Podcasts about pdpm

In this episode of Heart-to-Heart with HealthCap, Angie Szumlinski is joined by MDS expert for Part 1 of our two-part deep dive into the MDS process. Robin shares how the MDS is used across care delivery, compliance, and reimbursement—and why coding accuracy and interdisciplinary collaboration are more critical than ever. Whether you're new to MDS or need a refresher, this episode offers foundational insights you won't want to miss. Robin has also created a f to support your learning!

Accurate OASIS coding is essential for all home health clinicians due to the direct impact quality indicators will have on an agency's star rating. With the CMS plan to move to a universal outcome measure for all post-acute settings, OASIS will become an important tool beyond home health. Payment through PDGM and PDPM are driven, at least in part, by improvement as measured through OASIS. This course will provide easy-to-use and understandable methods that will improve a clinician's ability to provide correct coding to all OASIS M1800 items and compare them to the OASIS GG items. This podcast will provide sample questions throughout the course to ensure the participant's understanding. Clinicians conducting OASIS assessments will immediately see an improved understanding of accurate OASIS coding, as will those participating in collaborative assessments now allowed by CMS. To view accreditation information and access completion requirements to receive a certificate for completing this course, please click here. The content of this Summit podcast is provided only for educational and training purposes for licensed physical therapists and occupational therapists. This content should not be used as medical advice to treat any medical condition in either yourself or others.

The podcast explores strategies for SNF teams to thrive under PDPM by adopting daily PDPM huddles. LCS categorizes beneficiaries into four groups, streamlining meetings and emphasizing key drivers during specific phases of the Part A stay.

Patient-Driven Payment Model (PDPM) in Skilled Nursing Facilities [Replay]Today's episode is all about the Patient-Driven Payment Model (PDPM) in Skilled Nursing Facilities (SNF).Join the Amplify OT MembershipAs an exclusive bonus for podcast listeners, you can join the Amplify OT Membership at any time! Join today to take control of your career! It's time to become your own best resource on Medicare and advocacy.Amplify OT ResourcesWant to keep learning about how insurance and reimbursement impact you? Then head to AmplifyOT.com/Services to see what resources we have available!CLICK HERE to save 40% off Medbridge Today! CONNECT WITH AMPLIFY OT:WebsiteServicesFree NewsletterInstagramLinkedInFacebookTikTokLINKS MENTIONED IN THIS EPISODE:Amplify OT SNF Resources ©Amplify OTMentioned in this episode:Join the Amplify OT MembershipAs a exclusive bonus for podcast listeners, you can join the Amplify OT Membership at any time! Join today to take control of your career! It's time to become your own best resource on Medicare and advocacy. Join the Membership Today

Have you ever wondered what a good SNF “outcome” looks like? Join QRM's Mark Hyder and Megan Ussery in the latest episode of the #BuzzPodcast as they discuss crucial elements to achieve optimal results.

Join QRM's Mark Hyder for a captivating conversation with Advion Executive VP, Cynthia Morton, as they discuss the recent CMS updates and Cynthia's response to the hypothetical scenario: "If you stumbled upon a genie in a bottle and granted 3 wishes for the SNF industry, what would you wish for?" Check it out now!

Medicare and Medicaid Policy Updates: RUGS, PDPM, MDSIs Medicare No Longer Paying for OT in SNF?I've seen a lot of concern on social media and in my DMs about potential significant changes to PDPM in Skilled Nursing Facilities, specifically around Medicare no longer paying for OT in SNF. You can rest assured that there have NOT been any major changes to Medicare Part A for therapy but other changes have been made. That's why this week on The Amplify OT Podcast, I am talking about updates to PDPM in Skilled Nursing Facilities (SNF) and when these changes are set to take place.Join the Amplify OT MembershipAs an exclusive bonus for podcast listeners, you can join the Amplify OT Membership at any time! Join today to take control of your career! It's time to become your own best resource on Medicare and advocacy.The updates I cover in this episode include:CMS finalized that it will no longer support the utilization of RUG payments for Medicaid programs. There have not been any cuts to Medicare Part A SNF funding but rather a 4% increase. Removal of Section G (former ADL section), integrating some items into Section GG (function and self-care).The changing of quality measure scores. Changes and modifications around COVID-19 policies. ICD 10 Code mapping changes for Parkinson's and COVID-19. Amplify OT ResourcesWant to keep learning about how insurance and reimbursement impact you? Then head to AmplifyOT.com/Services to see what resources we have available!CLICK HERE to save 40% off Medbridge Today! CONNECT WITH AMPLIFY OT:WebsiteServicesFree NewsletterInstagramLinkedInFacebookTikTokHelpful LinksMedicare.gov Care CompareAOTA: Major Changes to the Minimum Data Set in Skilled Nursing Facilities Fiscal Year (FY) 2024 Skilled Nursing Facility Prospective Payment System Final Rule - CMS-1779-F | CMSOccupational Therapy in Skilled Nursing FacilitiesAmplify OT: SNF Resources Ep 5: Patient Driven Payment Model (PDPM) in Skilled Nursing Facilities

Change is difficult, but sometimes we're so focused on it, we can overlook the basics. Join QRM's Mark Hyder and Megan Ussery as they discuss some of the important SNF fundamentals you don't want to forget.

