The Swing Bed Patient Driven Payment Model (PDPM) and ... · Governance & Strategy Recruitment...

© HTS3 2020| 1

Brentwood, TN 37027

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The Swing Bed Patient Driven Payment Model (PDPM) and

Understanding the Importance of the MDS v1.17

April 14, 2020

Presenter: Reta A. Underwood, Medicare Specialist, RAC-CT, QPC

Host: Carolyn St.Charles, Chief Clinical Officer, HTS3

5110 Maryland Way 2745 North Dallas Pkwy

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Dallas, TX 75093

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Nationwide Client Base

Currently provides hospital management, consulting services and technology to:

• Serving community, district, non-profitand Critical Access hospitals

Example Managed Hospital Client: Barrett Hospital and Healthcare in Dillon, MT, Ranked as a Top 100 Critical Access Hospital for 8 years in a row

Example Technology and AR Services Clients: Two-hospital NFP systems in southeast GA with numerous associated physician practices

Preferred vendor to:

• California Critical Access Hospital Network

• Western Healthcare Alliance Partner with Illinois Critical Access HospitalNetwork

• Vizient Group Purchasing Organization

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• Executive management & leadership development

• Community health needs assessment

• Lean culture

• Executive and interim recruitment

• CEOs, CFOs, CNOs

• VP and Department Directors

• Performance optimization & margin improvement

• Revenue cycle & business office improvement

• AR outsourcing

• Continuous survey readiness

• Care coordination

• Swing bed consulting

Governance & Strategy

Recruitment Clinical Care & Operations

Finance

Areas of ExpertiseStrategy – Solutions - Support

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Interim Executive & Department Leadership 4

▪ The Right Person – Our experience and understanding

of your hospital is the key to placing the right Executive

or Department Leader

▪ Immediate Response – Interim needs are typically

immediate. Our bench strength allows us to find the

right executive quickly to provide a seamless transition

▪ Experience – Over 49 years of supporting executives &

teams in hospitals and healthcare companies of all

sizes

▪ Support Services – Our business is managing hospitals

more efficiently. We provide comprehensive support

services to all our Interim Executives and Department Leaders

▪ Our Depth:

We support all positions including CEO, CFO, CNO,

CIO, Clinic Administration and Department

Leaders

▪ Interim Executive Placement Services:

“Blue Mountain Hospital District has benefited from

the interim executive placement services

HealthTech S3 provides. Our current CFO started

as an interim placement for BMHD, prior to joining

our organization in a permanent capacity. The

success with this placement has motivated us to

consult Health Tech with two subsequent interim executive needs.” Derek Daly, CEO BMHD

Staffing Community Hospitals since 1971

HealthTechS3 Design.Build.Optimize High Performance Teams

Retained Contingency Interim Contract

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Mentoring/Support Team 5

Every Interim Executive and Department Leader is backed by a support team and mentor who help ensure that the team gets the right results

HealthTechS3 Design.Build.Optimize High Performance Teams

Retained Contingency Interim Contract

6© HTS3 2020|

The Swing Bed Patient-Driven Payment Model (PDPM) and Understanding the Importance of MDS v1.17Date : April 14, 2020 Time : 12pm CSTPresenter : Reta A. Underwood, RAC-CT, C-NM, QCP, CPC Host : Carolyn St.Charles, RN, BSN, MBA, Chief Clinical Officerhttps://bit.ly/3ao5Xjn

Appendix A and Appendix W Revised by CMS: A Road Trip Through the New Standards and Interpretive GuidelinesDate : April 17, 2020 Time : 12pm CSTPresenter : Carolyn St.Charles, RN, BSN, MBA, Chief Clinical Officerhttps://bit.ly/2UERPLT

Survey Savvy: How to Manage a Regulatory SurveyDate : May 1, 2020 Time : 12:00 pm CSTPresenter : John Coldsmith, DNP, MSN, RN, NEA-BC - Clinical Consultant, HealthTechS3Host : Carolyn St.Charles, RN, BSN, MBA, Chief Clinical Officerhttps://bit.ly/3apGsxV

Building an Effective 30-Day Hospital Turnaround PlanDate : May 22, 2020 Time : 12:00 pm CSTHost : Derek Morkel, CEO HealthTechS3Presenter : Neil Todhunter, President, HealthTechS3Registration TBD

Building the Bridge Between Annual Wellness and Care CoordinationDate : May 28, 2020 Time : 12pm CSTPresenter : Faith M Jones, MSN, RN, NEA-BC – Director of Care Coordination and Lean Consulting, HealthTechS3 https://bit.ly/2UnU9YK

