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.
From a senior care perspective, we are starting to see many senior living communities shift their focus towards putting technology first. In fact, the shift over the last three years is exponentially more than all the progress from the last ten years combined.
As we continue to see an increase in the implementation of technology, we’ll also see residents’ quality of life improve because we are enabling them to age in place longer and remain in their preferred care setting.
In actuality, technological advancements and innovation are more likely to come to the senior living industry over any other care setting. Since these types of facilities are largely privately funded, senior living facilities are more likely to adopt these new innovations over those organizations that are funded by the government.
Overall, technology is starting to be more widely implemented to improve senior care by managing resident data more efficiently, all with a primary focus of helping our seniors to maintain the independence, health, and general wellness.
We have officially entered into a New Normal and technology overall will continue to play a larger role within the senior living space. Mobile technology will be even more critical and engaging family in care through the use of family engagement solutions will become foundational.
Leveraging an EHR as an underlying platform to improve overall care quality allows care providers to truly see resident needs and find creative ways to address them.
By taking a comprehensive approach to an EHR, providers in the senior living space can gain insight into the community’s key operating metrics, then adapt and adjust accordingly by regularly tracking clinical outcomes, staffing, and quality indicators.
From a data perspective, more and more senior living communities are recognizing the importance of interoperability. Data being collected shouldn’t just tell us where we are at, it should tell us where we are going by helping us predict potential issues before they happen.
By B.J. Boyle, vice president and general manager of post-acute insights, PointClickCare.
In my last post, I discussed how our healthcare system is approaching a critical time in which the looming “silver tsunami” will drive baby boomers into hospitals and post acute care facilities in record numbers. Similarly, we will see dramatically increased patient transfers between care facilities, as an aging population moves between hospitals, skilled nursing facilities and senior living facilities in unprecedented numbers. At the same time, a seamless and accurate patient data transfer process is critical, given our current and predicted future nursing shortage, and the time-consuming and error-ridden nature of manual data transfers.
In order to determine if our system is optimized to deliver what is needed, PointClickCare recently conducted a Patient Transition Study in partnership with Definitive Healthcare, which found that alarmingly, many facilities haven’t yet fully embraced all of the possibilities of integrated electronic health record (EHR) platforms and are, instead, still relying on manual-based processes to handle patient transfers.
Respondents to the survey, which included c-suite executives from acute and post-acute care facilities, explained their current data sharing policies, interoperability issues, as well as other care delivery and coordination concerns in this important blinded voice-of-customer quantitative study. The data shows that while EHRs are nearly ubiquitous in hospitals and skilled nursing facilities, many healthcare professionals still struggle with — or have reservations about — sharing critical patient information with their care partners.
Instead of relying on secure, simple, HIPAA-certified technology to streamline patient transitions, providers have been utilizing manual processes like phone calls and faxes — systems that require a human touch and are prone to inefficiencies, mismatched details, and omissions.
The Over-Reliance on Manual Processes = Inefficiency
As patients move from acute-care facilities to LTPACs, the sharing of critical patient information and associated data safely and securely is extremely important for coordinating care. But despite best efforts and intentions, many providers still aren’t sharing all patient data and information.
The most startling findings from the survey dive into the number of acute care and LTPAC facilities that still use manual-only strategies to coordinate patient care. In fact, thirty-six percent of acute care providers use manual-only strategies to coordinate patient transitions with the LTPAC community, compared with only 7 percent of LTPACs with acute care providers. Although a majority (84 percent) of LTPACs use a mix of digital and manual strategies to manage processes, only 56 percent of acute care providers do.
One respondent to the survey, a CEO of an LTPAC facility, explained that their local hospital “uses faxes to accommodate HIPAA and [to] be confidential.” He (or she) found this particularly frustrating as it creates more work and slows down care delivery: “Almost everything we touch is obtuse. You have to search it out, figure it out, and confirm it by phone,” adding that the absence of standardized forms and data-entry fields makes faxes especially inefficient.
By B.J. Boyle, vice president and general manager of post-acute insights, PointClickCare.
As every nurse, physician,
clinical case manager, and healthcare IT professional knows well, we have
passed the stage in which locking up patient data is an effective care
practice. In fact, ineffective data siloing can slow down operations and can
drastically and negatively impact patient care, as well as put unnecessary
strain on an already overtaxed workforce. In short, data silos are a great
barrier to realizing a fully
implemented state of interoperability.
