Get PDGM-Ready in 90 days - HomeCare Magazine · 2020. 4. 27. · PDGM Details In November 2018,...
Transcript of Get PDGM-Ready in 90 days - HomeCare Magazine · 2020. 4. 27. · PDGM Details In November 2018,...
Get PDGM-Ready in 90 days
Wednesday, September 11, 2019
Webinar
Mary Henschel Andrew Kaul Tyler Lloyd
PointClickCare Presenters
Director of Client Success PointClickCare, Home Care
Mary Henschel
Product Manager PointClickCare, Home Care
Andrew Kaul
Implementation Specialist PointClickCare, Home Care
Tyler Lloyd
PDGM Details
Implementation
Application Readiness
Mary Henschel
Andrew Kaul
Tyler Lloyd
T90 to PDGM Mary Henschel
Agenda
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PDGM
PDGM Details
In November 2018, CMS finalized a new case-mix classification
model, the Patient-Driven Groupings Model (PDGM),
effective beginningJanuary 1, 2020.
Patient Centered CareRelies more heavily on clinical characteristics and patient information to place home health periods of care into payment categories.
Characteristic Based PlanEliminates the use of therapy service thresholds.
Shorter EpisodesChanges the unit of home health payment from a 60-day episode to a 30-day period.
Motivation
The Medicare home health benefit was ill-defined.
Define BenefitPayments based on
therapy thresholds create financial incentives that
distract agencies from focusing on
patient characteristics when setting plans of care.
Align Focus Home Health payment
should be determined by patient characteristics.
Center on Patient
432 HHRGs with PDGM
Journey Through PDGM
Conceptualize Analyze Optimize Operationalize
How is PDGM going to impact your business
and what do you need to plan to
do differently?
What does your data say?
What are you doing well and what do you
need to improve in order to make the
transition?
How do you begin to utilize standardized
data to gain insight to clinical and financial performance under
PDGM?
Make the change and monitor / improve your
performance under the new payment
model.
PDGM Experience Map
Identifies the people and pain points to address under PDGM
Application Readiness
2019 PDGM Roadmap
Q119
Q120
Q219
Q319
Q419
ü Understand Requirements
ü PDGM Design Thinking Workshop
ü Prioritization & Planning for Changes & Enhancements
ü Solution Designs
ü Medicare Grouper Pricer –Beta / Internal
ü Charge & Claims Generation
ü Accounting Transactions
ü Order tracking integration with Forcura
ü Claims Compliance & Billing Management
ü Acct. Trx: 1/30th -Unbilled Ledger & AR Ledger
ü KPI Dashboards
ü Episodic Console Updates (RAP & Final)
ü Displaying valid PDGM diagnoses
o OASIS Annual Update
o Medicare Grouper Pricer –Final
ü Intake Admission Source Tracking
ü Medicare Claim Processing Updates
o ICD10 Annual Update
o Notifications & Alerting Enhancements
o Additional KPI Dashboards
Change Themes
PDGM Requirements Efficiency Improvements
• 2 RAPs/Finals
• 30-day billing periods
• Additional occurrence codes on claims
• Completing assessments faster
• Getting orders sent and signed more quickly
• Viewing agency-level metrics
Intake – Timing and Discharge Location
Define Episode Timing and Discharge Location fields added during Intake
Assessment - Timing and Discharge Location
Assessment displays selections from Intake
PDGM Details on OASIS
PDGM details including reimbursement, billing periods, and LUPA threshold
Valid PDGM Diagnoses
• Displays on Assessments, OASIS, and Diagnosis pages• Ability to add 24 secondary diagnoses and included on claim
QA Workflow
QA workflow helps efficiently route charting documents between the author and QA personnel. It also helps with timely and accurate charting and with getting the Start of Care Assessment completed, reviewed, updated and submitted within 5 days.
QA Dashboard and Report
Forcura Integration – Orders Tracking
Integration with Forcura provides the ability to send, track and manage orders electronically.
Order sent in PCC
Order sent to Forcura
Order signed by physician
Order updated as signed
PDGM Claim Requirements
30-daybilling periods for each episode
PDGM claim type with 2 RAPs and Finals
Automatic claim creation
when first appointment is
completed
Tracking 1/30th transactions
instead of 1/60th
Occurrence codes 50, 61, 62
included on Final claims
PDGM Claims Console
• Added functionality to include PDGM claims• Shows claims in progress and what needs to be completed prior
to submission
LUPA Threshold - OASIS
LUPA Threshold - PDGM Claims Console
LUPA Count and % Report
LUPA Dashboard
LUPA Threshold - Patient Calendar
LUPA Threshold – Scheduling App
LUPA Warning When Cancelling Appointment
KPIs to Support PDGM
Financial Operations
• Questionable encounters
• Outstanding orders
• Length of stay
• Open assessments by days/type
• *Coming – Therapy utilization
• *Coming - Hospitalizations
• LUPA %
• Episode reimbursement comparison
• Payer mix
• *Coming – Days to RAP and Final
• *Coming – AR aging
• *Coming – Unbilled claims
Clinical
• Admission source
• Episode timing
• Current and historical census
• Days to admission
• Referral sources
• Employee turnover
Dashboard Examples
Implementation
What does success look like to you?
