rural swing bed management program - hthu · mds 3.0 version 1.16.0 data set for proposed quality...

Rural Swing Bed Management Program

Presented by: Kerry Dunning, MHA, MSH, CPAR, RAC-CT

PPS Hospitals: What you Need to Know about October 2018

Webinar Etiquette

• All attendees are in “Listen Only” mode

• Questions or comments?- Open “Questions” pane in dashboard.- Type in comments or questions- Comments will be monitored - Questions will be addressed at end of the webinar

Webinar Etiquette

• This webinar will be recorded and emailed to you to share with others on your team, as well as posted on your program dashboard.

• Handouts are available for download in the Handouts pane and will be emailed out to attendees after the webinar.

Continuing EducationAs an IACET Authorized Provider, HomeTown Health, LLC offers CEUs for its programs that qualify under the ANSI/IACET Standard. HomeTown Health, LLC is authorized by IACET to offer 0.1 CEUs for this program.

In order to obtain these units, you must: • Attend webinar/view recording in its entirety

within 30 days• Pass online quiz with 80% or better.• Complete webinar evaluation.

Following this webinar, all attendees who have viewed the recording in its entirety will receive an email with a link to the quiz and evaluation. Anyone that misses the webinar can view the recording online, posted on the program Dashboard, for CEUs.

Agenda

Welcome & Introductions – Jennie Price, HTH2018 Program Overview

Training: “What you Need to Know about October 2018” - Kerry DunningQ&A

Upcoming Events - Jennie Price, HTH

Program ObjectivesRural Swing Bed Management (RSBM) Training Program1. To provide comprehensive Education and Training in Rural

Swing Bed Best Practices for compliance and efficiency.2. To provide Hospital Consultation Services to individual

hospitals to include site visit and technical assistance.3. Compilation of Data Collection and Monitoring in order to

monitor status of hospital swing bed program and provide expert recommendations.

4. Continue to develop of a Swing Bed "Community of Practice" for sharing of best practices among participants.

5. To provide of ongoing expert technical assistance and support to participating hospitals.

2018 Program OverviewAugust 16 at 10am: Webinar: What you Need to Know about October 2018: For Program Directors, MDS Coordinators, Therapy Director, Therapists, Coders

August/September Release: Swing Bed Foundations Certificate Program

September 6 at 10am: Webinar: What you Should be Doing now to Prepare for 2019For Program Directors, MDS Coordinators, Therapy Director, Therapists, Coders, Billers, Compliance

October 16/17, 2018: Live RSBM Meeting: Breakout Sessions at HTH Fall Conference: 9am - 10:30 PPS Only: (CAHs join at 10:30) - 12:30

2018 Program OverviewNovember Release: Support Course: “Opioids and the Elderly”by Kim Shaw-Grant and Kerry DunningFor CNO, Pharmacists, Program Directors, MDS Coordinators, Nursing, Medical Direct

December 6 at 3pm: Webinar: “Swing Bed Best Practices: Compliance"For C-Suite, Program Managers, MDS Coordinators, Therapy Director, Compliance

January 3, 2019 at 3 pm: Webinar “Swing Bed Best Practices: Activities Programs“-For Program Managers, MDS Coordinators, Nursing, Therapy Director, Compliance

2018 Program OverviewFebruary 2019 Release: Support Course: "Swing Bed Nursing Documentation” Lisa Pando and Kerry Dunning

April 2019: TBDMarketing Workshop/Best Practices Showcase, Release of Marketing ToolkitTraining for C-level at the end of day two

May Release: Support Course: “Defining Quality Standards”Mary Madison + Kerry DunningFor CNO, Nurse Managers, SWB Director, Therapy Directors, Nursing staff, and Quality

June 6 at 3 pm: PPS Concluding Webinar for C-Suite, Program Managers, MDS Coordinators, Therapy Directors, Compliance, and Quality

