To say the least, 2020 was a difficult year for skilled nursing providers. Aside from the rapid, ongoing changes necessitated by COVID-19, providers are still reeling from recent, sweeping regulatory changes, including the CMS Patient Driven Payment Model (PDPM).
A year into life under the new model, some skilled nursing facilities are adapting to the new case-mix classification system mu
ch better than others, according to Russ DePriest, vice president and general manager of skilled nursing at PointClickCare.
“Under PDPM, CMS wants you to up your game when it comes to care outcomes, so fewer of your residents end up being readmitted to the hospital,” DePriest said. “As part of the new model, Medicare can withhold as much as two percent of reimbursements if a SNF has high readmission rates.”
The good news: Medicare pays facilities in full when they have low readmission rates, and offers added incentives up to 1.6 percent for exceptional performers. But what contributes to high readmission rates? For starters, a lack of automation, integration, and digitization across the resident journey.
Electronic Health Reporter recently spoke with Russ DePriest and Lauren Talbot, an EHR Consultant for Reliance Healthcare. Here, they discuss PDPM, the pandemic, and how digital transformation is driving outcomes in skilled nursing.
Question 1: Russ, how has the pandemic affected PDPM? And how have providers been leveraging technology to adapt to those changes?
Prior to COVID-19, PDPM was one of the biggest changes the SNF industry had seen to its system of operations. Prior to COVID-19, rather than focus on therapy, the new system incentivized treating the needs of the patient as a whole.
In terms of dealing with a high-needs population, PDPM is arguably better designed for a pandemic than the prior RUG system. Given COVID, where we know patients with co-morbidities are at a higher risk, paying on patient characteristics rather than therapy is beneficial to SNFs. So, although it wasn’t designed in anticipation of a pandemic, the new system is well-matched.
To help us further understand the impact of our technology on skilled nursing providers’ operations, including PDPM, we commissioned Forrester Consulting – part of an independent, objective research firm – to conduct a study and talk to some of our skilled nursing customers. I should note that Reliance Healthcare and Heritage Living were not among those customers.
Some of the interviewed facilities were able to save over $200,000 per year in PDPM-related penalties. This is because our platform enables digital transformation, and allows facilities to trace all treatments and associated results delivered to a resident. As a result, it’s easier for management to standardize and improve their evidence-based care plans, translating into better outcomes for residents. The result: facilities using the PointClickCare platform are better positioned to maintain the low readmission rate necessary to avoid penalties.
Question 2: Lauren, how has your facility used technology throughout the pandemic?
Throughout the pandemic, PointClickCare has put out some really great products, such as Infection Prevention and Control (IPC) that we have been able to quickly integrate into, and use to enhance, our existing workflows.
From a compliance perspective, skilled nursing facilities are required to have a respiratory screener. But without IPC, we would have had to create our own. Through IPC, PointClickCare created and placed scoring-based triggers in the assessment. If residents pass a certain scoring threshold, care staff are automatically triggered to immediately follow-up.
Additionally, Cliniconex, which PointClickCare recently acquired, has been a huge asset to our care staff. In regards to stakeholder communication, the solution has truly been a game-changer throughout the pandemic. We’ve been able to automate communications and deliver critical information, such as safety and outbreak announcements, policy changes, care plan reminders, and appointment notices via voice, text or email, and automatically log them in resident’s charts. This has helped us not only ensure regulatory compliance, but has also helped us to manage expectations and relationships with our residents’ loved ones.
Question 3: Russ, aside from the pandemic and PDPM, what are some of the challenges long-term care organizations are facing, and how is technology helping?
Before PDPM and COVID-19, staffing has been an ongoing challenge for skilled nursing providers. And I don’t believe it’s likely to go away even after COVID, or anytime soon for that matter.
Nurse burnout is one of the leading elements of the US nursing shortage. Increased demands, insufficient staffing and extended hours, especially in post-acute care settings, all contribute to burnout, and are some of the primary reason’s nurses leave the profession. This is especially problematic in post-acute care where patients are sicker and their conditions are more complex than ever.
When our customers were interviewed for Forrester Consulting’s study, we were able to learn more about the direct, quantifiable ways our platform is helping support nurses, and combating burnout. This includes reducing the time needed for charting, which amounts to approximately $698,000 in annual savings; streamlined and integrated workflow efficiencies, which amounts to $53,716 in savings. For many of our customers, these features of our platform have enabled them to reduce burnout and turnover, and has saved them north of $126,000 in staff turnover.
Question 4: Lauren, Heritage Living Center was the first-ever recipient of the HIMSS Davies Awards of Excellence. Can you explain how you used technology to improve your quality measures?
For context, the HIMSS Davies Awards of Excellence recognizes the thoughtful application of health information and technology to improve care delivery and patient outcomes. We were humbled to be the first long-term post-acute care organization recognized with the HIMSS Davies Award of Excellence. As an organization, Reliance Healthcare and Heritage Living Center are dedicated to promoting better health through sharing use cases, model practices and lessons learned on how to effectively embrace digital transformation.
Over twelve months, our Medicare 30-day readmission rates went from approximately 27 percent to 16 percent. Additionally, unintentional weight loss improved from more than 18 percent at the start of the program to less than one percent by the end. At the onset of the program, the national average was 8.2 percent.
To do this, an interdisciplinary team identified key technical components in PointClickCare’s skilled nursing platform to drive improvement, including integrated tools focused on analytics, eInteract, point of care, nutrition management and electronic messaging capabilities. Once the technical changes were implemented, we created staff communications and educational programs to increase to promote the new, integrated workflows.
Enhancing Care with Technology
As the senior care sector is transforming at an unprecedented, and rapidly changing pace, the power and impact technology can have on the quality of care remains constant. As we look ahead, providers across all sectors of healthcare, especially within the senior care space are recognizing the ability to lean on technology to simplify and optimize operations, while providing returns on both the top and bottom line.
For a comprehensive breakdown on how skilled nursing organizations can generate significant savings using technology solutions, read Forrester Consulting’s full report: The Total Economic Impact of PointClickCare’s Skilled Nursing Solution.