak- psychosocial support, whether
prompt the user to reconsider, have to think about the rigors ers, highlighting relevant clini- they would benefit from more
Youngman says. of reimbursement. Tools like cal information that can be activities or simply what kinds
“Because PDPM is such a templates, summary notes, challenging for a working nurse of music or food might make
paradigm shift, there’s a lot flags and alerts will be criti- to keep up with. their stay more enjoyable.
for nurses to think about,” she cal as facilities juggle finan- For instance, the electronic Those observations also will
adds. “We’re really getting our cial viability under PDPM and medication administration require nursing staff — from
staff ready to answer the new compliance with Phase 3 of the record can list contraindica- CNAs to DONs — to talk about
MDS questions and think about Requirements of Participation. tions and show photos of pills what they’re seeing at opportu-
documenting in the resident “Accountability still counts,” to ensure patients are receiving nities like morning stand-ups
record so our workflow isn’t Jackson says. “With everything, the right prescription. and embrace input from a mul-
suddenly affected in October.” you have to remember, we’re Consultants say those types tidisciplinary team.
Providers also should be always trying to make it easier. of built-in protections, com- “It’s being quality-based,
bined with proper training, will thinking big picture and being
give nurses increased confi- empathetic to those residents,”
BRIDGE THE GAP: Better technology can
free up nursing time to enable more personal dence in their abilities. That’s Jackson says. “It’s not just
observations. This familiarity leads to better all the more important in facili- about the disease they have
caregiving practices. ties courting hospitals for their or the modalities of treatment
medically complex patients or anymore.” ■
SPECIAL MARKETING SECTION
6 BEYOND PDPM 3
PDPM and
Beyond:
Are you ready?
I
t might feel as though the entire skilled nursing to read the writing on the wall, Joint Commission. Since 2014,
even if the original start date the community has ramped up
world is perched on a fault line as it hurtles toward for a new SNF payment model its best practices. Cole doesn’t
was set for 2021. expect it will have any difficulty
October, when a new payment model kicks off a series
“We have been forced to complying with the final phase
of industry-shifting changes. make so many changes. This of the Requirements of Partici-
just feels like another wave,” pation and its long-anticipated
But providers who treat and market general manager says the Rev. Chuck Cole, COO infection control and staff train-
quality transformation as a for skilled nursing at PointClick- and CFO of The Chaparral ing requirements that must be
resolution to deliver better care Care. “To succeed, providers House in Berkeley, CA. implemented by November 28.
across the LTPAC continuum will have to have a full view of Chaparral House is one of But he concedes Chaparral
rather than an earth-shattering patients across care settings.” only four long-term care facili- House has a larger than aver-
revolution should find them- That’s likely going to be the ties in Northern California that age private pay population,
selves well positioned. case, regardless of politics or has been accredited by the which affords him the flexibility
“The Centers for Medicare how soon federal officials can
& Medicaid Services is trying create a viable unified payment PLAN TO IMPROVE STAFF: It is imperative
to incent the right things. Call approach. you plan for training and upskilling of staff,
it value-based care delivery in Facing quality-repor ting including adding and training on new tech-
a general sense,” says Russ audits and claw backs, provid- nology.
DePriest, senior vice president ers have had at least a decade
SPECIAL MARKETING SECTION
BEYOND PDPM 7
to make big-impact investments, such as a of Health and Human Services vendor
nursing staff that has about 40% registered is already building that model, an initial
nurses.
Finding a patient-population mix that
2014 version of which could be submitted to
Congress as early as 2022.
Impact Act 2014
supports the pursuit of quality will be for Much like PDPM is expected to rede-
providers with high Medicaid census. If the fine how providers devise care strategies,
Medicare Payment Advisory Commission namely away from pay-for-volume, the
gets its way and rates are frozen or cut in
2020, providers will need to lean on a sys-
2015 Patient-Driven Groupings Model will do
the same for home health operators start-
Five Star
tem that promotes a continual focus on Update ing in 2020.
