MatrixCare PDPM Technology Empowers Providers to Transition with Ease

A message from Kevin Whitehurst, Senior Vice President

Kevin WhitehurstSNF Operators: Are you receiving enough emails, webinar invitations, articles, and other forms of communication regarding PDPM? Those of you who have been in this industry for a long time (like the ’90s) have experienced similar shifts in reimbursement like PPS and many variations of MDS. Whenever a significant regulatory change is underway, the market is always a-buzz. MatrixCare providers are no exception to that, and we are aware of the messages you are receiving from other vendors and consultants in the industry. As a partner, we take pride in connecting with you and engaging you every step of the way and will continue to provide you with information and tools to help deal with this change.

Although there are a variety of ways we communicate about PDPM, I wrote this article to address some of the questions and anxiety you may have about your transition to PDPM. Although you may feel bombarded with PDPM information, this summary provides you with guidance to successfully implement your PDPM business model.

How MatrixCare Customers Advance their PDPM Task Force and Operating Models Today

The PDPM paradigm shift in reimbursement is forcing a change in the way you do business and is also creating tighter synergies between provider and technology vendor. MatrixCare has operated under a philosophy of provider-driven engagement for years, and that has enabled us to deliver value as well as comply with ever-changing regulations. Our customers have encouraged us to innovate and have provided operational insight into areas where technology could provide them relief, efficiency, and better outcomes. To meet those demands, MatrixCare has developed new tools to further improve our robust clinical documentation and revenue-cycle management solutions. The best way to explain this collaboration is to describe what our savviest of providers are leveraging today.

MatrixCare and PDPM – Technology to Enhance Decision Making

The MatrixCare platform—by design—provides operators with tools to support clinical decisions, admission decisions, and financial decisions. These tools become especially important with PDPM because an accurate diagnosis is a key driver of revenue and the clinical capabilities directly impact reimbursement. To accomplish this, MatrixCare providers have leveraged the Clinical Observations and Events tools to collect accurate data on clinical complexities and to track changes in condition. Evidence-based assessments are embedded in MatrixCare Clinical Decision Support; this is not a third-party plug-in; it is part of the workflow in the system. In addition, we have sophisticated providers levering ReferralConnect to make better decisions about which residents are admitted to the facility. Additionality, the exception-based workflows in Revenue-Cycle Management empower financial users to not only get paid faster but identifies gaps in processes to ensure they can maximize reimbursement. These tools are being leveraged today, and forward-thinking providers are taking their existing processes and mapping out these workflows in a PDPM world. As a result, MatrixCare providers are way ahead of the game. If you are not leveraging these tools today, you should act today to implement them into your workflows.

MatrixCare and PDPM – Analytics for Root Cause Analysis

MatrixCare delivered its third generation of Analytics tools in the last two years, and we continue to improve their capabilities to make them more robust than ever. Our MyAnalytics platform has given high-performing operators access to data to further aid in root-cause analysis and decision making. Analytics are different from reports, in that they will guide you toward “why” something occurred vs. just showing you what occurred. Our MyData offering, designed for those with data-mining savvy, will give your organization access to critical data from the MatrixCare database and also gives you the ability to create custom reports and dashboards that are unique to your organization’s specific needs.

MatrixCare and PDPM – Minimize Transition of Care Risks with CareCommunity

Providers are leveraging the benefits of MatrixCare CareCommunity in a variety of ways. The sharing of information between facility and hospital is key, and the ability to coordinate care post-discharge with all stakeholders is another value-add. Our customers have shared their challenges of monitoring care after the resident leaves their facility and demand ways to minimize risk and ensure better outcomes. This drove our mission to develop innovative ways to coordinate care, engage everyone involved in the care, and do it all in an easy-to-use, seamless workflow. MatrixCare CareCommunity addresses this with the industry’s most advanced platform for care coordination and operators who are leveraging this technology are better positioned to succeed under PDPM.

