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!