Trainer Biography: Kerry Dunning, MHA, MSH, CPAR, RAC-CTKerry has over 30 years in the health care industry, and over 25 specifically working in post-acute. She worked for national rehabilitation chains in varied roles and in hospital leadership positions. Kerry has experience with start-up units/facilities, programs beginning Medicare services, ongoing management of hospital business office operations, IRF units, skilled facility operations, and in 100-day turn around programs centered on cost reduction, cost avoidance and revenue enhancement. As a consultant, Kerry has worked with swing beds (CAH and PPS), skilled nursing units, freestanding and hospital-owned long term care facilities. She has served as an educator for hospital and LTC associations, hospital associations and for CAH associations in the areas of corporate compliance, Medicare compliance, medical necessity documentation, therapy services, and coding/billing. She is the primary SNF/Swing Bed consultant for two rural health state associations and a presenter at two other rural health associations annually.Her international work includes projects in Russia (training and starting the first nursing home services), China (teaching graduate students on western post-acute services and training on western inpatient rehabilitation); volunteering with an orphanage in Bolivia; teaching on outpatient surgery (National Health Services, England); Home Health (European Health Conference, Spain); presentations on Chinese Health in a Poster Session and a Free Theme Session at the 36th World Hospital Congress (Brazil); and study projects in Italy, Cuba, and Canada.

Disclosure of Proprietary Interest& Partnership

Kerry Dunning has no proprietary interest in any product, instrument, device, service, or material discussed during this learning event.

A portion of this program was produced in partnership with the Georgia State Office of Rural Health, Rural Swing Bed Management Program for 2018, Contract #18048G.

Rural Swing Bed Management



What you Need to Know about October 2018

Learning OutcomesBased upon Center for Medicare and Medicaid (CMS) Swing Bed Providers guidelines, and hospital based skilled nursing and swing bed program best practices.

By the end of this training, you should be able to:

• Describe the October 2018 updates to the MDS• Identify key section changes• Recall the importance of Section GG• Identify how these changes impact survey and audit

Here’s What You Need to KnowNursing Home Performance Measures: The purpose of NQF-endorsed standards is to provide information to help consumers select nursing home care facilities, although they also may be used by nursing homes for internal quality improvement efforts and by discharge planners, physicians, Quality Improvement Organizations, purchasers, policymakers, researchers, and state survey and certification personnel for their various purposes

Quality Reporting Program (QRP): The IMPACT Act requires that CMS develop and implement quality measures from 5 quality measure domains using standardized assessment data. In addition, the Act requires the development and reporting of measures pertaining to resource use, hospitalization, and discharge to the community. Through the use of standardized quality measures and standardized data, the intent of the Act, among other obligations, is to enable interoperability and access to longitudinal information for such providers to facilitate coordinated care, improved outcomes, and overall quality comparisons.

MDS 3.0 Version 1.16.0 Data Set for Proposed Quality Measures Effective October 1, 2018: There are 34 pages of changes. This change table provides information on the item set affected (i.e. SP-PPS for swing beds), item/text affected, the data set version, the proposed MDS 3.0 data set version with modification in yellow, and rationale for change.

Changes Keep Coming Revised DRAFT version was posted May 30, following

the January posting of the first version and then two edits/errata in between and now one in July. Be aware that the MDS is a “fluid” document . . . Changes coming

Here’s the List to Study Changes to the MDS Updates the Quality Reporting Program (SNF

QRP) The final MDS item sets – look for v1.16.1 Make sure you have the latest RAI Manual

after the final item sets are released Updates to the Redbook (Guidance to Federal

Surveyors)

Changes are Based On: Impact Act of 2014 SNF Quality Reporting Program Requirements of Participation

(RoPs) for SNFs and Conditions of Participation (CoPs) for PPS SWBs

Additional clarifications by CMSOn JULY 10, 2018 . . . An updated errata (V2.02.2) was posted for the DRAFT version (v2.02.0) of the MDS 3.0 Data Specifications, which are scheduled to go into effect on October 1, 2018. Three additional issues have been identified; one additional edit was defined, one existing edit was revised, and one correction was identified for the Edit Change Report posted on April 9, 2018.

More changes Sections A, C, GG, I, J, M, N, O Changes like assessors must

choose from a list of 13 codes to identify the primary medical

condition code at the timeof admission

Section A Add MBI to A0600B as soon as Medicare

beneficiary receives new number/new card SSN being removed from Medicare cards

April 2018 through April 2019 Effective January 1, 2020 all Medicare

claims and the MDS must show MBI

MBI = Medicare Beneficiary Number

Section C

Section GG Changes This is changing the “skilled” way of showing

improvement = functional gain This comes from:

IMPACT Act of 2014SNF QRP requirements and new measuresRisk Adjustments

Additional options needed for activity not attempted

THIS IS PAC – LTACH, IRF, SNF AND HH GETTING GRADED ON SAME STANDARDS LOOKING FOR

BEST OUTCOMES AT LEAST AMOUNT OF $

Section GG Key Definition: Helper

Common Ground: Section GG

Section GG Expanded codes to be used when an activity is not

attemptedNot applicableNot attempted due to environmental limitationsNot attempted due to medical condition or safety concern