The MatrixCare PDPM Solution – Compliance, Change Management, Ease of Adoption

MatrixCare has been actively engaging customers in focus groups and collaborating with industry leaders to provide education on PDPM. Just as you, the provider, have formed your dedicated PDPM Task Force, MatrixCare has aligned its leadership and subject matter experts with a strategic focus on PDPM. In this section, I will describe our engagement strategy and what we are delivering to take providers to the next level.

MatrixCare PDPM Compliance Strategy

Providers have all been informed by CMS of the regulatory changes. With a huge focus on MDS items, Section GG, ICD10 codes, case-mix adjustment components, and VPD (variable per diem) adjustments, we know there are specific areas to address for compliance. MatrixCare’s stance on compliance has always been to give it the highest priority, and we are committed to incorporating the necessary changes. To support the regulatory requirements, we are addressing the operational impact of changes, and the real value becomes evident with workflow efficiency, exception reporting, alerts, stronger clinical documentation, reimbursement risk management, care management, and care coordination. The PDPM change is significant and impacts multiple workflows in the MatrixCare solution. Our strategy is to deliver a PDPM solution that empowers MatrixCare providers to operate at peak performance, continue to deliver positive outcomes and better quality of care, and achieve desired bottom-line results.  To accomplish that, we have identified and are actively working in the following key areas for PDPM.

  • Billing/Financial
  • Clinical Documentation
  • MDS/ICD10 Coding Accuracy
  • Reporting/Analytics
  • Intake Management/Transitions of Care
  • Interoperability
  • Education/Communication

MatrixCare and PDPM – Change in Reimbursement Drives Enhanced Tools and Alerts

With the topic of PDPM on center stage, we took a multi-tier approach in market research and engagement of stakeholders to ensure operational benefits for our customers. To accomplish that, we have held focus groups at various levels, 1:1 interview with executives, industry experts and consultants, and also leveraged knowledge from our partners. We continue to address critical areas of the operation, and this will persist as our customers acclimate to the changing environment. MatrixCare is delivering Operational Benefits in the following areas:

    • We are committed to streamlining the communication and collaboration of the interdisciplinary team. Understanding that admissions, case managers, MDS, clinical, and financial staff members need to be on the same page. Workflows will ensure information is shared in real time and leverage automation for better, more timely decision making. You will soon be leveraging more technology for task management, clinical category mapping, scheduling and alerts, and real-time monitoring.


    • We are focused on improving staff productivity and satisfaction by eliminating manual analysis of data from claims, orders, and clinical documentation. This will be accomplished by auto-generating data that would otherwise be manually compiled.
    • We are providing all levels of the organization with data and dashboards tailored for their roles and their needs. Our already widely used Analytics tools will be enhanced to look at data in a variety of ways that provide new insights and information affecting care and reimbursement.


  • Projection of revenue is critical for our customers, and we are placing a very specific focus on this to place our providers in the best position. You will soon be leveraging tools to compare reimbursement under RUGS and PDPM rates. We’re creating more reports that provide easy-to-identify risks and results. With PDPM, there are over 2,800 reimbursement rates. So we will give you the ability to get rates assigned early in the process – essentially, you will have more upfront analysis. You also will leverage enhanced workflows, alerts, and more dashboards to monitor the length of stay, discharge planning, alerts for ICD10 codes, and other reimbursement risks.

MatrixCare and PDPM – Education Today, Before, and Beyond October 2019

Transition to the PDPM model will be more successful when paired with well-defined professional services that help providers adapt to the new technology. MatrixCare’s experience with regulatory changes, migration to new technology platforms, and overall implementation of new functionality allows us to create a methodology tailored to provider needs.

Providers will be incentivized under PDPM to provide person-centered care. The workflows within MatrixCare have supported person-centered care for a number of years. However, PDPM will require providers to become engaged and show evidence of person-centered care early in the stay. To accomplish that, schedules and workflow within the first five days are critical. This change in approach has driven MatrixCare to not only re-engineer workflows, but our services to support the workflow changes.