In the latest episode of the #BuzzPodcast, Mark Hyder is joined by QRM's Director of Reimbursement, Megan Ussery, and Sr. VP of Integrity and Quality Improvement, Stacey Hallissey, to discuss CMS's move from the PHQ-9 to the PHQ-2 to 9 assessment model.

In this week's episode of the #BuzzPodcast, QRM's Mark Hyder and Megan Ussery explore the important topic of "Changes in Skin Integrity Post-Acute Care" and shed light on the newly released Standardized Pressure Injury Prevention Protocol (SPIPP) checklist.Are these changes leading us to embrace a "back to the basics" approach to skin integrity? Tune in now to gain insight and decide for yourself!

In this episode of FrameworkFocus, we delve into the world of regulatory compliance in long-term care with experts Donna Adendorff & Jamie Butler from The Compliance Store. This valuable resource supports skilled nursing facilities in meeting regulatory requirements efficiently. We explore the collaborative efforts required to achieve and maintain compliance, discussing its crucial impact on LTC quality. We also address post-COVID-19 challenges, staffing issues, payment concerns like PDPM, and the complexities of operations in LTC. 

In this week's episode of the #BuzzPodcast, #QRM's Mark Hyder and Ashley Duggan delve into the challenging yet significant topic: Documentation! The recently mandated 5-claim review for CMS MACs brings documentation to the forefront. Listen along to gain valuable insight into how this critical form of communication can ensure accuracy, compliance and efficiency.

In the latest episode of the #BuzzPodcast, QRM's VP of Reimbursement Strategy & Education, Mark Hyder; Director of Reimbursement, Megan Ussery; and Sr. VP of Integrity & Quality Improvement, Stacey Hallissey discuss the impact of the upcoming proposed CMS changes to Section GG, the potential impact on various payment & quality reporting systems, and provide tips to prepare your team.

Accurate OASIS coding is essential for all home health clinicians due to the direct impact quality indicators will have on an agency's star rating. With the CMS plan to move to a universal outcome measure for all post-acute settings, OASIS will become an important tool beyond home health. Payment through PDGM and PDPM are driven, at least in part, by improvement as measured through OASIS. This course will provide easy to use methods that will improve a clinician's ability to provide correct coding to all OASIS-C and D (cognitive and mental health) items. This podcast will provide sample questions throughout the course to ensure the participant's understanding. The podcast format will enable participants to listen and review the material at their own leisure, while providing an in-depth look at very specific sections of the OASIS. Clinicians conducting OASIS assessments will immediately see improved understanding of accurate OASIS coding, as will those participating in collaborative assessments now allowed by CMS. To view accreditation information and access completion requirements to receive a certificate for completing this course, please Click here   The content of this Summit podcast is provided only for educational and training purposes for licensed physical therapists and occupational therapists. This content should not be used as medical advice to treat any medical condition in either yourself or others.

In the latest episode of the #BuzzPodcast, QRM's VP of Reimbursement Strategy & Education, Mark Hyder; Director of Reimbursement, Megan Ussery; and Sr. VP of Integrity & Quality Improvement, Stacey Hallissey discuss the impact of the upcoming proposed CMS changes from a compliance perspective.

In the latest episode of the Buzz Podcast, QRM's VP of Reimbursement Strategy & Education, Mark Hyder; Director of Reimbursement, Megan Ussery; and Sr. VP of Integrity & Quality Improvement, Stacey Hallissey enter the QM Corner to discuss quality measures focusing on preventing falls with major injury.

Introducing the newest series of the Buzz Podcast covering all things MDS! Led by our team of MDS and Section GG pros, this series will explore a variety of topics to equip your entire IDT with the knowledge, tools, and resources necessary for a smooth transition on October 1st. Tune in to the first episode as QRM's VP of Reimbursement Strategy & Education, Mark Hyder, and Director of Reimbursement, Megan Ussery, dive into the upcoming proposed CMS changes and share their views of what may be expected. As you prepare for the upcoming changes, this is worth a listen!