RAI Manual revisions includeMore clarificationsMore coding tipsMore coding examples

Environmental Limitations =Lack of equipmentWeather constraints

GG0100

NQF#2633 – Application of IRF Functional Outcome Measure in Self-Care Score for Medical Rehabilitation PatientsNQD#2616 – Percentage of Family or Designated Responsible Party for Long Stay Residents

GG0100

New and Updated GG Codes

GG0130

NQF#2631 – Percent of LTCH Patients with an Admission and Discharge Function Assessment and Care Plan that Addresses FunctionNQF#2633 – Application of IRF Functional Outcome Measure Change in Self-Care Score for Medical Rehabilitation PatientsNQF#2635 – Application of IRF Functional Outcome Measure Discharge Self-Care Score for Medical Rehabilitation Patients

GG0170

Notice HELPER?How much more important is the Practical Mater statement?

GG0170 -- Mobility

NQF#2631 – Percent of LTCH Patients with an Admission and Discharge Function Assessment and Care Plan that Addresses FunctionNQF#2634 – Change in Mobility Score for Medical Rehabilitation PatientsNQF#2636 – Discharge Mobility Score for Medical Rehabilitation Patients

GG0170

GG0130


GG0170

GG0170

NQF#2631 – Percent of LTCH Patients with an Admission and Discharge Function Assessment and Care Plan that Addresses FunctionNQF#2634 – Change in Mobility Score for Medical Rehabilitation PatientsNQF#2636 – Discharge Mobility Score for Medical Rehabilitation PatientsPU/1 – Changes in Skin Integrity Post Acute Care Pressure Ulcer/Injury Calculated on Discharge

GG0170

GG0170

NQF#2631 – Percent of LTCH Patients with an Admission and Discharge Function Assessment and Care Plan that Addresses FunctionNQF#2634 – Change in Mobility Score for Medical Rehabilitation PatientsNQF#2636 – Discharge Mobility Score for Medical Rehabilitation PatientsPU/1 – Changes in Skin Integrity Post Acute Care Pressure Ulcer/Injury Calculated on

GG0130 Discharge Self-Care NQF#2631 – Percent of LTCH Patients with

an Admission and Discharge Function Assessment and Care Plan that Addresses FunctionNQF#2633 – Application of IRF FunctionalOutcome Measure Change in Self-Care Score for Medical Rehabilitation PatientsNQF#2635 – Application of IRF FunctionalOutcome Measure Discharge Self-Care Score for Medical Rehabilitation Patients

GG0170

Discharge Mobility

Section I Two new items: I0020 and I0020A (Indicate the

Resident's Primary Medical Condition Category) I0020 asks assessors to choose from a list of 13 codes to

identify the resident’s primary medical condition category at the time of admission on the 5-day PPS MDS

If none of the 13 codes apply, assessors will code the 14th code and enter the relevant ICD-10-CM code in I0020A

The primary medical condition coded in I0020 MUST ALSO BE CODED in I0100-I1800 (active diagnoses in the last 7 days

Section I

NQF #2633 – Application of IRF Functional Outcome Measure Change in Self‐Care Score for Medical Rehabilitation Patients NQF#2634 – Change in Mobility Score for Medical Rehabilitation Patients NQF#2635 – Application of IRF Functional Outcome Measure Discharge Self‐Care Score for Medical Rehabilitation Patients NQF#2636 – Discharge Mobility Score for Medical Rehabilitation Patients

Section J J2000 (asks whether the resident has had major surgery in the 100

days prior to the admission CMS says most major surgeries will meet all three of the

following criteria:The resident was an inpatient in an acute-care hospital for at least one day in the 100 days prior to admission to the SNF

The resident had general anesthesia during the procedure

The surgery carried some degree of risk to the resident’s life or the potential for severe disability.

J2000 is a risk adjustor for 4 new self-care and mobility functional outcomes under QRP; however J2000 will not be an item impacting the 80% data submission threshold

Section J


Section M First Warning from CMS:

accurately identify the primary etiology of the ulcer/injury

This is critical to BOTH medical necessity documentation and what is written in the plan of care

Still collect the information on skin documentation and care plans – it is part of your medical necessity documentation to describe the wound characteristics

CMS Added a NEW TermMICROCLIMATE can be found in two areas:

(1) Microclimate will now be included as an example in the definition for pressure ulcer/injury risk factors. (2) Microclimate also will be included in the list of external risk factors in the item rationale for M0100 (determination of pressure ulcer/injury risk).

