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Outcomes matter with PDPM

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Written by Kirby Cunningham, RN, Senior Product Manager, MatrixCare

With PDPM on the horizon for the Medicare A billing and documentation world, it is important to remember that outcomes matter– always have and always will. But, how Medicare interpreted and paid for clinical outcomes, has changed over time.

Changes in the minimum data set have occurred since the Omnibus Budget Reconciliation Act of 1987 or OBRA, was introduced. These changes in the required documentation have generally been targeted at rehab minutes and ADL scores, while other types of clinical charting only come into the “payment” picture if the rehab groups are of lesser value. We’ve even developed ways to capture “focus charting” for ADLs and conditions related to diagnosis codes to support the rehab documentation if doing so correctly allowed us to capture a few extra dollars in reimbursement.

Interestingly, the documentation we developed for payment led to us developing better clinical care plans. This development included adding more discreet data points to analyze the intended outcomes vs. the actual outcomes, advancement of clinical workflow/pathways, and improvement of clinical caregiving from a more holistic stance. We have learned, and sometimes struggled with, the fact that keeping someone in our services and in our facilities longer (i.e., getting them to the highest level of care in our facilities), may in fact impede their progress toward their goal of going home.

Despite our best efforts, and at the prodding of CMS, to make skilled nursing sites more “home-like,” it’s become apparent that they are not. Some of us have researched and found that our residents may improve at a more rapid rate after initial care in our sites if they are released to the comfort of their own surroundings at home.

Medicare has been under pressure to reduce costs by improving outcomes in the least expensive setting possible, and as it happens that may be in the resident’s home, and not in a SNF, over 100 days.

What do we do now to make sure that outcomes are improved and documented? Click To Tweet

What do we do now to make sure that outcomes are improved and documented? Please keep in mind that all our clinical education, in all disciplines, has been geared to improve outcomes. Put all your clinical prowess in action and work with your software vendor as a partner. Make sure your software has evidence-based templates and workflow/clinical pathways, EASY to understand documentation for all disciplines, and documentation from the acute care setting that is available and at your clinicians’ fingertips from pre-admission through discharge. These factors combine to ensure that all your residents are placed in the proper environments, improving outcomes.

MatrixCare offers tools to place, track, and follow up on the documentation and outcomes of our residents in all care settings and reduce subsequent acute care transfers and admissions. During the continuum of care, MatrixCare’s toolset uses state of the art technology to trend and help predict declines in function and thus facilitate changes in care that lead to shorter stays, improved on-time reimbursement, resident and family satisfaction and engagement, and better relations with our regional referral sources.

MatrixCare has more clients and sites with 5-Star ratings than any other software. These 5-Star ratings equate to improved revenue streams and indicate much better survey outcomes, meaning: Outcomes Matter!

Kirby Cunningham

Kirby Cunningham is a Registered Nurse and joined MatrixCare in February of 2002 with the acquisition of AOD. He worked his way through the organization ranks managing several departments and is currently Sr. Product Manager for the LPC Solution. Kirby has spent most of his Nursing career in the long term care industry and has held numerous leadership positions from Director of Nursing to Regional Consultant at major for-profit SNF organizations. Kirby graduated from Palm Beach State College with an ASN. He has extensive experience in Business Operations Management serving long term care and other industries. Kirby is married, has three children, and resides in the Boca Raton area of South Florida.