We must unlock — and
importantly, share — critical health data to improve the quality of
patients’ care throughout their medical journey. Data sharing will
improve efficiencies in our nation’s health facilities by reducing
readmissions, reducing negative drug interactions, and improving care to
decrease patient length-of-stay, to name a few. Acute providers know that
reducing readmissions is critical in a value-based payment environment because
the penalties can be detrimental to the financial health of the facility.
That makes the need to share data quickly and efficiently more
pressing than ever. Only by embracing technological innovations and sharing
data can care providers see a holistic view of the patient — from potential
injuries and emotional challenges to drug interactions and comorbidities.
That’s not to say that keeping
up with demand while offering high-quality patient care will be an easy task.
But we know it certainly isn’t possible with the way things are.
Further, by accessing data about previous patient outcomes, case
managers can help patients and their families determine the right treatment
facility for them, increasing the effectiveness of referrals and increasing the
chances that your facility will become the preferred provider. When patients
are matched with the right facility for their specific needs the first time,
their recovery time and health outcomes will improve. That’s good for everyone:
decreasing costs and increasing hospital ratings by reducing readmissions is a
More confident care
Data that has been removed from silos and integrated into a
cohesive and actionable digital chart allows providers to follow their
patient’s journey post-discharge, improving the speed and quality of
information exchange with skilled nursing and acute care facilities, which
leads to more confident care.
Modern EHR technologies and cloud-based solutions can finally make
interoperability possible and can increase efficiency so providers can stop
waiting by the fax machine and instead get back to doing what is most
important: helping patients heal.
Patient discharges, for example, can be extraordinarily labor-intensive and are further complicated when they are transferred to a post-acute care provider. As a result of the inherent complexities, hefty paperwork and need for seamless transitions, manual processes, a lack of transparency and data silos can cause significant negative impacts on patient health and frustration for families and providers alike.
The cloud-based technology we need already exists to assist with such paperwork, cutting down discharge time and allowing providers to get back to the myriad of other tasks awaiting them. Faster discharges mean more free hospital beds, helping with overall efficiency and an improved bottom line.
More information sharing between clinics also means patients can make informed decisions about their own health. Both patients and physicians or case managers will have a full picture of both acute and chronic issues while referrals can be made more effectively based on past results of patients with similar conditions.
When you think about it, using integrated technology to share success rates is a no-brainer. People research their meals on Yelp before going to dinner, or read reviews on a pair of shoes before buying them, so why shouldn’t patients be equally as informed about something as important as their health in real-time?
Data sharing can also effectively eliminate issues like drug or
medication problems. Researchers estimate that nearly half of all seniors between the ages of 70 to 79 take five
medications a day. A patient might be given his or her medication twice—or perhaps
not at all—because their care information is siloed between facilities. It’s a
problem that can easily be solved.
We know that outdated, labor-intensive processes that involve manually transmitting data to separate servers doesn’t make sense in a cloud-based world, especially when it comes to solving a crisis we know is coming. While a piecemeal data strategy might have worked in the past, we can’t afford to be less than buttoned up now or in the future.
With the anticipated increase in demand for skilled nursing and acute care services, innovative and integrated data systems are critical. Increased interoperability means patients and providers can make informed decisions, quality care is improved, and paperwork-heavy tasks are simplified, improving hospital and clinic efficiency and making life easier whether we’re the patient, caregiver, or provider.
We already live in a data-driven world, but it’s up to us to
embrace a better way to take care of our patients’ health information now and
in the future.
PointClickCare, the leading cloud-based software vendor for the long-term and post-acute care (LTPAC) and senior living sectors, announced today the launch of PointClickCare Companion. The new mobile app leverages the powerful design possibilities of iOS to significantly improve the way senior living providers track and manage the delivery and documentation of care services, medication, and billing. In addition to Companion, PointClickCare will be showcasing a variety of significant new enhancements to its senior living platform while at the Argentum Senior Living Conference.
“After gathering direct input from senior living communities, as an Apple mobility partner, we’ve harnessed iOS, the most robust development platform available to thoughtfully and confidently create a mobile experience that addresses providers’ complex needs while still keeping the simplicity and the user experience in mind,” says Travis Palmquist, vice president and general manager of senior living, PointClickCare. “As a result, we believe Companion’s sophisticated user interface and streamlined workflow capabilities will drive mobile-led business transformation and help to redefine and improve how communities provide resident care.”