NPUAP has used the term since 2016 but in an effort to standardize wound care definitions, CMS has continued a process to make sure evaluating and treating wounds use the NPUAP standards

NPUAP =National Pressure Ulcer Advisory Panel

What Does it All Mean? Perspiration Drainage Incontinence

Moisture increases friction and shear• Increased tissue deformation• Maceration

Position and MicroclimateSkin Temperature

Alteration in superficial blood flowChanges in positioningContact with skin (sleep positions)

Blood flow Blood flow differs from person to personOver bony prominences . . .

GOAL: Address all issues leading to breakdownand determine/care plan options to control moisture and temperature

Second Warning Determine “present on admission”

accuratelyUnstageable?Return of patient/resident to SWB/SNF – what is different?Address skin tears

CMS clarified MASD (Moisture-Associated Skin Damage stating it is “superficial skin damage – partial-thickness skin loss – and cannot be covered with slough or eschar.”

Section M “Injury” or “injuries” has been added to better reflect the most recent

guidelines from the National Pressure Ulcer Advisory Panel (NPUAP)” Section M items retired on 10/1:

o M0300B3 (date of oldest Stage 2 pressure ulcer)o M0610A – M0610C (dimensions of unhealed stage 3 or 4 pressure ulcers or eschar)o M0700 (most severe tissue type for any pressure ulcer)o M0800A – M0800F (worsening in pressure ulcer status since prior assessment OBRA or scheduled PPS)o M0900A – M0900D (healed pressure ulcers)

Although removed from the MDS, the information must still be collected on the skin grids and/or care plans,” stresses Belt. “The information is still vital to describe wounds and the characteristics of the wounds.”

Removed from Section M

Section M

Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury (Measure calculated on Part A PPS Discharge)

Section M

Section N

Drug Regimen Review conducted with follow up for identified issues

The drug regimen review (DRR) coded in Section N is completely separate from the regulatory requirement that all nursing homes have a pharmacist conduct a monthly review of each resident’s medications as detailed in F757 (Drug Regimen Review) in Appendix PP of the State Operations Manual. The new items are for Medicare A only and go to calculation of

the new SNF QRP – a pharmacist is not required to complete the DRR for Section N

Section NDON’T FORGET: DRR includes prescribed, over the counter (including nutritional supplements, vitamins, and homeopathic/herbal products AND TOTAL PARENTERAL NUTRITION and OXYGEN

The new DRR “intent” is to show whether the provider conducted a DRR at admission (start of a Part A stay), throughout the stay to discharge AND that there was significant discussion about med issues with the physician. There must be a reported response from the physician (in person, phone, voice mail, fax, etc.) and it must show ACTION to the reported issue by midnight of the next calendar day – at the latest

Section O -- UpdatedChanges to this section include modifying existing text and:

O0100F: Invasive Mechanical Ventilator (Ventilator/ Respirator)

O0100G: Non-Invasive Mechanical Ventilator (BiPAP/CPAP)

Survey and Audit This is the beginning of 2 years of distinct changes CMS plans to release the revised v1.16 of the Long-Term

Care Facility Resident Assessment Instrument 3.0 User’s Manual by the second week of September.

The SNF QRP Measure Calculations and Reporting User’s Manual will soon be updated to include the new/modified and revised assessment-based SNF QRP QMs that implement on Oct. 1

CMS is discontinuing public reporting of Percent of Residents or Patients With Pressure Ulcers That Are New or Worsened (Short Stay) and replacing it with Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury by October 2020

The only new MDS-based SNF QRP QM without a clear start date for public reporting is Drug Regimen Review Conducted With Follow-Up for Identified Issues – Post-Acute Care SNF QRP

Time to Get Ready1. Share this presentation handout with your IDT. Review

all of the new and changed items with your IDT.2. Download the NC (Comprehensive) Item Set. Review

the MDS for SWING BEDS3. Review the new and changed items in Section GG.

Make a plan for how to manage these items before October 1, 2018. Who/which department will manage data collection for each element in the time frame specified? How will you collect the data?

