Webinar Get PDGM-Ready in 90 days Wednesday, September 11, 2019
PointClickCare Presenters Tyler Lloyd Mary Henschel Andrew Kaul Mary Henschel Andrew Kaul Tyler Lloyd Director of Client Success Product Manager Implementation Specialist PointClickCare, Home Care PointClickCare, Home Care PointClickCare, Home Care
Agenda Mary Henschel 1 PDGM Details Andrew Kaul 2 Application Readiness Tyler Lloyd 3 Implementation Mary Henschel 4 T90 to PDGM
PDGM
PDGM Details Patient Centered Care Relies more heavily on clinical characteristics and patient information to place home health periods of care into payment categories. In November 2018, CMS finalized a new case-mix classification model, the Patient-Driven Characteristic Based Plan Groupings Model (PDGM), Eliminates the use of therapy service thresholds. effective beginning January 1, 2020. Shorter Episodes Changes the unit of home health payment from a 60-day episode to a 30-day period.
Motivation Define Benefit Align Focus Center on Patient The Medicare home health Payments based on Home Health payment benefit was ill-defined. therapy thresholds create should be determined by financial incentives that patient characteristics. distract agencies from focusing on patient characteristics when setting plans of care.
432 HHRGs with PDGM
Journey Through PDGM Conceptualize Analyze Optimize Operationalize How is PDGM going to What does your How do you begin to Make the change impact your business data say? utilize standardized and monitor / and what do you need What are you doing data to gain insight to improve your to plan to well and what do you clinical and financial performance under do differently? need to improve in performance under the new payment order to make the PDGM? model. transition?
PDGM Experience Map Identifies the people and pain points to address under PDGM
Application Readiness
2019 PDGM Roadmap Q1 Q2 Q3 Q4 Q1 19 19 19 19 20 ü Understand ü Claims Compliance & o OASIS Annual Update ü Medicare o Notifications & Requirements Grouper Pricer – Billing Management Alerting Beta / Internal Enhancements ü PDGM Design o Medicare ü Charge & Claims ü Acct. Trx: 1/30th - Thinking Workshop Grouper Pricer – o Additional KPI Generation Unbilled Ledger & Final Dashboards ü Prioritization & AR Ledger ü Accounting ü Intake Admission Planning for Changes ü KPI Dashboards & Enhancements Transactions Source Tracking ü Order tracking ü Medicare Claim ü Episodic Console ü Solution Designs integration with Processing Updates Updates (RAP & Forcura Final) o ICD10 Annual Update ü Displaying valid PDGM diagnoses
Change Themes PDGM Requirements Efficiency Improvements • 2 RAPs/Finals Completing assessments faster • • 30-day billing periods Getting orders sent and signed • more quickly Additional occurrence • codes on claims 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 Order sent Order signed Order updated in PCC to Forcura by physician as signed
PDGM Claim Requirements 30-day PDGM Automatic Occurrence Tracking 1/30th billing periods claim type claim creation codes 50, 61, 62 transactions with 2 RAPs for each episode when first included on instead of and Finals appointment is Final claims 1/60th completed
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 Clinical Financial Operations • Questionable encounters • LUPA % • Admission source Outstanding orders Episode reimbursement comparison Episode timing • • • Length of stay Payer mix Current and historical census • • • • Open assessments by days/type • *Coming – Days to RAP and Final • Days to admission *Coming – Therapy utilization *Coming – AR aging Referral sources • • • • *Coming - Hospitalizations • *Coming – Unbilled claims • Employee turnover
Dashboard Examples
Implementation
What does success look like to you?
Elements of a Successful Implementation Defined Dedicated Project Commitment to Goals Management Training Know what you want to Agency resource Be sure all staff attends all get out of the committed to managing trainings and completes implementation and the details of assignments. This may how you will implementation. mean adjusting schedules measure success. to accommodate trainings.
Implementation Timeline Pilot Train the Trainers Staff Training Go-Live Key personnel learn Super users learn program Staff work in training Supported go-live period program and create a so they can support the database to learn the transitions staff to change management agency both during program from agency working with real cases. strategy. transition and into super users with the future. implementer support. Timeframe: Timeframe: Timeframe: Timeframe: 2-3 weeks of discovery, Dedicated, in-depth Guided staff training Approximately 10-12 configuration and review. training with follow to go-live date. weeks, followed by up sessions. transition to PointClickCare support.
Training Designed for Retention Auditory Lecture 5% 10% Reading Visual Passive 20% Audio-visual Home Care Training Zone 30% Demonstration Average Retention Rates • Trainer led demo with Kinesthetic hands-on exploration 50% Discussion • Small groups to encourage discussion • Class practice time and 75% Practice reinforcement assignments Peer teach-back sessions to • Active 90% cement skills Teach Back Video and written resources to • support all learning styles
Super User Training - a Model for Ongoing Success DURING IMPLEMENTATION AFTER IMPLEMENTATION AFTER IMPLEMENTATION Super Users Intensive Super-User Become Agency Training by Trainers PointClickCare New Staff Training New Feature Training Go-Live Support Staff Training Super Users on-board Super Users train staff on Super Users provide Super Users train staff with new staff, ensuring new features released by at-elbow go live support. PointClickCare support. continued agency success. PointClickCare, as well as regulatory changes.
Ongoing New Feature Education Education Initiatives Release Notes Overview of all changes in each Newsletters, webinars, and support calls to help release presented in a visual format. you implement key features. Release Webinars Demonstration of release features.
T-90 to PDGM
Action Steps Analyze Optimize Operationalize What does your data say? How do you begin to utilize Make the change and What are you doing well and standardized data to gain monitor / improve your what do you need to insight to clinical and financial performance under the new improve in order to make performance under PDGM? payment model. the transition?
Current Clients 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 Use KPIs to Review by Clinical Grouping. Analyze Your LUPAs Current Data How many LUPAs would I have in the new 30-day payment periods?
Example – Episode Reimbursement
Example – Episode Reimbursement
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