By simplifying the critical task of patient documentation in an easy-to-use iOS app, PointClickCare Companion delivers unique benefits without interrupting the resident caregiver interaction, and provides senior living communities several significant outcomes, which include:
Enhanced resident experience: With immediate access to information on their iPhone or iPad, caregivers may reduce the time typically required for documenting a task. Tasks can be completed accurately and efficiently, in a timely and less clinical manner, increasing resident satisfaction with the service they are receiving.
Improved financial health: Senior living communities can quickly identify, capture, deliver and bill for ancillary services, as well as justify additional service billings (scheduled or unscheduled), with accurate documentation.
Expanded talent retention: Companion’s user-friendly tools empower staff to manage their day by simplifying the medication distribution and documentation process with intuitive workflows. Many activities of daily living (ADL) can be completed in 30 seconds or less at the point of care. Caregivers can spend more time focusing on patient care and less on administrative tasks
These outcomes can be further enhanced when Companion is integrated with other PointClickCare solutions, such as its point of care (POC) and electronic medication administration records (eMAR) modules.
The Patient Driven Payment Model (PDPM) is more than just a new name attached to Medicare payment reform. The shift from Resource Utilization Group (RUG) IV to PDPM moves the skilled nursing reimbursement model away from therapy provision as its main driver. Instead, payment will be determined by the provision of nursing care with higher rates being attached to more clinically complex patients.
PDPM will also align reimbursement with the industry-wide shift to value-based care (as opposed to volume).
It is designed to:
Incentivize treating the needs of the whole patient
Refocus care on good clinical practices
Decrease focus on the volume of services that the patient receives
Reduce administrative burden on the provider
Why do we need it?
The skilled nursing industry has advocated for payment reform for years. In response to requirements in the IMPACT act of 2014 and the resulting PAMA act, post-acute care must have a unified prospective payment system by 2024. Different post-acute settings use different data to determine payment. PDPM is the beginning of unifying the data tied to reimbursement.
In addition, the Medicare Payment Advisory Commission (MedPAC) and the Office of the Inspector General criticized the current RUG IV system for incentivizing therapy over the provision of clinical care. Essentially, the more therapy minutes provided, the higher a skilled nursing facility would be reimbursed. Since the majority of minimum data sets (MDS) that were submitted in the highest RUGs categories were within five minutes of the 720-minute threshold, the RUG IV system was scrutinized for promoting the threshold as a goal for care, rather than the outcomes of the therapy.
Also, RUG IV has been criticized for its strenuous administrative requirements. Providers needed to complete many assessments for a single Medicare A stay. For many years, CMS has been under pressure to reduce the administrative burden associated with RUG IV.
These factors illustrate the need to link reimbursement to patient need, as well as the imperative to focus on good clinical care.
The Resident Classification System, Version 1 (RCS-1), was proposed in May 2017. In May 2018, RCS-1 was replaced with PDPM. It was finalized on July 31, 2018 and will go into effect on October 1, 2019.
A reduction in scheduled PPS assessments from five to one required assessment and only two unscheduled assessments, the IPA and the Discharge PPS assessment
More focus on the clinical characteristics of the resident
Utilization of ICD-10-CM documentation to drive reimbursement process for therapies and non-therapy ancillaries
Opportunity to increase reimbursement with proper co-morbidity capture
Shifting resident population away from rehab-intensive focus to more clinically focused care
How you can start preparing now
To adequately prepare for PDPM, there are several activities facilities can begin performing to ready themselves for the transition. These steps to change management for PDPM will help any facility succeed through the immediate shift in payment. They will also strongly position a facility to readily adapt to future payment reforms or shifts that may be imposed as all payors transition to the PDPM methodology.
To start, facilities need to understand the plan and the financial, cultural and operational impact it will have on their business. Providers need to consider their current state, as well as areas they want to be successful in once PDPM goes into effect. Homes should be looking at staff skills and competencies to support the shift to a more clinically driven patient population and determine where changes, education, or upskill training is required.
Facilities need to understand the impact of the conversion. For example, will they have the right mix of residents and needs to support revenue goals? This is also the time homes should examine how they capture required documentation and ICD-10 coding practices. Do they have the right information to code appropriately? To get the right code? To accurately code the MDS? This is the foundation for being successful with PDPM.
After facilities understand PDPM and its impact on their business, it is crucial that they standardize their processes and content to capture the right data elements. This will better enable facilities to gain insights into what else they may need to change to be successful, as well as identify gaps, level the playing field for staff care provision, and make possible the measurement of expected outcomes against actual outcomes. This standardization will also serve homes well in the future. PDPM affects Medicare A residents in 2019, but when CMS retires the PPS item set in 2020, homes that have mastered the move to standardization will find the shift to PDPM for all payers much smoother.