In this episode of the Post-Acute POV, originally featured in the McKnight’s Long-Term Care Expo, Jenny Lee, Regulatory Compliance Manager, and Cassie Diner, BSN, RN, CPHIMS, CSPO, SA, Clinical Product Manager, have a conversation on the major changes coming to MDS and how skilled nursing facilities can prepare. Join Jenny and Cassie as they discuss how the new MDS items may affect your assessment process moving forward, what you should do to help your staff prepare for these changes, and what to look for to ensure your technology vendor is working to ease this transition. Listen to their discussion below. Topics discussed during today’s episode: [01:47 – 07:09]: Cassie greets the audience, introduces the topic, and provides background on her expertise in managing regulatory changes. She then offers seven recommendations for providers as they prepare for the MDS changes going into effect, on October 1, 2023. [07:09 – 12:13]: Next, Cassie elaborates on the main changes: Section G or functional status being removed from standard OBRA forms, the potential for new OSA or state forms, 29 new or modified MDS questions bringing more commonality between post-acute care and the OASIS form used in home health, and more. [12:13 – 18:06]: Cassie describes both a complicated and simple reimbursement change that was made at the state level. Wisconsin’s elaborate PDPM transition and Illinois’ much simpler transition to PDPM. She goes on to discuss the state-level uncertainty and nuance with the OSAs. [18:06 – 22:58]: Cassie and Jenny share what the audience can do now to prepare. Review your assessments or observations completed by nursing and other parts of the interdisciplinary team within your EHR system to see where changes need to be made and eliminate questions or change questions prior to the October 1st deadline to capture necessary data. [22:58 – 28:29]: Next, Cassie describes how organizations should work with their technology vendor as we approach these major changes. Attend your vendor’s advisory council meetings and share your status or any new information to stay on the same page with your vendor. Also, consider participating in complimentary training provided by CMS. [28:29 – 33:47]: Cassie describes the three roles that facilities should focus on as CMS begins to release the requisite documentation: caregiver or nursing staff, dedicated educators, and MDS coordinators. She then shares some key insights and feedback she has gathered within the industry. [33:47 – 38:15]: Cassie closes the discussion by sharing how the coming months will be huge for continued success leading to October as the CMS is expected to release final MDS questions and item sets. It will remain a top priority to stay in the loop with your technology vendor. Resources Learn more about MatrixCare: https://www.matrixcare.com/ Find out more about McKnight’s Long-Term Care News: https://www.mcknights.com/ Read the transcript of today’s episode Listen to more episodes of the Post-Acute POV Disclaimer The content in this presentation or materials is for informational purposes only and is provided “as-is.” Information and views expressed herein, may change without notice. We encourage you to seek as appropriate, regulatory and legal advice on any of the matters covered in this presentation or materials. ©2023 by MatrixCare

In this episode of the Buzz Podcast, we sit down with QRM Regional Operations Director, Brett Seely, as he shares insight on the success he's found with Section K Capture under the PDPM model at the facilities he oversees. Learn how PDPM has put the speech component front and center, what Section K involves, the importance of the interdisciplinary team in the modern-day SNF and much more.

Marie, Matt, Michael, Michelle, and Rachel dive into the research and pop news in and related to the field of Speech and Language Pathology and the Informed SLP breaks down the latest research.   On this week's episode the group looks at hearing awareness and brain injury awareness days, a new study on PDPM, and a new law mandating staffing sizes in nursing homes.  The Informed SLP looks at writing deficits in Deaf and Hard of Hearing students. The Discord is up and ready for people to interact with the crew 24/7 with a new website, www.discord.speechsciencepodcast.com. SSPOD Shoutout: Do you know an SLP who deserves a digital fist bump or shout-out?  We want to know your #SSPODSHOUTOUT, which is recognition for someone doing something awesome somewhere.  SSPOD Due Process: Your opportunity to message us about a problem in your area that you would like us to talk about, use the #SSPODDUEPROCESS.  Contact Email: speechsciencepodcast@gmail.com Discord: https://discord.speechsciencepodcast.com Speech Science Stuff: http://merchandise.speechsciencepodcast.com/ Presence Learning GiveAway: http://giveaway.speechsciencepodcast.com/   New Episode and Interact here: www.speechsciencepodcast.com podcast.speechsciencepodcast.com   Support Patreon – https://www.patreon.com/speechsciencepodcast   Rate and Review: https://podcasts.apple.com/us/podcast/speechscience-org-podcast/id1224862476?fbclid=IwAR3QRzd5K4J-eS2SUGBK1CyIUvoDrhu8Gr4SqskNkCDVUJyk5It3sa26k3Y&ign-mpt=uo%3D8&mt=2   Credits Intro Music: Please Listen Carefully by Jahzzar is licensed under a Attribution-ShareAlike License. Bump Music: County Fair Rock, copyright of John Deku, at soundcloud.com/dirtdogmusic The Informed SLP: At The Count by Broke For Free is licensed under a Creative Commons Attribution License Closing Music: Slow Burn by Kevin MacLeod is licensed under a Creative Commons Attribution License. ----more---- Show Links The Informed SLP: https://www.theinformedslp.com/review/the-writing-s-on-the-wall https://pubs.asha.org/doi/10.1044/2021_LSHSS-21-00062 WHATS UP ASHA? https://www.ashfoundation.org/apply/?utm_source=asha&utm_medium=enewsletter&utm_term=updates&utm_content=022222&utm_campaign=ashanow&fbclid=IwAR1cbQpJaqiHrMyIfml598unhE4lrCvxzIYi-Smtom_29r-Ko4bgrmyl1sw#Awards Brain Injury and Hearing Awareness Days https://leader.pubs.asha.org/do/10.1044/free-hearing-test-app-launched-for-world-hearing-day/full/?fbclid=IwAR2udIIzUh0iGP9GLuKfQ_PoUkplgnAmZrfSwpBHr0-2fQu-mCGLPOcEcH8 https://leader.pubs.asha.org/do/10.1044/2022-0302-who-safe-listenting-standards/full/?fbclid=IwAR0dZswzx9JJANqmCvGhXqD-5Rww3KRnI64-wVKw2ACKyQouBVJBpvn3tS4 https://register.gotowebinar.com/register/6788923971276869903?fbclid=IwAR2a7Elp6gWjyUIZL5mV-jexIg72xBoFrt3605GXCD-Y71Bj5Dv98P17ow4 https://www.biausa.org/public-affairs/public-awareness/news/biaa-announces-2022-legislative-issue-briefs?fbclid=IwAR1rrDmzR5EI8CyjrwPDcbpwl8ofIfedbUurZNRlu95SptBUX07xUEGLFwU PDPM Study https://www.mcknights.com/news/pdpm-lowered-therapy-minutes-but-not-outcomes-study-shows/?utm_source=newsletter&utm_medium=email&utm_campaign=MLT_Weekly_20220114&hmSubId=7_VUd0yWuec1&hmEmail=3fOCg7EwmQExiIJakCwpBUlM-jC4ofvl0&email_hash=647aced71664f4c075f382105aac74d3&mpweb=1326-24577-809775 https://leader.pubs.asha.org/do/10.1044/2022-01234-study-pdpm-effects/full/?utm_source=asha&utm_medium=enewsletter&utm_term=picks&utm_content=022222&utm_campaign=ashanow&fbclid=IwAR3ANtlGkZ1xXl5xMIbY1fRJpGSPjXU1BUa_N8AEWX1VjgABWtSi13ZB3cs New CMS Laws https://www.mcknights.com/news/cms-wallops-nursing-homes-with-planned-staffing-requirements-and-increased-penalties/?fbclid=IwAR0e66ROz6MtDA2HuJH9Digp1uWRp7aZriG_uc-TTe08rWkqnWkAW38EYf8 Shout Out https://www.jconline.com/story/news/local/lafayette/2022/03/01/purdue-grad-nickey-ramsey-goes-shark-tank-wins-deal-her-business-junobie/9329753002/ Book Link https://www.amazon.com/gp/product/B09JS6BK1F?ref_=dbs_mng_crcw_0&storeType=ebooks   Speech Science Powered by: PresenceLearning! https://www.presencelearning.com/  

