Outcomes Matter! Representing True Baseline and DC – determining the future of PDPM changes and more

Mark Parkinson, President of AHCA recently shared that from all indications, it is too soon for CMS to determine the impact of PDPM in order to enact changes to the model at this point. The industry is patiently waiting to review patient outcomes as well as the degree of reimbursement shift from budget neutrality while keeping a “keen” eye on delivery of therapy.

We continue to observe teams struggling to truly capture baseline GG (self-care and mobility) performance needed for accuracy in PDPM’s PT/OT and Nursing categories.

Contributing factors to accuracy include:

  • Capturing CNA / “helper assistance” during those first critical 3 days prior to the benefit of intervention

  • Capturing CNA / “helper assistance” involvement in the final 3 days - DC date and 2 days prior

  • Assessment to include direct observations, resident self-reports and reports from qualified clinicians, care staff, or family as captured in the medical record - from admission through 11:59 on the 3rd day of the stay – prior to benefit of intervention - per RAI manual

  • Understanding terminology and detailed task description to be assessed is essential

- Scoring is inverse from G ADL scoring utilized for Medicaid RUG levels

- Critical to educate nurses or those gathering from C.N.A’s / caregivers/ family / resident how to ask questions according to the RAI instructions

- Coding Descriptions:

• Independent: Did the resident complete the activity by him/ herself with no assistance from a helper

• Set up or Clean Up: Helper sets up or cleans up, resident completes activity. Helper assists only prior to or following the activity

• Supervision or Touching: Helper provides verbal cues and/or touching/ steading and/or contact guard assistance as resident completes activity – assistance may be provided throughout the activity or intermittently

• Partial / Moderate Assistance: Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs but provides less than half the effort

• Substantial/ Maximal Assistance: Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort

• Dependent: Helper does ALL of the effort. Resident does none of the effort to complete the activity Or, the assistance of 2 or more helpers is required for the resident to complete the activity.

• Activity Not Attempted: (remember this is usual performance prior to benefit of intervention from rehab or nursing during first 3 and last 3 days) - PDPM / QRP Self Care and Mobility Items:

• Self-Care:

• Mobility:

Remember: Section GG also impacts the following 5 Quality Measure Programs

  • MDS 3.0 Quality Measures

  • Nursing Home Compare Quality Measures

  • SNF Quality Reporting Program (QRP) Measures

  • SNF Value-Based Purchasing (VBP) program measures

  • Five Star Quality Rating program on Nursing Home Compare

Let's Get to the Point:

Functional Patient Outcomes are being assessed by CMS right now. They are being captured through our reporting on the MDS of baseline vs DC GG self-care and mobility assistance that is required. Let’s get it right. We must establish prioritized functional goals that are essential for each individual’s successful transition to the next level of care (at least 1 per the RAI manual), set realistic/ attainable goals, care plan and ensure IDT (including rehab) focus on these tasks, then monitor as a team towards DC readiness.
Wishing you and your patients all the best. Please let us know if we can help!