MatrixCare customers can leverage many of these benefits now, by engaging with us in PDPM Optimization Assessment and Services. Our approach is to maximize your use of the workflows mentioned earlier in this article. We will ensure that by optimizing your use of the software, you will be in a solid position for the PDPM transition. By taking this step, you will minimize disruption, maximize the productivity of your staff, and have a very good grasp on your reporting and data needs. We encourage all providers to optimize their use of MatrixCare today, so please contact your Account Manager for more information.

Our Directions Conference, April 24 – 26, in Nashville, TN will provide the best near-term opportunity to see and hear first-hand, how the MatrixCare PDPM technology works. You cannot afford to pass up the opportunity to network with 100s of providers who are faced with the exact same challenges under PDPM. A series of PDPM panels, PDPM breakouts, and live PDPM demonstrations will be provided at Directions, and we look forward to seeing everyone there.

Beyond Directions, we will continue to provide a variety of education and service options that will allow you to adapt the MatrixCare PDPM-related technology to your business. Many of the tools that will help you reap PDPM benefits exist today, and the R2 Release will be the first live iteration of changes in the system.

MatrixCare PDPM – Innovation to Empower your Organization

To summarize the innovative ways our technology will support you and your staff, the illustration below is a visual depiction of where you will benefit today and tomorrow. As you collaborate with your staff and with MatrixCare resources, this innovation will secure your success and take your care outcomes—and your business—to the next level.

MatrixCare PDPM

It’s not too late to register for Directions 2019!

2019 Directions

MatrixCare Directions will provide you with comprehensive learning experiences, networking with peers, the newest technologies, and one-on-one time with industry experts to help you maximize your use of MatrixCare software and do your job more efficiently.

There will be a special focus on PDPM this year at Directions! MatrixCare is prepared for PDPM, and we are committed to easing your transition to this new reimbursement model by providing helpful information, tools, and tips. Programming at this year’s Directions User Conference includes a number of intensive-focus sessions on PDPM, as well as dozens of others that are designed to help your organization succeed under value-based care.

Don’t miss the premier educational event of the year! Register today and download a copy of the Session Planning Guide to plot your schedule and make the most of your time.

Need more information? View the Conference Summary for complete details.

MatrixCare Celebrates National Nutrition Month 2019

Written by Amy Wootton, RDN, Director of Nutrition Management

Amy Wootton

MatrixCare recognizes the Academy of Nutrition and Dietetics’ National Nutrition Month this March. Finding resources to provide appropriate nutrition information and evaluate the needs of your community members is key in helping them succeed in living a healthful life. Look to these five areas to ensure you are putting your residents in the best position to succeed:

  • Be a Food Safety Ambassador– Have a no-tolerance rule for poor food handling. Provide monthly education on food safety topics and follow proper food temperature control guidance.
  • Menu Planning Management– Providing proper meals that meet the Dietary Guidelines is not just for regulatory purposes. Nutrition is important. Allow adequate time and expertise for meal planning, and have your menus reviewed by a Registered
  • Provide Proper Portion Sizes– A scoop goes a long way! Make sure your portions not only meet the minimum nutritional guidelines, but are monitored for risk of over-serving and eating into your bottom line.
  • Evaluate Nutrition Needs–Food Preference & Nutrition Assessments capture the true picture of your resident. Dietary professionals are key resources in providing an accurate nutritional care plan.
  • Adhere to Diet Orders– To liberalize or not to liberalize is an ongoing conundrum. If a special diet is prescribed to meet medical needs and manage disease conditions, adherence can be critical. Creating an agreed-upon diet order formulary—that is adhered to from order to delivery—is the best standard of practice so that all team members and resident know what will be provided.