Melissa Brown welcomes, Irene Henrich, VP of Quality and Compliance with Flagship Rehabilitation, and Director of Compliance for EDGE Therapy Solutions. We will be having a robust discussion about PDPM, therapy and reimbursement during this episode.

Today's episode is all about PDPM in Skilled Nursing Facilities (SNF). We talk about the fundamentals of the old payment system or RUG levels and how it is different from the payment model we have today. We also take a good look at Section GG, its impact on reimbursement and quality outcomes, how therapy specifically is paid for, group and concurrent therapy, and more! As promised, here are the links I mentioned in the show. Sign up on Patreon for ad-free content: www.patreon.com/amplifyot Link to the SNF/HH Workshop with OT Flourish: amplifyot.teachable.com Link to the Virtual Geriatric Therapy Summit* *indicates an affiliate link --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/amplifyot/message Support this podcast: https://anchor.fm/amplifyot/support

Welcome to the Healthcare Compliance Insights podcast, a series focused on healthcare regulatory, revenue integrity, compliance, and risk management topics. In this episode, BerryDunn healthcare consultants Regina Alexander and Olga Gross-Balzano discuss the contemporary revenue integrity landscape specific to post-acute healthcare facilities, including the impact of PDPM and COVID-19 emergency flexibilities. Tips shared include how facility compliance officers, finance, and revenue cycle leaders can leverage their organization's PEPPER report and the data compiled through the Medicare cost reporting process to identify compliance gaps and revenue integrity opportunities.

Megan joins the pod to share our QRM community PDPM trends from 2021 using QAI (Quality Assistive Insights) info in DataIQ. She takes us through each PDPM component and shares multiple great trends which are directly related to our QRM educational focus areas this year! Way to go QRM teams! She also pointed out what we will be working on together next year to address our trend opportunities. If you didn't get a chance to hear about QAI from our partners at DataIQ, listen to this roundtable Friday's with Freda podcast episode: https://www.qrmhealth.com/podcast/episode/797537b6/fridays-with-freda-roundtable-with-data-iqReach out to Megan for any MDS questions using her MDS hotline: https://forms.office.com/Pages/ResponsePage.aspx?id=5QGdE4AYhEOO6Z2CGrlQTmicn3cArCpDgA-bFVoc1FJUQTZMWkRNM1o0VldCSVQ4OU5RV1RKQTQ2UyQlQCN0PWcuAnd, if you need a PDPM refresher, register for Megan's most recent webinar training on PDPM with a case study: https://attendee.gotowebinar.com/recording/8231716322231967752

PDMP and EPCS are two emerging abbreviations essential to curbing the current opioid epidemic. David McFarlane, Marketing Communications Manager with Medsphere, and Host Tyler Kern discussed what they are and their relevance.PDMP, or Prescription Drug Monitoring Programs, are state registries that track opioid administration by pharmacists. PDMPs are not implemented in every state and are not state-standardized. EPCS, or Electronic Prescriptions for Controlled Substances, is when providers send a prescription to a pharmacy and there is an electronic record that can link to the PDMP. Currently, PDMP and EPCS are not federally mandated. Twenty-two states lack one program while six lack either. This will likely soon change, as the government moves to enforce overarching requirements that could prevent addicted individuals from doctor shopping across state lines.A federal mandate would not change pharmacist workflow much if these programs are automated. In fact, implementation would benefit healthcare workers such as physicians. An ER physician might pull up a patient record and observe a history of their prescriptions on the registry to see if anything indicates addiction. McFarlane explained, “It also gives him or her a clear picture of where that patient sitting in front of him or her sits and what their real needs are.” This data is useful but there is no protocol for how to approach it in terms of funneling patients to rehab programs or administering weaning medications. McFarlane stated, “That's something that has to be discussed widely in the country in terms of programs, in terms of protocols for physicians in different hospitals.” As for next steps, McFarlane believes protocol standardization at the state level is achievable if small hospitals receive funding to implement opioid programs and comply with a mandate.Learn more about PDPM and EPCS and get in contact with McFarlane by visiting medsphere.com.

