Get PDGM-Ready in 90 days Wednesday, September 11, 2019 - - PowerPoint PPT Presentation

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

1 2 3 4

PDGM

PDGM Details

In November 2018, CMS finalized a new case-mix classification model, the Patient-Driven Groupings Model (PDGM), effective beginning January 1, 2020.

Patient Centered Care Relies more heavily on clinical characteristics and patient information to place home health periods of care into payment categories. Characteristic Based Plan Eliminates the use of therapy service thresholds. Shorter Episodes Changes 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 Benefit

Payments 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

• rder 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

Q1 19 Q1 20 Q2 19 Q3 19 Q4 19

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

• OASIS Annual Update
• Medicare

Grouper Pricer – Final

ü Intake Admission

Source Tracking

ü Medicare Claim

Processing Updates

• ICD10 Annual Update
• Notifications &

Alerting Enhancements

• 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-day billing 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 Active Passive

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 Users Become Agency Trainers

Go-Live Support

Super Users provide at-elbow go live support.

DURING IMPLEMENTATION AFTER IMPLEMENTATION

New Staff Training

Super Users on-board new staff, ensuring continued agency success.

New Feature Training

Super 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 Mix

How many of today’s primary diagnoses would be considered “unacceptable” under PDGM?

Admission Source

What percentage are Institutional vs Community?

Admissions

Consider the number of 30-day periods per admission.

Case Mix / Average Reimbursement per Period

Review by Clinical Grouping.

LUPAs

How 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 Intake

Train Intake staff to get detailed information about diagnoses, admission source, insurance verification.

Reduce Unacceptable Codes

ICD 10 Coders working to get their “unacceptable” codes to 0% prior to 1/1/2020.

Improve Documentation Quality

Implement a smooth Q/A process: Dx Coding / OASIS Review / Plan of Care / Admission Source.

Automate Processes

Get automated systems in place for Order Tracking.

Optimize Clinical Requirements and Billing

Use the Episodic Console to manage Clinical Rules for billing. Getting the right staff mix in place for billing / cash posting.

Review Outstanding A/R

Review 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 Insight

Gain insight into the percentage breakdown for of each of the 12 Clinical Groupings based on your agency data.

Analyze LUPA Percentage

Determine estimated LUPA percentage under PDGM – broken down by the 12 Clinical Groupings as well as early and late periods.

Examine Clinical Groupings

Compare average visit utilization for each Clinical Grouping to national average numbers by each visit discipline.

Study Length of Stay

Determine 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!