We are happy to help you meet these five critical areas through our MealTracker dietary software. MatrixCare offers nutrition software for your facilities that can encourage your efforts to help residents live their best life! Check out MealTracker and RetailTracker to see how we can serve you.

Product News

MatrixCare 2019 R2 is coming soon!

The next MatrixCare for Skilled Nursing release is planned for May/June 2019, and we are busy preparing the following new features and enhancements. Be sure to join us for our First Look Webinar on Tuesday, April 30 at 1:00 PM Central Time to learn more about what will be included in the release. Register today!

  • PDPM Primary Clinical
    The resident’s primary diagnosis is used to classify the resident into a PDPM clinical category. We will be adding a check-box on the face sheet as well as on a resident’s MDS in Section I named PDPM Primary Clinical that you can select if the diagnosis should be used to determine the PDPM category.
  • Discharge Summary/Transition of Care
    This is your MatrixCare One-Stop Shop for an effective discharge! The Discharge Summary provides necessary information to continuing clinicians, facilities, agencies, practitioners, families, and other caregivers, to help ensure a smooth and safe discharge.
  • CareAssist eMAR Worklists Enhanced
    Enhancements will be made to worklists which includes seeing all active orders for a resident and viewing the associated flowsheets. These enhancements make documenting easier and faster, giving you more time back to work with your residents.
  • NEW AR Statement Options
    Personalize your AR statements and maximize cash flow in the 2019 R2 release with the ability to upload and print your logo on the statement as well as the ability to include a place for credit card information to be written in by residents and their families.
  • Sequestration calculations automated for commercial insurance payers
    If you have managed care commercial insurance payers that use sequestration deduction, you will be able to set that up automatically by payer, just as you can now for your Medicare A, Medicare B, Like Medicare A, and Like Medicare B payers.
  • Import Eligibility Information from ABILITY
    There is now a way to seamlessly import critical eligibility information from ABILITY into Resident Documents for easy, real-time, and historical access.

What Can You Do Today to Prepare for PDPM?Plan, Prepare, Perform

The countdown to the October 1, 2019 implementation date for the Patient-Driven Payment Model (PDPM) is well underway, and MatrixCare is dedicated to helping you make a successful transition to value-based care.

We encourage you to read the MatrixCare for Skilled Nursing PDPM White Paper to learn more about the functionality that is being built into MatrixCare in support of PDPM and what tools can help you work more effectively in the fee-for-value future.

While many enhancements will be made to the system prior to the implementation date, there are many features currently available in MatrixCare that can help you prepare for PDPM.

  • Observations, Events and CDS Assessments
    Observations will be important evaluation tools related to changes to the resident condition. Events, such as a fall, could be an indicator for further resident evaluation.
  • Alerting to Out of Range Vital Signs
    Alerts can be generated on vital signs. Acceptable ranges can be set for the facility and the resident. The alert will be generated when vitals fall outside of the acceptable range. These values could be important for monitoring a change of condition.
  • Functional Abilities Capture in POC
    The PDPM calculation is dependent on functional abilities observations to generate the Function Scores. This data will be needed for the 5-day MDS and the Interim Payment Assessment.
  • Restorative Nursing Programs
    POC and Care Assist allow data capture for provided restorative services. The collected information will be used in the PDPM calculation.
  • Section GG Documentation and Reporting
    Section GG will drive the Function Score used in the PDPM calculation. Supporting documentation of the data used on the MDS can be collected through POC/Care Assist (displayed on reports) or the functional abilities observation forms.
  • Care Planning
    Care planning ties together multiple elements of resident care such as Diagnosis, Restorative Nursing goals, Therapy, and pertinent Clinically Complex issues not listed with the diagnosis codes.
  • Reports/Widgets
    Both reports and widgets serve as tools that alert you to new residents, when MDSs are scheduled, and vitals that fall outside the range.

As we continue the process of implementing PDPM-related functionality into MatrixCare, we will be providing updates and planning resources on our website.