In this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, vice president of education and certification strategy for AAPACN and Jennifer LaBay, RN, RAC-MT, RAC-MTA, CRC, AAPACN's newest curriculum development specialist, discuss some common missteps related to MDS coding and PDPM that nurse assessment coordinators (NACs) need to know.

In this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, vice president of education and certification strategy for AAPACN and Jennifer LaBay, RN, RAC-MT, RAC-MTA, CRC, AAPACN's newest curriculum development specialist, discuss some common missteps related to MDS coding and PDPM that nurse assessment coordinators (NACs) need to know.

Melissa Brown, Gravity's COO and self proclaimed PDPM healthcare nerd, interviews Autumn Wade, Therapy Operational Consultant for Gravity healthcare Consulting/Director of Outpatient and Long Term Care Services with Flagship Rehabilitation. In this episode they discuss how  PDPM has been a huge shift for therapy, compounded even further by COVID arriving just 6 months after the implementation. Flagship Rehabilitation Flagship Rehabilitation is a contract therapy partner providing PT, OT and SLP therapy services.

Michael Angelo Datu is a physical therapist, a certified strength and conditioning specialist, an American Physical Therapist Association - Certified Clinical Instructor and a proud Angelean. Michael is a Physical Therapy supervisor in an orthopedic geriatric skilled nursing facility. In this episode, we talked about what a typical day is like in a skilled nursing facility, changes he experienced because of PDPM and COVID19, challenges and memorable experiences in his practice. Also, he shared valuable lessons he learned from his mentors and through his career. Let's take a listen. --- Support this podcast: https://anchor.fm/ptmealpodcast/support

Join Michele Kramer and  Christina Bruenderman as they discuss the details of  How therapy, nursing, dietary and MDS can prevent denials Speech Therapy Services and PDPM.  

Gravity Healthcare consulting welcomes, Edwin Frost, the CEO of Aeris Consulting and Management. In this episode we will discuss how to educate multiple clients about how to leverage Respiratory Therapy in the PDPM era, all while improving resident outcomes and reducing hospitalizations.Aeris - Respiratory Therapy

Check out this episode for a heated discussion about logical vs. illogical storytelling. If a story is illogical, let's really understand why and what it says about our services, our patient population, and the care we provide. Logic has an emotional foundation as it drives us to action! In this episode, we discuss how to apply emotional logic to your PDPM storytelling. Let's get fired up!

Rita joins the pod to continue her PDPM series focused on the ST component. Today she reveals a new Quality Improvement & Education (QIE) Program to improve the allocation of resources to the residents we serve by increasing accuracy of conditions captured. This program is called the SLP Road Map to Success and she takes us through a case study of questions to ask when you approach a Yellow Light Road - check this one out!

Tune in to hear compliance expert, Irene Henrich, Vice President of Quality and Compliance for Flagship Rehabilitation and Director of Compliance for EDGE Therapy Solutions, share her thoughts about the SNF proposed rule for FY 2022 and what it means to you. Huge changes with PDPM, analysis of therapy impact with PDPM and COVID, payment changes and Value Based Purchasing are just some of the topics covered in this packed podcast. Understand more about what is behind the information in the proposed rule and how you can make an impact, and help SNFs to avoid PDPM payment cuts.Flagship Rehabilitation Flagship Rehabilitation is a contract therapy partner providing PT, OT and SLP therapy services.

In the skilled nursing world, it was a truth universally acknowledged that the Patient-Driven Payment Model was a lifeline for operators trying to navigate the COVID-19 pandemic and the resulting “business nightmare.” But the federal government has proposed a recalibration of the new system, and it’s not clear yet what that could mean for providers. Mark Parkinson, the president and CEO of the American Health Care Association, joined Rethink to talk about why SNFs can be more optimistic than in years past about the proposed changes from the Centers for Medicare & Medicaid Services – and why the Biden administration’s push to invest $400 in home- and community-based care isn’t as antagonistic to SNFs as it might first appear. Listen to this episode to hear about: -The unanswered questions around occupancy and what needs to happen for recovery -Why the proposed PDPM recalibration isn’t likely to be a repeat of drastic Medicare cuts in 2011 -Elevating and investing in frontline caregivers, and what it will take to do that properly

