How does Patient-Driven Payment Model (PDPM) affect nurse practitioners, physician assistants, and doctors in Nursing homes? With the payment models changing in nursing homes, the main question from medical providers in nursing homes is, “How does this affect me?”<\/p>\n\n\n\n
The truth is that there isn’t a significant\nimpact on medical providers. Doctors, APRNs, and PAs, are already doing most of\nthe things that are needed to help the facilities meet their goals. <\/strong><\/p>\n\n\n\n
Medical providers are needed to order skilled\nnursing services for illnesses or conditions that required a hospital stay\nrequiring follow-up skilled nursing care.<\/strong><\/p>\n\n\n\n
The doctors, advanced nurse practitioners, and\nphysician assistants continue providing the same great medical care to the\nresidents of the facilities. <\/strong><\/p>\n\n\n\n
They now need to improve their ICD 10 coding\nabilities and properly document the diagnosis codes for the patient. <\/strong><\/p>\n\n\n\n
The provider will need to identify any missed ICD 10s upon admittance to the facility. Chart reviews will require more time spent on the evaluation of paperwork from the hospital. <\/strong><\/p>\n\n\n\n
The history of present illness may be more time-consuming as you comb through the discharge summary and W10 to capture data points needed for the diagnosis codes.\u00a0 \u00a0<\/strong><\/p>\n\n\n\n
It’s not known if the new payment model will\nmean less or more revenue for the medical providers. The increased time spent\non documentation could be offset by the increased reimbursement from higher\nacuity patients, including higher complexity visits.<\/strong><\/p>\n\n\n\n\n
As\na provider in the nursing home, you shouldn’t look at PDPM as a “facility\nissue.” PDPM is a team issue that includes providers, nursing, and\nphysical therapy. Therefore, you will need to improve communication among\nmembers of the team and families.<\/p>\n\n\n\n
PDPM\nis having a significant impact on nursing homes in the United States. The shift\naway from physical therapy as the primary driver of revenue has affected many\npeople in this industry. <\/p>\n\n\n\n
Many\nphysical therapy companies are laying off staff or cutting back on hours for\ntheir employees. They are also shifting how they will provide care and the\nnumber of hours for patients. <\/p>\n\n\n\n
PDPM\nis focusing on the patient rather than the volume of services provided to the\npatient. Nursing homes will start to receive improved reimbursements for\npatients with more medical problems and higher complexity.<\/p>\n\n\n\n
Predictions\nare that nursing homes are going to be taking on sicker and higher acuity\npatients due to the potential for higher reimbursement. Doctors, APRNs, and\nPAs, are going to be needed to care for these ill residents.<\/p>\n\n\n\n
We\nhave all heard the phrase, “if it isn’t documented, it isn’t done.”\nThis saying will have a direct impact on reimbursement for nursing homes. <\/p>\n\n\n\n
The nurses in the facilities are pressed for time to properly document the information needed for MDS. There is a shortage of nurses in many parts of the country, making it even more challenging to get the nurses to document at a higher level of detail as required. If they spend more time on documentation, that means less time providing direct patient care. <\/p>\n\n\n\n
Due to the nurses, not potentially documenting enough for reporting, the facilities are going to rely on the provider’s notes more than ever before. The facilities need documentation to back up the level of care provided to patients in the nursing home.<\/p>\n\n\n\n
Providers can help nurses by providing coaching on proper documentation. Many times it is just clarifying the importance of what needs documentation. <\/p>\n\n\n\n
Some\nnursing staff feels they either have to document long notes or nothing at all.\nWhen in reality, a short note on what is occurring can meet the need of the\nfacility.<\/p>\n\n\n\n
Unfortunately,\nwith the new PDPM model, there isn’t any extra money or reimbursements involved\nin helping the facilities succeed with the new payment model. <\/p>\n\n\n\n
The\nnew model does not affect the reimbursement for CPT codes other than increasing\nthe potential level of complexity.<\/p>\n\n\n\n
Your\nchances of doing better in the nursing home are directly related to the success\nof the nursing home. If the nursing home is fully occupied, you will have more\npatients on your nursing home panel. Increased panel size may potentially\nresult in more patients needing medical evaluations.<\/p>\n\n\n\n