Elements of a Successful Implementation
Know what you want to get out of the
implementation and how you will
measure success.
Defined Goals
Agency resource committed to managing
the details of implementation.
Dedicated Project Management
Be sure all staff attends all trainings and completes assignments. This may
mean adjusting schedules to accommodate trainings.
Commitment to Training
Pilot Train the Trainers Staff Training
Key personnel learn program and create a change management
strategy.
Staff work in training database to learn the program from agency
super users with implementer support.
Timeframe:2-3 weeks of discovery,
configuration and review.
Super users learn program so they can support the
agency both during transition and into
the future.
Timeframe:Dedicated, in-depth training with follow
up sessions.
Timeframe:Guided staff training
to go-live date.
Supported go-live period transitions staff to
working with real cases.
Timeframe:Approximately 10-12 weeks, followed by
transition to PointClickCare support.
Go-Live
Implementation Timeline
Teach Back
Practice
Discussion
Demonstration
Audio-visual
Reading
Lecture
Training Designed for Retention
5%
10%
20%
30%
50%
75%
90%
Average Retention Rates
Activ
ePa
ssiv
e
Auditory
Visual
Kinesthetic • Trainer led demo with hands-on exploration
• Small groups to encourage discussion
• Class practice time and reinforcement assignments
• Peer teach-back sessions to cement skills
• Video and written resources to support all learning styles
Home Care Training Zone
Super User Training - a Model for Ongoing Success
Intensive Super-User Training by
PointClickCare
Super Users train staff with PointClickCare support.
Staff Training
Super UsersBecome Agency
Trainers
Go-Live SupportSuper Users provide
at-elbow go live support.
DURING IMPLEMENTATION AFTER IMPLEMENTATION
New Staff TrainingSuper Users on-board
new staff, ensuring continued agency success.
New Feature TrainingSuper Users train staff on new features released by PointClickCare, as well as
regulatory changes.
AFTER IMPLEMENTATION
Overview of all changes in each release presented in a visual format.
Release Notes
Demonstration of release features. Release Webinars
Ongoing New Feature Education
Newsletters, webinars, and support calls to help you implement key features.
Education Initiatives
T-90 to PDGM
Action Steps
Analyze Optimize Operationalize
What does your data say?What are you doing well and
what do you need to improve in order to make
the transition?
How do you begin to utilize standardized data to gain
insight to clinical and financial performance under PDGM?
Make the change and monitor / improve your
performance under the new payment model.
Current Clinical Grouping MixHow many of today’s primary diagnoses would be considered “unacceptable” under PDGM?
Admission SourceWhat percentage are Institutional vs Community?
AdmissionsConsider the number of 30-day periods per admission.
Case Mix / Average Reimbursement per PeriodReview by Clinical Grouping.
LUPAsHow many LUPAs would I have in the new 30-day payment periods?
Use KPIs to Analyze Your Current Data
Current Clients
Example – Episode Reimbursement
Example – Episode Reimbursement
Collect More Information at IntakeTrain Intake staff to get detailed information about diagnoses, admission source, insurance verification.
Reduce Unacceptable CodesICD 10 Coders working to get their “unacceptable” codes to 0% prior to 1/1/2020.
Improve Documentation QualityImplement a smooth Q/A process: Dx Coding / OASIS Review / Plan of Care / Admission Source.
Automate ProcessesGet automated systems in place for Order Tracking.
Optimize Clinical Requirements and BillingUse the Episodic Console to manage Clinical Rules for billing. Getting the right staff mix in place for billing / cash posting.
Review Outstanding A/RReview outstanding A/R to see what you can clean up in advance of 1/1/2020.
Current Clients
Optimize
New Clients
There's still time but you need to
act fast!
PointClickCare will partner with BlackTree Healthcare Consulting to use 2018 Medicare LDS data file to analyze claims info to determine impact across a variety of PDGM impact areas.Gain InsightGain insight into the percentage breakdown for of each of the 12 Clinical Groupings based on your agency data.
Analyze LUPA PercentageDetermine estimated LUPA percentage under PDGM – broken down by the 12 Clinical Groupings as well as early and late periods.
Examine Clinical GroupingsCompare average visit utilization for each Clinical Grouping to national average numbers by each visit discipline.
Study Length of StayDetermine how your length of stay is impacting your PDGM payment periods.
Act Now Before it is Too Late
By failing to prepare you are preparing to fail!
Benjamin Franklin
Questions
Thank You!