As the founder of MNT Associates and an experienced long-term care dietitian, Esther Gutman hires, trains, and provides dietitians to long-term care facilities. Dietary is often disregarded as glorified catering when, in fact, it is one of the most prominent facets of a facility. It is the one area of service that every resident and every family member can understand and look forward to. For this reason, Esther always tries to bring excellent standards to the kitchen. In order to fully comprehend the reality of what staff must deal with, dietitians should spend time in the kitchen. This will allow them to make informed orders that staff will be able to carry out. Esther states that personality and attitude are 75% of a dietitian's success and they should seek to be team players and establish rapport with staff, especially CNAs.Obtaining weights may be one of the biggest problems that dietitians face. Rather than dealing with it on their own, they should hold team meetings around weights so everyone can understand the complex issue.  LEARN MORE ABOUT ESTHER AND MEDICAL NUTRITION THERAPY ASSOCIATES!  LinkedIn Website  RELATED EPISODESEp. 49: Better Care Coordination; Real Patient ChoiceEp. 17: Staffing, Retention and Vendor Relations with 3rd Generation Operator; Mark KaszirerEP. 2: Recruitment and Staffing in Long Term Care with Alvin Kahn

Join Michele Kramer as she discusses the top 5 reasons for PDPM denials with Christina Bruenderman, Director of Denials and Appeals with TMC.

In this episode Melissa Brown, examines the positives and pitfalls of various contract model approaches. If your in house program is in trouble you will learn identify the right contract oversight model for your community.

In this podcast, Kim Hicks, vice president of business development with AAPACN talks with Michelle Karl, LVN, BSHA, MBA-HC, RAC-CT, RAC-CTA, clinical sales engineer with ABILITY Network, an AAPACN Diamond Partner and our 2021 Premier Conference Sponsor, about the freeze on the Skilled Nursing Facility Quality Reporting Program (SNF QRP) Quality Measures, what facilities need to do now to prepare for when the freeze ends and reporting and audits resume, how section GG will become even more important, and how processes have changed with some states now collecting PDPM payment codes on OBRA assessments. Don't miss this podcast!

In this podcast, Kim Hicks, vice president of business development with AAPACN talks with Michelle Karl, LVN, BSHA, MBA-HC, RAC-CT, RAC-CTA, clinical sales engineer with ABILITY Network, an AAPACN Diamond Partner and our 2021 Premier Conference Sponsor, about the freeze on the Skilled Nursing Facility Quality Reporting Program (SNF QRP) Quality Measures, what facilities need to do now to prepare for when the freeze ends and reporting and audits resume, how section GG will become even more important, and how processes have changed with some states now collecting PDPM payment codes on OBRA assessments. Don’t miss this podcast!

In this episode of the Post-Acute POV, we sit down with Amy Wootton, RDN, LDN, Director of Nutrition Management at MatrixCare, to discuss the prevalence of malnutrition in older adults and how technology can help facilities to identify malnutrition in the data and take quick and appropriate action to combat it. Amy describes the challenges related to malnutrition and the importance of pairing a malnutrition screening tool with observation and assessment information when preventing and treating residents. Topics discussed during today’s episode: [01:09 – 02:09]: Amy dives into her backstory and her journey into nutrition management and post-acute care. [02:24 – 03:10]: Concern surrounding malnutrition, specifically in older adults. [03:17 – 04:16]: Malnutrition related challenges. [04:26 – 07:15]: Benefits of a malnutrition screening tool (MST) and the importance of observation and assessment information. [07:33 – 09:25]: A description of the frontline and how providers can benefit from a malnutrition screening tool under PDPM. [09:46 - 12:27]: Other tools that support care planning for malnourished individuals. Resources Learn more about MatrixCare solutions at: https://www.matrixcare.com/ Find out more about malnutrition in the data Read the transcript of today’s episode Listen to more episodes of the Post-Acute POV Disclaimer The content in this presentation or materials is for informational purposes only and is provided “as-is.” Information and views expressed herein, may change without notice. We encourage you to seek as appropriate, regulatory and legal advice on any of the matters covered in this presentation or materials. ©2021 by MatrixCare

Long-term care expert Reg Hislop looks back on how SNFs fared over the first year of PDPM, and discusses the Part B therapy rate cut by 9%.

Learn how IPAs can protect you! IPAs are a critical weapon in our PDPM arsenals. This episode covers how effective IPA management helps drive appropriate and accurate reimbursement while keeping you protected.

Freda Mowad is the CEO of Quality Rehab Management, QRM, and as a speech and language pathologist who has worked in the rehab industry for 20+ years,  has a lot of experience to bring to the table.Despite its importance, rehab predominantly stands apart from the rest of a nursing facility and often administrators don't completely understand its complexities. For this reason, facilities often outsource the entire rehab team to third party vendors. It can create an internal rift between the rehab team and the rest of the team.Freda highly recommends the integration of in-house rehab but warns that attempting it alone has its own risks. Administrators don't have the time or expertise required to manage the billing and oversee the productivity of rehab programs. They also typically lack the clinical expertise necessary to ensure therapists are complying with the rules and regulations and keeping up to date with current practices. Seeking out an in-house rehab management corporation such as QRM will alleviate these risks and also other challenges the rehab department may encounter,  such as staffing and communication.FIND OUT MORE ABOUT QRM!QRMhealth.com  Related EpisodesTeletherapy During Covid-19What is PDPM and How Will it Affect You? With Marc Zimmet of Zimmet Healthcare

Gravity Healthcare Hacks welcomes, Ashley Haltenhof, Director of PDPM Operations for Flagship Rehabilitation. This episode covers successful tips on how Flagship has helped their customers achieve PDPM Champion status.