Interoperability, as it was envisioned, should be built on transparency and connectivity, allowing a patient’s critical health information to be easily accessible, regardless of where treatment is being administered. By creating an infrastructure that supports the sharing of patient data along the care continuum, hospitals, skilled nursing facilities (SNF) and long-term post-acute care (LTPAC) facilities can offer the best care possible. As a result, organizations that participate in interoperability best practices are positioned to become preferred providers.
Unfortunately, interoperability is still a work in progress for many organizations. While more than 95 percent of hospitals and 90 percent of office-based physicians are now utilizing electronic health record (EHR) platforms, many struggle with — or have reservations around — sharing information outside of their facility. As such, silos represent a great barrier to realizing a fully implemented state of interoperability.
The current data gap can drastically impact care. For example, a patient experiences a serious medical incident — such as a fall or stroke — and arrives at the hospital where staff may not have access to existing patient data which could inform the best delivery of care. Or perhaps they’re able to access that data, but not right away. Care is now delayed, which can be additionally concerning depending on the time-sensitivity of the patient’s condition.
Taking this example a step further, let’s explore what happens after care at the hospital has concluded. The patient requires rehabilitation, and a continuation of care document (CCD) is issued to a post-acute care facility. From there, the patient’s information is transferred by less-than-foolproof methods such as fax, for example. A glitch as simple as a jammed paper feed could prevent critical information from reaching the appropriate caregiver.
As value-based care and payment-care models are moving toward the forefront, blind handoffs of patient information are no longer viable, as they drastically increase the financial risks hospitals and payer groups are subject to — not to mention the clear detriment the system has on delivery of care.
Closing the gap
The larger question is how does the industry get from Point A to Point B? The easy answer is to liberate the data through a cloud-based infrastructure that supports an efficient, easy-to-access data exchange between all caregivers. An integrated solution would connect stakeholders across the care continuum, providing accurate insights when needed, eliminating data silos between care partners, and enabling more confident decision-making.
These systems would promote:
Optimized transitions: Data needs to travel with the patient — or before movement — discretely across all systems.
Patient visibility: Data should reflect the most current ADT information, identifying and sharing where a patient is and from where they’ve been discharged.
Central view of LTPAC patients: This facility-agnostic feature should offer automated updates of a patient’s functional progress.
Ongoing status and monitoring: Maintaining continued care is facilitated through alerts and notifications to caregivers regarding any change to their status or well-being and meaningful feedback on care pathway progress.
Facility performance: Beyond understanding a patient’s status, it’s also helpful to understand how facilities in and out of their PPN have performed.
The concept of interoperability, in some ways, seems contradictory to traditional best practices. Healthcare organizations are charged with protecting patient data at all costs, and the idea of sharing data in a way that opens access to a wider group of stakeholders could give pause. Regulatory infractions for data loss in the healthcare industry can be steep, and the number of well-publicized data breaches in recent years reinforces how valuable health records are to both the organizations who keep them and those who try to steal them.
So, it should go without saying that an EHR “superhighway” must be developed with security in its DNA, taking stringent regulatory requirements into account. The good news is that the newest breed of information exchange platforms is being built with security roles in mind, drastically reducing the possibility of data loss.
Interoperability between healthcare’s disparate systems seems to be the stickiest of wickets, and a Holy Grail that every soul in the sphere is trying to find. Given the number of conversations about the topic, there’s often little discussed about its actual importance. Perhaps this is an assumed measure or an outcome that should be clearly understood as positive, but every relevant aspect of every story should be covered, not simply assumed. Because far better reporters and publications have done a far better job of describing the interoperability issue and its place in the current healthcare landscape, I decided to ask one question of the community, in an search of a foundational answer to: How is interoperability critical to healthcare innovation?
The prospective provided here, from some of healthcare’s most knowledgeable insiders, offers some interesting insight into a topic that seems more or less overlooked in the larger conversation of achieving interoperability or its capabilities.
Rick Valencia, senior vice president and general manager, Qualcomm Life Interoperability is the future of healthcare innovation, especially as we move toward an era of connected, team-based care. We need to create platforms and devices that enable the seamless, frictionless flow of data to allow doctors, patients, providers and care teams to collaborate efficiently to make critical care decisions. As care moves from the hospital to the home and more patients are remotely monitored, we need solutions that enable continuous care, informed interventions, and better management of at-risk populations. Without interoperability, we can’t innovate. Without innovation, we can’t improve the health of our nation.