4. What’s your plan for collecting the data if therapy is not involved/not ordered?

Additional Reviews

Reviews

Medical Necessity

References & Resourceshttp://www.npuap.org/wp-content/uploads/2016/11/Margaret-Goldberg-Microclimate-presentation-final.pdfCMS Post-Acute Care Quality Initiative websitehttps://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Downloads/Proposed-MDS-30-V1160-Change-Table.pdfInformation on the IMPACT Act of 2014 can be found at:http://www.gpo.gov/fdsys/pkg/BILLS-113hr4994enr/pdf/BILLS-113hr4994enr.pdfhttps://www.govtrack.us/congress/bills/113/hr4994For SNF Quality Reporting Program comments or questions: [email protected] QRP Table for Reporting Assessment-Based Measures for the FY 2020 SNF QRP APU [PDF,

122KB] Final MDS 3.0 Data Set Version 1.16.0 - Effective October 1, 2018.pdf [PDF, 1MB] Final MDS 3.0 Data Set Version 1.16.0 Change Table - Effective October 1, 2018.pdf [PDF, 317KB] Final Specifications for SNF QRP Quality Measures and Standardized Resident Assessment Data Elements-Effective October 1 2018.pdf [PDF, 593KB] SNF QM User's Manual V1.0 FINAL 5-22-17 [PDF, 394KB] SNF QRP Measure Specifications_October 2016.pdf [PDF, 138KB] 2016_07_20_mspb_pac_ltch_irf_snf_measure_specs [PDF, 822KB] SNF Function Quality Measures TEP Summary Report August 2016 [PDF, 2MB]

What you Need to Know about October 2018

Learning OutcomesNow that you have completed this training, you should be able to:

• Describe the October 2018 updates to the MDS• Identify key section changes• Recall the importance of Section GG• Identify how these changes impact survey and audit

Questions?If you have questions about this course, please contact:[email protected] [email protected]

Upcoming Events

By September 1: Release of Swing Bed Foundations Certificate Program

Swing Bed Foundations: Laying the Groundwork: CAH and PPS swing bed programs must understand the reason behind the initiation of swing beds and the reliance on understanding skilled nursing regulations to operate and financially manage the program. This first course (of three foundation courses) provides historical, operational, regulatory, and management basics to review, both by existing SWB programs and those thinking about initiating swing bed services.

Swing Bed Foundations: Setting the Standards: Swing Bed programs must center programs around basics such as Medicare required documentation, management decisions on programming, and move operationally to successful models as skilled nursing goes through major changes in 2019.

Swing Bed Foundations: Expanding the Footprint: Swing bed programs must adapt to the changing health care regulatory and program design changes. This includes identifying the strengths of the current program, future patient flow initiatives, and how to coordinate with multi-level health care services to retain and/or grow their swing bed programs.

Swing Bed Foundations: Medicine Best Practices: In multiple defined areas of review and for seven distinct medication concerns, CMS is asking for all skilled facilities to be more diligent in reducing unnecessary medications, in performing drug regimen reviews, in scheduling gradual dose reductions, and in building a team that does what is right for our LTC, skilled nursing and swing bed patients. Through examples and by providing tracking aids, this course will help swing bed leadership and team members initiative or expand current compliance efforts.

Swing Bed Foundations: Therapy: For both PPS and CAH swing bed programs, reviews and audits are underway. Therapy services are the most audited and reviewed component to skilled nursing services, often because therapists have not been made aware of very specific and required elements of documentation. More importantly, in current reviews, increased importance has been placed on goals and improved outcomes prior to discharge. Review of key elements during and at completion of therapy services is a necessary internal audit. This course will help seasoned and new therapists take stock of Medicare intent for therapy services in a swing bed program.

Swing Bed Foundations: What is the Interdisciplinary Team (IDT)?: The Interdisciplinary Team (IDT) is mandated in federal regulations, and not following those guidelines can lead to survey issues. Perhaps more importantly, a good IDT meeting is the best method for communicating progress, discharge planning, medical necessity and other key compliance issues to all involved in patient care. This webinar is a review of requirements, compliance, and other opportunities to document care provided your patients.

Upcoming EventsSeptember 6 at 10am:Webinar: What you Should be Doing now to Prepare for 2019 - REGISTER HEREFor Program Directors, MDS Coordinators, Therapy Director, Therapists, Coders, Billers, Compliance

October 17, 2018: REGISTER NOWLive RSBM Meeting: Breakout Sessions at HTH Fall Conference: 9am - 10:30 PPS Only: (CAHs join at 10:30) - 12:30

Dashboard & Assistancewww.hthu.net/swingbedppsPassword: pps

HTH Program Assistance:Annie Lee [email protected] or [email protected]

Rural Swing Bed Management Program



rural swing bed management program - hthu · mds 3.0 version 1.16.0 data set for proposed quality...

Documents