Your Swing Bed Program – It Takes A VillageDate : June 5, 2020 Time : 12pm CSTPresenter : Carolyn St.Charles, RN, BSN, MBA, Chief Clinical Officerhttps://bit.ly/2WJKNrX

What an Interim Leader Can Bring To Your Hospital and Why You Might Need One - NowDate : June 12, 2020 Time : 12pm CSTPresenter : Michael Lieb, FACHE, Vice President – Interim Services, HealthTechS3https://bit.ly/3dxyGnD

Connecting the Dots between Transitional Care Management and HCAHPS Date : June 25, 2020 Time : 12pm CSTPresenter : Faith M Jones, MSN, RN, NEA-BC – Director of Care Coordination and Lean Consulting, HealthTechS3 https://bit.ly/33VN8BB

ALL WEBINARS ARE RECORDED

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https://bit.ly/3apGsxV

https://bit.ly/2UnU9YK

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https://bit.ly/33VN8BB

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You may type a question in the text box if you have a

question during the presentation

We will try to cover all your questions – but if we don’t get to

them during the webinar, we will follow-up with you by

e-mail

You may also send questions after the webinar to our team

(contact information is included at the end of the

presentation)

The webinar will be recorded and the recording will be

available on the HealthTechS3 web site:



HealthTechS3 hopes that the information contained herein will be informative and helpful on industry topics. However, please note that this information is not intended to be definitive. HealthTechS3 and its affiliates expressly disclaim any and all liability, whatsoever, for any such information and for any use made thereof. HealthTechS3 does not and shall not have any authority

to develop substantive billing or coding policies for any hospital, clinic or their respective personnel, and any such final responsibility remains exclusively with the hospital, clinic or their respective personnel. HealthTechS3 recommends that hospitals, clinics, their respective personnel, and all other third party recipients of this information consult original source materials and

qualified healthcare regulatory counsel for specific guidance in healthcare reimbursement and regulatory matters.

Instructions for Today’s Webinar



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PresenterReta has over 34 years of professional work experience in the long-term care industry. Reta’s experience has included management and director positions with nursing facilities and health care companies. She has also provided corporate-wide MDS support services, numerous mock surveys, regulatory compliance correction, educational programs, clinical documentation, quality assurance programming and, most recently, implemented PDPM in facilities nationwide.

Reta has supplied input to CMS and has been included on projects and discussions pertaining to post-acute care. She holds national certifications through the American Association of Nurse Assessment Coordination (AANAC) as a Resident Assessment Coordinator (RAC-CT); Quality (QAPI) Professional and Nurse Manager and as a certified ICD-10-CM coder.

Reta has had numerous articles published in the long-term care industry trade publications and has been used as an expert resource professional for media interviews including McKnight’s News; HCPro MDS and PPS Advisor and Provider AHCA magazine. She has also copyrighted several clinical documentation forms and tools, such as for Medicare Triple Check Process, nutritional assessment, skilled clinical and MDS documentation, and restorative nursing programming.

[email protected]

Reta A. Underwood,RAC-CT, C-NM, QCP, CPC

PresidentConsultants for Long Term Care, Inc.

www.CLTCinc.com

mailto:[email protected]

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Learning Objectives

Participants will…

1. Further develop their Swing Bed MDS v1.17 assessment skills

2. Learn how the PDPM reimbursement methodology six (6) components calculate along with the relationship of the patient’s active diagnoses to generate HIPPS score

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Acronyms

▪ AIDS: Acquired Immune Deficiency Syndrome ▪ ARD: Assessment Reference Date ▪ BIMS: Brief Interview for Mental Status ▪ CMI: Case-mix Index ▪ CMS: Centers for Medicare and Medicaid Services ▪ CFS: Cognitive Function Scale ▪ CPS: Cognitive Performance Scale ▪ HIPPS: Health Insurance Prospective Payment System ▪ HIV: Human Immunodeficiency Virus ▪ ICD-10-CM: International Classification of Diseases, Tenth

Revision, Clinical Modification ▪ IPA: Interim Payment Assessment ▪ MDS 3.0: Minimum Data Set, Version 3

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Acronyms

▪ NTA: Non-Therapy Ancillary▪ OBRA: Omnibus Budget Reconciliation Act of 1987 ▪ OMRA: Other Medicare-Required Assessment ▪ OSA: Optional State Assessment ▪ OT: Occupational Therapy ▪ PDPM: Patient Driven Payment Model ▪ PPS: Prospective Payment System ▪ PT: Physical Therapy ▪ RUG-IV: Resource Utilization Group, Version IV ▪ SLP: Speech Language Pathology ▪ SNF: Skilled Nursing Facility ▪ UPL: Upper Payment Limit ▪ VPD: Variable Per Diem

