MatrixCare PDPM Technology Empowers Providers to Transition with Ease

April 3, 2019
Categories: Corporate, Home health, Private duty
Reading Time: 5 minutes

SNF 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 reimbursements 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.

Advance your PDPM Task Force and Operating Models

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. Additionally, the exception-based workflows in Revenue-Cycle Management empower financial users to not only get paid faster but identify 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 is different from reports, in that they 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 full 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.

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.

Compliance, Change Management, and 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.

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 on the following key areas for PDPM.

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

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 interviews 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.

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.

Want to learn more? Let’s connect!

Kevin Whitehurst
Kevin Whitehurst

Kevin Keith Whitehurst, Senior Vice President, Skilled Nursing Solutions, has been a key player in LTPAC technology since 1990. Whitehurst has held many leadership positions including IT Director for one of the first developers of MDS software systems to, most recently, SVP, Client Services for MatrixCare. In his current role, he is responsible for the success of the Skilled Nursing Solutions Group and oversees Product Management, Professional Services, Sales and Marketing, and Client Support for that group. A 26 year veteran, Whitehurst has dedicated his career to improving Skilled Nursing Providers experience with technology. Whitehurst holds degrees from San Bernardino Valley College and the Los Angeles School of Business and also served in the U.S Air Force.

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