In the episode we discuss the challenges and opportunities the new payment model present to operators and how they will affect the residents and patients of these facilities.  Here's a partial list of what we discussed in this episode. Who will be affected most by these changes? What is the best way for providers to successfully navigate this transition? What are the 3 biggest myths 'outsiders' perceive regarding the nursing home industry? 

Steven was privileged enough to have known what he wanted when he was young. He took up nursing and realized that he wanted to be involved in caring for the elderly, being someone who was close enough to live with his grandparents. Then took up a graduate degree in Gerontology. Steven also worked in clinical care in Hebrew SeniorLife in Boston. He then transitioned in research and training institute and became a part of the development team for other projects where he developed the importance of standardized clinical assessment, its reliability and validity, and the power of what can be done in the datasets for this assessment. Recruited to Pointright, he started studying the data and creating proprietary algorithms to help operators, nurses, and other professionals to have data driven insights about the industry. This has given the professionals and stakeholders with real-time, actionable information. Being involved with a lot of information and assessment data, Steven realized his passion in filling the gap between the quality of clinical outcome and the lack of fully grasping the financial aspect . It was then that he joined Zimmet Healthcare, with his enthusiasm for analytical thinking on the reimbursement models and how to best equip their clients and was appointed as the Chief Innovation Officer to lead the Zimmet team in discovering new ways to help the providers and stakeholders in achieving great nursing service. Steven has pointed out the sad truth of the current payment structure, which doesn't motivate people to think about a systematic approach to end of life. He gave various examples showing that should have been of financial advantage, elders would have been given better care. Shmuel shared his insights on how the system has been rigged with thinking that the financial impact gets the better tilt on the scale as it provides viability to the business, overlooking the quality of services that it should have been prioritizing in the first place, as it was the major force to improve the financial aspect of the business. Steven explains how the PDPM is an improvement to the current healthcare system that will be beneficial to everyone involved in the business, since nursing is more fund-centered. As he goes teaching classes for PDPM, he points out the mix of people included in seminars that is involved and interested in this model, and he appreciated how well aligned these people are into listening and getting as much information as they can to prepare for the common goal. The Therapists' Role in the SNF A great example that he mentioned are the therapists being boxed in their reimbursements per minute. For him, therapists are one of the most commonly overlooked health care provider, and they are being valued only per minute, even though they provide healing and rehabilitation, which are incredible. PDPM will allow them not only to be reimbursed with the timed service they provided, but to be comfortable in giving the quality service that is required of them without the hesitation of being underappreciated. The new model allows everyone from the management to skilled workers to join together, be in the table together and discuss the appropriate care needed for the patients, which minimizes the tension in between departments. PDPM Concerns Although beneficial, Steven still emphasizes his few concerns with PDPM. Since it will be all about the patient, he believes that behavior will have to change come October. Terms will also have to change accordingly. In nursing facilities, residents will no longer be called “residents” but “patients”. He also acknowledges the importance of documentation as it will be heavy in implementation of PDPM. This change will also mean taking the rules of the past and trying to apply them to the future. If you want to gain a better understanding about PDPM and how this new model works, listen to the podcast as Steven and Shmuel intelligently discuss about this change and gives their deep analysis about it. Steve's final thoughts on PDPM: I hope my passion and excitement about this change comes across. I just think that we are in such an unbelievable inflection in our industry. PDPM is not certainly propped for success. PDPM is here for five years before, it will be replaced by another system, and that other system is already foretold. We are going to site neutral reimbursement where all institutional post-acute settings will get the same rate. PDPM and the data that we are now collecting is really going to demonstrate that we are the best game in town. We're providing the best outcomes at the lowest cost. So this is just a simple stepping stone, if we crush this we are going to do exceedingly well in the future. Shmuel's Take on SNFs People come in completely paralyzed and walked out the front doors; we get the trimmest, leanest reimbursement, and many times we get outstanding results, and if that (PDPM) is the way to the future, then that is really amazing news for providers. Key Takeaways: 08:24 When the clinical results and the clinical product have a direct financial impact, that's when everybody wins; that's when the residents win, that's when the operators win, that's when all the various partners win. 10:34 How can it be that in the industry that is created to care for elders, how can we be so bad at identifying someone's at the end of life? How can we struggle so much with identifying people who are in pain. It is because our system does not reward that. 17:40 You push on one side of the water bed and the other comes up. 32:16 CMS believed PDPM will be budget neutral and there's no way it's going to be budget neutral. These changes are never budget neutral because behavior changes, we play by the rules, we change our behaviors, we start documenting things we never documented before.