RoP Rule
patient mix and services provided. Changes
“This is a move in the right direction if
It is unclear how PDPM will influence we want to talk to each other using the
other payment methods once the RUG same language,” Wemyss says. “It’s not
model is suspended for all purposes in 2016 just between environments. We have dif-
April – New
2020. Medicare Advantage plans are hugely Quality Measures ferences between disciplines too. Nursing
popular with consumers, while Medicaid QRP Quality charts things one way, therapy another.”
Advantage plans have been criticized for Domain Reporting Aligning those two types of providers
– Functional
low reimbursements, denied claims and Status, Skin with similar systems makes sense, given
pushing SNF patients toward lower-quality 2017 Integrity, Major
Falls that many long-term care companies are
settings. Failure to
Five-Star Update already extending their brands to capture
report data -2%
“It’s going to be interesting to see what RoP - Phase 2 November some of the home care market.
those plans do in 2019 and 2020,” DePriest RoP-Phase 1 LeadingAge, for example, announced in
says. “Some Advantage plans may adopt March that it was affiliating with the Vis-
a ‘levels’ model or other reimbursement
models instead of PDPM. Some might use
2018 iting Nurse Association of America and
home care and hospice provider Elevat-
April – New
Quality Measures
it. Either way, it clearly impacts our revenue ingHOME.
QRP Quality
cycle pulls.” Domain Reporting Such moves may be more common in a
That’s one reason understanding PDPM – Functional future that emphasizes aging in place and
Status, Skin
and all the nuances that affect Medicare
reimbursement will be critical.
2019 Integrity, Major
Falls
pays more appropriately for SNF support
and home care.
Updates to QRP Five Star Update
“There’s certainly a lot here, but we’ve Measures Any partnerships that depend on shared
been given so much from CMS,” says Paul October – information will require strident data col-
PDPM Med
Wemyss, RN, RAC-CT, IS, an MDS Techni- November lection and strong analytics to drive smart
cal Resource at Ensign Services Inc. “We RoP-Phase 3 strategies. EHRs will continue their trans-
can do this.” 2020 formation from record-keeping program
Other payor
model changes - to intelligence delivery systems.
TECHNOLOGY EASES TASKS eventual
retirement of
“As the MDS is de-emphasized, you
Technology is already helping providers RUGS need to be sure you have the right infor-
adjust, particularly in areas that are new HH PGDM mation as the patient enters the facility
to skilled nursing, such as setting primary 2021+ Mandatory
so your one shot at capturing it is timely
diagnosis codes that may be different from Continued Bundled and accurate,” DePriest says. “Having a
volume-to-
those used at a hospital and measuring value pressures
Payments — standardized method to capture data on
Data collection
function under Section GG. Interoperability ends your people will get you the insights you
standards will need to make decisions for the patients
Those features are establishing a base change
for 2024, the goal date for an industry-wide Unified PPS you have but also show you the possibili-
2024 ties for the future.” ■
unified payment system. A Department
Your Journey
to PDPM and
Beyond
Every Journey Requires a Plan
We’ll Help Get You There With These Five Stages
STAGE 1:
Conceptualize Develop the plan for your journey to and through PDPM.
STAGE 2: Ensure consistency across your business, to get the right
Standardize information at the right time.
STAGE 3: Analyze the changes you’ve made – learn what’s working and
Analyze what needs more attention.
STAGE 4: Look for ways to build efficiencies into what you learned and
Optimize adjusted in previous stages.
STAGE 5: Monitor and maintain the successful changes you’ve made
Operationalize through your journey – and continue this beyond PDPM.
BUILD YOUR PLAN NOW
We’ve prepared in-depth resources to support you along your PDPM Journey.
We also have a team of experts who are ready to answer any questions you have.
Visit our website to get started www.pointclickcare.com/pdpm-journey
Copyright 2019 PointClickCare®. PointClickCare® is a registered trademark. Care confidently.
SNF_PDPM_ad_Supplement.indd 1 2019-04-01 2:21 PM
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