View the PDPM White Paper here!

PDPM White Paper

Services News

Upcoming Live Webinars

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Utilize Restorative Nursing to Maximize Your Reimbursement
Join Stephanie Lundeen, Senior Implementation Consultant, to learn how to easily schedule resident specific restorative programs! You will also learn how to run reports to view the needed documentation and track the changes.

Register now for this webinar on Tuesday, April 9, 2019, at 1:00 PM CT.

On-Demand Webinars

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Get Ready for the Patient-Driven Payment Model (PDPM)
During this session we discussed:

  • The major differences between RUGS-IV and PDPM
  • The emphasis on coding associated with the new payment model
  • The key components of PDPM
  • Strategies for success

Developing a Successful Facility Action Plan for PDPM & ICD-10
During this session we discussed:

  • An overview of the requirements of PDPM
  • The impact of ICD-10-CM codes on reimbursement
  • The importance of clinical documentation supporting ICD-10-CM codes
  • Strategies for developing a successful facility action plan for PDPM & ICD-10-CM

Critical Coding Clues – The Key to maximizing Revenue Under PDPM
During this session, hosted in partnership with McKnights, we discussed:

  • The impact of ICD-10-CM codes on reimbursement
  • The importance of clinical documentation supporting ICD-10-CM codes
  • The importance of section I8000 of the MDS

Stay Compliant with PDPM with MatrixCare’s Observations and Care Plans
During this session we discussed:

  • How to organize observation categories and libraries considering PDPM components.
  • Ways to formulate new ideas around PDPM documentation
  • How to conduct an evaluation of current documentation as it relates to PDPM’s resident centered emphasis.
Regulatory News

Nursing Home Compare and the Five Star Rating System Updates

The Centers for Medicare & Medicaid Services (CMS) has issued improvements to Nursing Home Compare and the Five Star Rating System which will go into effect April 2019.

Changes include:

  • Ending the Freeze on Health Inspection Star Ratings
  • Quality Measure (QM) Domain Improvements
    • Short-stay and long-stay ratings
    • New QM rating thresholds
    • Process for continual improvement of QM threshold
    • QM weighting and scoring
    • Other QM updates
  • Staffing Domain Improvements
    • New staffing rating threshold
    • Reduction of number of days without an RN for a one-star staffing assignment

Review the CMS Memorandum, Press Release, and Five-Star Quality Rating System Technical Users Guide for more information.

Specialized Infection Prevention and Control Training Now Available

The Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) collaborated on the development of a free online training course in infection prevention and control for nursing home staff in the long-term care setting.

The training provides approximately 19 hours of continuing education credits as well as a certificate of completion.

The “Nursing Home Infection Preventionist Training Course” is located on the CDC’s TRAIN website.

Review the CMS Memorandum for complete details.

Revisions to Appendix Q of the State Operations Manual

The Centers for Medicare & Medicaid Services (CMS) has published revisions to Appendix Q of the State Operations Manual which provides guidance for identifying immediate jeopardy.

Review the CMS Memorandum and State Operations Manual – Appendix Q for complete details.

Changes to Quality Improvement and Evaluation System

There are two important updates issued by the Centers for Medicare & Medicaid Services (CMS) that affect the Quality Improvement and Evaluation System (QIES) users.

  • An upgrade is required to the Juniper VPN Network Client software (Network Connect Client) currently used by the QIES community to log-in to CMSNet for required submission and reporting.
    • The upgrade will be initiated automatically and will take effect the next time users launch the Juniper VPN Client and log-in following the scheduled upgrade dates.
    • Users must have Administrator rights on their workstation or have an IT staff member with Administrator rights assist the first time a user attempts to log-in following the upgrade dates.
    • Upgrade for Nursing Homes (MDS, EPOC, and PBJ) is scheduled June 30, 2019.
  • The Quality Improvement and Evaluation System (QIES) will undergo a series of system enhancements resulting in what will be now called the Internet Quality Improvement and Evaluation Systems (iQIES).
    • To comply with federal security mandates, CMS is initiating new security requirements for access control to CMS Quality Systems through Remote Identify Proofing (RIDP) via the HCQIS (Healthcare Quality Information System) Access, Roles and Profile Management system. Users will create accounts in HCQIS Access Roles and Profile Management (HARP) to gain access to the iQIES system.