What does Zimmet Healthcare actually do? Zimmet Healthcare is a consulting support firm specializing in skilled nursing facility reimbursement, compliance and strategic planning. Initially started as a service vendors creating cost reports and appeals for Medicare and expanded as the industry has matured. Zimmet Healthcare currently employs about 60 people servicing about 300 facilities across the country. Do you see a significant trend in the reimbursement method for SNFs from when you started out to today? There's a complete shift in SNF reimbursement. To be frank, clinical reimbursement is a complex topic and the goal of this conversation is to get a better understanding of the big picture, the coming changes and how they will affect day to day operations of your nursing home. With that in mind, let's go back to Marc's answer. In the earlier days, reimbursement was based on the costs a facility incurred when caring for a particular resident. The more the facility spent on the resident, the more was their reimbursement within reason. This is now changing to a model that is based on price and not cost. There is a fixed rate per day for a residents' condition, diagnosis and plan of care. The facility will get reimbursed at that rate regardless of the actual costs incurred by the facility. Why is Medicare Changing the Reimbursement Methods? One of the biggest challenges with the current PPS/RUG method of reimbursement is that there is too much of an emphasis on the therapy received by the resident. For example, if there are to residents who receive the same level of therapy, the facility will receive similar reimbursement for them even if one has significant other clinical challenges (such as wound care or cognitive issues etc.). PDPM - Patient Driven Payment Model PDPM which is starting October 2019, enhances the reimbursement sensitivity of the all the different payment drivers and takes the focus away from therapy as the primary driver of payment. PDPM Vs. RUGs To understand the difference in reimbursement consider the following. We are going from a RUG system which has 66 RUG scores (of which we only use 20 or so of them), to PDPM which has almost 29,000 rate composite possibilities, which boils down to 15-20,000 rate combinations that will actually be used. In simpler terms, with more words in the language we can be that much more precise. How Does This Affect the MDS Process? The MDS job description will change a bit. There will be fewer assessments, however, it will require working more extensively with the other disciplines. Whereas in the past the reimbursement was driven primarily by therapy and ADLs, now the other disciplines will play a significant role in the reimbursement process. For example, dietary will need to capture a mechanically altered diet. The psychologists, respiratory therapists and others will play a large part in this process. Who is Pushing for These Changes? The federal government is pushing for these changes. MedPac (The Medicare Payment Advisory Commission) has been almost begging congress and CMS to implement a patient specific payment model that does not recognize the frequency and duration as the payment driver because it provides an incentive to over treat the patient. Is the Government Trying to Save Money With This? Theoretically, this is supposed to be budget neutral. It's a redistribution from facilities that focus primarily on the therapy intense patients, to facilities that take the sicker, more compromised patients on the vents and trachs. The medically complex patients reimbursement will go up considerably and the therapy intense patients will go down. Will Facilities Make More Money in PDPM? Zimmet Healthcare expects that facilities will get better at taking credit for the care they provide and in the first year Medicare will actually spend more than their budgeted amount. This will be followed by a rate reduction that will recalibrate the dollars to make it budget neutral. So perhaps in year 1, the facilities that learn and implement programs to accurately take credit for the care they provide, may make some extra money. However, once the rate is adjusted, it should remain budget neutral. Who Gains by These Changes? Ultimately, these changes are indeed in the best interests of the patient. The problem with the system is that you almost have to provide a high level of therapy in order to keep your doors open. Let's take the dialysis patient as an example. In the RUG reimbursement model, the facility would lose money. The rates are simply inadequate. Facilities would try an aggressive treatment approach where they would take the resident to therapy early in the morning knowing that the resident will not be able to tolerate the therapy on their return. With PDPM, this will not be necessary because the other clinical challenges will be considered as well in the reimbursement rate. What is Changing in the Medicaid System? Being that Medicaid is not a national system, and each state runs their own program, it's difficult to speak about the specifics of the program. However, in general terms, Medicaid started out as a cost based model, many states then went to a case mix and acuity model, to a priced based system and finally to managed care. This is not universal but is the general trend. More importantly, every state has x number of dollars to spend on their Medicaid program. The main concern is not the distribution of reimbursement for the program, rather, it's the overall total funding of the program. An astute operator will learn to maximize their Medicaid reimbursement dollars in any Medicaid system. The problem lies in the total dollar amount that the state allocates to the Medicaid program. Are the Articles That State the Amount a Nursing Home Loses Per Day Accurate? It may be true that the rates are inadequate, however, the facility was never going to be profitable just by the reimbursement payments. In order for a facility to be profitable they will need a good short term rehab census as well. This together with the Medicaid payments can make the facility viable and profitable. If the facility was 100% filled with Medicaid patients with the right acuity mix, and everyone had Medicare Part B you would not be losing $37 a day. Is Owning and Operating Nursing Homes Still as Profitable Now as it was 25 Years Ago? In the early 90's it seemed like a really simple business to run. Nowadays, it's a very complex business. Today, there is tremendous potential in the post acute care continuum which SNFs are such an important part of, is where the opportunity lies. In post acute care management, there real opportunity to meet the new demands of the new nursing home residents. A stand alone nursing facility that is well managed can absolutely be a profitable business and serve the community well. Where are Those Baby Boomers? We are always being fed information by the media that with the baby boomers are coming of age and nursing homes will have to scramble to meet the need. While in reality, nursing homes are struggling to survive due to lack of patients. As mentioned earlier, there are a variety of variables that are causing this to happen, including the push to provide for these elders within the community. However, the statistics do show a sharp increase in the Altzheimers disease in the coming years of which 75% of those over 80 will need to be admitted to a SNF. That is something that will significantly increase the utilization of SNF care and should sharply affect the overall occupancy. Contact Marc Zimmet and learn more about Zimmet Healthcare at ZHealthcare.com