By\nhelping the facilities, you help solidify your role as a team player. They need\nyour help to provide the required diagnosis codes and proper documentation\nethically.<\/p>\n\n\n\n
With\nthe new PDPM model, the doctor and the nurse practitioners have become a more\nintegral part of the team and not just a third party coming in to see the\nresidents. <\/p>\n\n\n\n
Helping\nout the nursing home in their PDPM journey often starts with the basics of\nproper documentations and ICD 10 coding. It is vital that you are coding the\nICD 10 to the farthest point while avoiding “unspecified” diagnosis\ncodes.<\/p>\n\n\n\n
You\nwill also want to familiarize yourself with ICD 10 codes that “Map”\nto codes that will provide reimbursement to the nursing homes. <\/p>\n\n\n\n
Sometimes\nattending basic ICD 10 training can make all the difference in the world. Many\nclasses offer coding and post-acute care nursing home training. <\/p>\n\n\n\n\n
It\nwill be essential to the skilled nursing facility to make sure the providers\ndocument the acuity and severity of the patient. <\/p>\n\n\n\n
Capturing acuity is done by recording the diagnoses and providing a good history on the patient. <\/p>\n\n\n\n
Providers\nwill be tasked with documenting a complete history, physical exam, including\nall the medical issues your patient may be experiencing upon arrival to the\nnursing home. <\/p>\n\n\n\n
The\ntiming of your medical assessments will also play a role. The patients will\nneed to be evaluated upon arrival to the facility as soon as possible. <\/p>\n\n\n\n
Timeliness\nof visits will help the facility obtain the required documentation to support\nthe admitting diagnoses. <\/p>\n\n\n\n
Make\nsure to document BMI on all overweight patients. If there BMI is higher than\n40, it will have a positive effect on the revenue of the facility. <\/p>\n\n\n\n
The\nfacilities will have to make sure they are documenting the heights on the\nresidents and the weight upon arrival.<\/p>\n\n\n\n
Proper documentation for PDPM<\/strong><\/p>\n\n\n\n
There\nwill be diagnosis codes that will have more impact on the reimbursements for\nthe nursing homes. Therefore, the providers will need to make sure their\ndocumentation captures these ICD 10 codes.<\/p>\n\n\n\n
Principal diagnosis to include in Diagnosis\nlist:<\/strong><\/p>\n\n\n\n
Capture\nthe comorbidities when possible. Document swallowing problems, speech and\nlanguage deficits, cognitive impairment, and mood changes.<\/p>\n\n\n\n
With\nthe PDPM model, you can include the surgery diagnosis if it occurred within 100\ndays before nursing home arrival. Even though this diagnosis may not be one you\nusually include, you should include it for the facility documentation.<\/p>\n\n\n\n
Of\ncourse, the list of diagnoses that can map to billable PDPM categories is much\nlonger than discussed and will help give a starting point in ICD 10\nidentification.<\/p>\n\n\n\n
Capture complex medical interventions:<\/strong><\/p>\n\n\n\n
PDPM Clinical Categories<\/strong><\/p>\n\n\n\n
Some facilities will supply the medical providers with a “cheat sheet” or chart to assist them in picking ICD 10 codes that the facilities can use to bill for their patients. You can utilize this basic list of ICD 10 codes to assist you in the documentation of ICD 10 for the patient.<\/p>\n\n\n\n
When\nyou look at PDPM as a provider, you will most likely nod your head and move on.\nHowever, if you can take on the role of PDPM expert, you will be appreciated by\nthe facility more than you know. <\/p>\n\n\n\n
The MDS nurses will come to you will issues and concerns affecting the patient which will require follow-up visits. You will learn how to properly document and capture diagnosis codes that will hopefully increase the level of the visit though increase complexity.<\/p>\n\n\n\n\n
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\n\nBackground & Finalized Changes to the Skilled Nursing Facility (SNF) Prospective Payment System (PPS). Patient-Driven Payment Model. https:\/\/www.cms.gov\/Medicare\/Medicare-Fee-for-Service-Payment\/SNFPPS\/Downloads\/PDPM-101_Final.pdf<\/a> Retrieved October 14, 2019\n\n<\/p>\n\n\n\n
Jennifer Gross, BSN, RN-BC, RAC-CT, CPHIMS, Is Your Documentation PDPM-Ready? https:\/\/pointright.com\/is-your-documentation-pdpm-ready\/<\/a> Retrieved October 12, 2019 <\/p>\n\n\n\n
McKnight’s Long-Term Care News. PDPM will reduce clinical requirements but demands more attention to detail. https:\/\/www.mcknights.com\/print-news\/pdpm-will-reduce-clinical-requirements-but-demands-more-attention-to-detail\/<\/a> Retrieved October 4, 2019<\/p>\n\n\n\n