Review the QIES Community Juniper VPN Network Client Upgrade and Remote Identify Proofing Requirements for iQIES memos for complete details.

Industry Events

AHCA/NCAL Quality Summit Highlights

Written by Amy Ostrem, Senior Product Manager

Amy OstremThe 2019 AHCA/NCAL Quality Summit offered loads of networking opportunities and excellent educational sessions. PDPM was in the air, and we were proud that MatrixCare was a primary sponsor of the conference.

Here are some key highlights from the educational sessions I attended:

  • MatrixCare client, Signature Healthcare, spoke on ‘Organizational Change: One Neighborhood at a Time.’ Chris Cox and Angie McAllister made a great team as they discussed some key differentiators of their organization that awakened many in the room:
    • Guiding a 5-10-minute morning huddle where the team is empowered to share changes in condition, upcoming appointments, and recognition of both employees and residents: for example, a birthday or anniversary. (They encourage Certified Nursing Assistants (CNAs) to run these huddles.)
    • Signature Healthcare requires that all leaders become CNAs.
    • In the resident neighborhoods, they encourage group activities such as game night or a chili cook-off to provide a home atmosphere.
    • They pride themselves on their nurses’ presence in the resident neighborhoods and have even removed nurses’ stations. Instead, they have a computer on a desk in a corner or on a cart that is kept in a closet area when not in use. Their goal with this was to remove the barrier between nurses and residents and keep them at eye level as much as possible to avoid them looking down on residents from behind a tall desk. The result, aside from getting nurses into resident neighborhoods more, is a nice and neat setting.
    • There are many goals and initiatives that are defined and measurable across the organization and the residents and employees work together on the prioritization of which to accomplish first. Some examples include:
      • Eliminating overhead paging
      • Being alarm-free
      • Reducing supplements
      • Animal companionship
      • Creating an art gallery open to the public

Excellent job, Signature Healthcare! You are inspiring positive change across America! We are proud to be your technology partner.

  • Another session that I chose to attend was “Competent Geriatric RNs: The New Driver of Financial Performance.”
    • In this session, statistical evidence was given around the American Nurses Credentialing Center (ANCC) and the link to VBP and PDPM. With board certification in Gerontological Nursing (RN-BC), they have found:
      • Improved Quality Ratings
      • Improved 5-Star Ratings
      • Lower Hospital Readmission Rates
      • Lower Anti-Psychotic Drug Use Rates
      • Survey Success
      • Reduction in Deficiencies
    • Gero Nurse Prep is an online training course designed to prepare RNs who care for elders to attain board certification in Gerontological Nursing (RN-BC) by the ANCC. The total cost for this important certification is $1,085.
  • The final sessions that took place were 3 LED Talks.
    • These will be posted on the Provider website – LED Talks 2019, and we strongly encourage you to watch the story of Paradise Facility in California as they evacuated their entire facility while facing imminent danger as a result of the fires quickly approaching, this past fall. Live through the emotions of the day, by hearing the Administrators’ story. (She brought her two small children to work with her that day and had to send them away to safety while she stayed behind to ensure the safety of the residents.)
    • A few key lessons learned from the administrator, that she was tremendously grateful for: surround yourself with a team of staff you trust, build strong and positive relationships with those in and near your community, and always trust your instincts.

Upcoming Tradeshows 

We look forward to seeing you at the upcoming events. Be sure to stop by our booth and learn more about all the MatrixCare solutions available to you.