Interoperability is critical to innovation in healthcare IT, particularly when it comes to connecting the care delivery ecosystem to provide safer transitions of care between acute and senior care. While some individuals may require short-term rehabilitative care, others may need home-based care, assisted living or long-term and hospice care. As seniors move through these different stages or between acute care and post-acute care, these transitions pose challenges for healthcare providers. Ideally, all the information that clinicians need to treat the individuals will be available when they arrive at their new destination. However, this is not always the case. Healthcare providers must invest in an infrastructure and emerging technologies, such as electronic health records and mobile communications, which support seamless transitions; interoperability plays a vital role. Compared to single-purpose or “best-of-breed” software solutions, comprehensive platforms can optimize many parts of the business, from enabling better-connected resident care and documentation, to delivering high quality data insights for financial management and risk mitigation. In the end, this will allow for better health outcomes, help reduce unnecessary hospital readmissions, ensure organizations are financially sound and keep healthcare costs down.
It is estimated that one-fifth of the U.S. population will be 65 years or older by 2030. According to Florida Atlantic University, out of the 1.6 million Americans currently living in a nursing home, 60 percent of that population is sent to the emergency room, while another 25 percent are admitted to the hospital each year. As a result, the care transition process between senior communities and acute care providers has become critical to ensure the best outcomes for patients.
Traditionally, when a senior care resident is sent to a hospital, the receiving healthcare provider may not have a complete view of the patient’s history. Ideally, documentation and medical records should travel with the resident so that all the information clinicians will need to properly treat the individual will be available upon arrival. Unfortunately, this is often not the case.
The good news is that there is technology to help improve this process in three main ways:
Reducing unnecessary hospital readmissions
Reducing paper and therefore medication errors
Increased focus on person-centered care
Reducing unnecessary readmissions
There is a lot of talk in the industry about how technology is helping to reduce hospital readmissions, but these conversations often lack tangible, measurable results. One thing is certain – providers have benchmarks to meet. On Oct. 1, 2012, The Centers for Medicare & Medicaid Services (CMS) implemented penalties for hospital readmissions at a rate of one percent. By Oct. 1, 2014 this rate increased to three percent. By 2018, CMS is mandating that those same penalties that apply to hospitals will apply to skilled nursing facilities.
CommonWell Health Alliance announces the addition of five new members enhancing the association’s nationwide footprint, share of the EHR marketplace and diversity across the care continuum. MEDITECH, Merge and Kareo join as contributing members while PointClickCare and Surgical Information Systems (SIS) join as general members.
With the addition of these new members, CommonWell membership now represents 70 percent of the acute care EHR market and 20 percent of the ambulatory care EHR market. CommonWell membership also represents market leaders in imaging, perinatal, laboratory, retail pharmacy, oncology, population health, post-acute care and others across the care continuum.
“We know it takes collective experience and dedication to break down barriers to nationwide data exchange, so we are especially pleased to welcome these industry innovators to the CommonWell family,” said Nick Knowlton, Vice President of Business Development at Brightree and CommonWell Membership Committee Chair. “Each organization will contribute to our effort by providing a commitment to action and new perspectives for additional use cases that will help us accelerate our current deployment of real-world interoperability services.”
• MEDITECH is one of CommonWell’s largest members to join since inception. It provides fully integrated technology solutions for hospitals, ambulatory care centers, physicians’ offices, long term care and behavioral health facilities, and home care organizations. MEDITECH’s membership increases CommonWell’s share of the acute care market from 50% to 70%.
• Merge is a leading provider of enterprise imaging, interoperability and clinical systems that seek to advance health care. It offers solutions in radiology, eye care, cardiology, orthopedics and clinical trials—all of which provide the opportunity for CommonWell to develop new use cases across a broader spectrum of the health care continuum. Additionally, Merge has the most complete radiology solution on the market, from small-volume sites up to the largest practices and chains in the country.
“Merge embraces the opportunity to join CommonWell at a critical moment in health care,” said Steve Tolle, Chief Strategy Officer at Merge Healthcare. “Industry leaders must actively come together to make interoperability real, and the Alliance provides an effective platform for meaningful dialogue and collaboration to help chart the future trajectory of the health care industry.”
• Kareo brings more than 30,000 providers and 60,000 users of its cloud-based medical office software suite into CommonWell. As CommonWell continues to deploy services nationwide, Kareo’s ambulatory experience and reach will accelerate universal provider access to critical health care data.