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The Swing Bed (SB)Prospective Payment System (PPS)

Patient Driven Payment Model (PDPM) and Understanding the Importance of the Minimum Data Set

3.0 v1.1.7 (MDS)

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Fast Facts –

• In effect since 10-1-2019

• The 5-dayPPS MDS calculates the HIPPS payment category for payment

• The 5-day PPS MDS is the only required PPS MDS in PDPM

• The 5-day PPS MDS HIPPS pays for the whole stay unless an IPA HIPPS is also generated

• The Interim Payment MDS Assessment (IPA) is an optional assessment used completely at the discretion of the provider.

The MDS 3.0 v1.17 Assessment & PDPM

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Certifications are required at the time of admission or as soon thereafter as is reasonable and practicable (42 CFR 424.20). The initial certification

— affirms, per the required content found in 42 CFR 424.20, that the resident meets the existing SNF level of care definition, or

— validates via written statement that the resident’s assignment to one of the upper PDPM groups (defined below) is correct.

Those nursing groups encompassed by the Extensive Services, Special Care High, Special Care Low, and Clinically Complex nursing categories;

o PT and OT groups TA, TB, TC, TD, TE, TF, TG, TJ, TK, TN, and TO; o SLP groups SC, SE, SF, SH, SI, SJ, SK, and SL; and o The NTA component’s uppermost (12+) comorbidity group.

Re-certifications are used to document the continued need for skilled extended care services. — The first re-certification is required no later than the 14th day of the SNF stay. — Subsequent re-certifications are required at no later than 30-day intervals after the date

of the first re-certification. — The initial certification and first re-certification may be signed at the same time.

Physician Certification

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In order to accommodate the new payment groups, the PDPM HIPPS algorithm is as follows:

• Character 1: PT/OT Payment Group • Character 2: SLP Payment Group • Character 3: Nursing Payment Group • Character 4: NTA Payment Group • Character 5: Assessment Indicator

HIPPS Code

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PDPM Components – Adding It Up 16

= HIPPS

SLP +

OT +

PT +

NTA +

Nursing +

Non-CMI +

Total Case-Mix Adjusted Per Diem Payment = (PT Component Per Diem Rate * PT Variable Per Diem Adjustment Factor) + (OT Component Per Diem Rate * OT Variable Per Diem Adjustment Factor) + SLP Component Per Diem

Rate + (NTA Component Per Diem Rate * NTA Variable Per Diem Adjustment Factor) + Nursing Component Per Diem Rate + Non-Case-Mix Component Per Diem Rate

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Physical and Occupational Therapies

Step 1. Clinical reason for SNF stay (Primary Diagnosis I0020B)(Clinical Category) +

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Step 2. Functional status (score range from 0 to 24) (Section GG Items) +

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Step 3. = the Clinical Medical Group (TA – TP)(1st character in HIPPS code)

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Speech Language Pathology and Audiology (SLP) Services

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Nursing

➢ There are 6 PDPM nursing categories

➢ The nursing functional score process is not the same as the PT and OT

➢ The patient will be assigned to highest paying nursing category group based on answer from the MDS 3.0 1.17 assessment

➢ Treatment and/or services qualifying the patient in the nursing category should be incorporated into the patients plan of care

➢ Daily treatment and services should be documented each time provided and can be found in a variety of medical record locations

➢ Skilled RN oversight is Medicare Part A skilled services standard of care

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Nursing

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Nursing

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Nursing

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Nursing

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Non-Case Mix Component

✓ Hospital SB will always use the states RURAL rate

✓ This ‘base rate’ differs from state-to-state and adjusted each fiscal year.

FY2020 examples (wage index adjusted):

Alabama = $73.59Kansas = $80.61

Kentucky = $82.76Illinois = 84.55

Texas Rural Rate = $83.79Tennessee Rural Rate = $76.57

Guam = $93.93

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Reta A. Underwood,President

Consultants for Long Term Care, Inc

We hope the information in this webinar has been helpful!

Please contact me if you would like to schedule a review of your Swing Bed Program

or have questions about the presentation

Carolyn St.Charles [email protected]

Office: 360-584-9868Cell: 206-605-3748

Carolyn St. Charles,Chief Clinical Officer

HealthTechS3

mailto:[email protected]

The Swing Bed Patient Driven Payment Model (PDPM) and ... · Governance & Strategy Recruitment...

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