Because CMS has provided limited to no guidance to SNF care delivery partners impacted by the PDPM implementation on October 1, AHCA members have asked if we could create a webinar about PDPM that providers could share with referring hospitals, physicians, Medicare Advantage plans, Accountable Care Organizations, and Bundled Payment program partners.

To help facilitate AHCA member discussions with care delivery partners about PDPM, we have prepared a one page document that includes links to the following five pre-recorded webinars and slides that are intended to be viewed by SNF care delivery partner to get a better understanding about what PDPM is, and how PDPM may impact their relationships with SNF providers. No password is necessary to access this content. 

Each webinar recording (approximately 30 minutes each) contains the following content:

• An overview of the PDPM payment model
• Key clinical characteristics impacting PDPM
• Specific PDPM considerations for SNF partners, and (each recording has partner-specific content)
• Where SNF care delivery partners can go for more information

Each recording is identical except for the third item that includes content that is customized to the specific type of SNF care delivery partner.  AHCA Members are encouraged to open a dialogue with their care delivery partners as part of their PDPM transition preparations.  We also encourage SNFs to consider sharing the respective links below with these partners as a supplement to your discussions. 

Please submit questions related to these webinar resources to pdpm@ahca.org.

Members have asked AHCA to update the PDPM Basics webinar to include updates announced by CMS since January as well as highlight the importance of collaborating with care delivery partners including hospitals and physicians as well as with vendors including therapy contractors and pharmacies.  This 40 minute webinar is designed for introductory in-services and individual learning for individuals that have limited knowledge about PDPM.  The webinar discusses the basic design of the PDPM payment model as well as discusses changes in operations and clinical processes that will be occurring with the introduction of the PDPM payment model.  After viewing the webinar the participant will understand:      

1. Key features of the new Medicare Part A Skilled Nursing Facility Prospective Payment System (SNF PPS) Patient-Driven Payment Model (PDPM) case-mix payment model that the Centers for Medicare and Medicaid Services (CMS) will be implementing on October 1, 2019.
2. How and why PDPM will require SNFs to transform their operational and clinical processes in order to be successful in achieving optimal resident care outcomes in a financially viable manner.
3. How and why it is critical for SNFs to consider “Win-Win” approaches when approaching care delivery partners to improve communications and service delivery.

Because SNF providers contract directly with MA plans, it is essential that both parties understand any changes in resident assessment and claims processing that may be necessary to assure that beneficiary access and provider cash flow are not interrupted. To assist, AHCA has added new resources to the PDPM and Medicare Advantage Toolkit that providers can use to help prepare for discussions with Medicare Advantage (MA) plans prior to October 1 to help assure a seamless transition as the SNF PPS transitions to PDPM. The Toolkit includes:

• For Providers – PDPM Impact on Medicare Advantage - PDPM Impact on Medicare Advantage, containing an overview of the impact that PDPM may have on your existing MA contracts and out of network payments, as well as suggested questions for health plans to ease the transition.
• Sample PDPM Survey for Medicare Advantage Health Plans - with sample questions to ask plans to better understand what operational and billing procedures regarding MA residents you may have to change on 10/1.

• PDPM in Medicare Advantage Contracts Readiness Checklist - to ensure you are fully prepared under your existing MA contracts and for out of network payments.
• PDPM Impact on Medicare Advantage Webinar - which reviews the recommendations and resources above.

• Template PDPM Messaging Brief – Medicare Advantage Plans 

To support PDPM transition work in Core Competency 3, Strengthening the Care Delivery Process, in this PDPM Academy webinar participants will learn about the Agency for Healthcare Research and Quality (AHRQ’s) teamwork and communication curriculum for nursing homes, TeamSTEPPS® 2.0 for Long Term Care and hear from AHCA members who have used TeamSTEPPS® 2.0 for Long Term Care. Teamwork has been found to be one of the key initiatives within patient safety that can transform the culture within health care. Patient safety experts agree that communication and other teamwork skills are essential for the provision of quality health care and for the prevention and mitigation of medical errors and of patient injury and harm. TeamSTEPPS is an evidence-based program aimed at optimizing performance among teams of health care professionals, enabling them to respond quickly and effectively to whatever situations arise and offers a solid basis for PDPM team work redesign. 

Speakers:

• Margie Shofer, BSN, MBA Director, Patient Safety Program, Center for Quality Improvement and Patient Safety, AHRQ
• Sharon Kostboth Harper, SHRM-CP and PHR, Project Director, TeamSTEPPS and Resident Safety Initiative Consultant, Tealwood Senior Living
• Amanda Johnson RN, LNHA, CHC, Vice President of Clinical Operations, Chief Compliance Officer, Tealwood Senior Living.

On May 7-8, 2019 and again (with minor updates) on August 13-14, 2019 the Centers for Medicare and Medicaid Services (CMS) conducted a two-day train-the-trainer session on the October 1, 2019 updates to the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP).  Examples of agenda items directly relevant to PDPM include: discussions on how to properly code Section GG of the MDS, Changes in Sections A, I, J, and O of the MDS, PDPM: What is changing and what is not, and Integrated coding & PDPM Case Study.  This PDPM Academy toolkit includes all available CMS agenda, slides, and video resources related to these training dates.

Additionally, this toolkit contains a direct link to the CMS PDPM-Related MDS-RAI Resources webpage containing the most current minimum data set resident assessment instrument (MDS-RAI) manual.  Scroll to the bottom of the page and download the file under “Related Links” labeled MDS 3.0 RAI Manual v1.17 October 2019.

• Chapter 2 contains a significant rewrite due to the elimination of the RUG-IV scheduled and unscheduled assessment types, and the introduction of the new SNF PPS Interim Payment Assessment (IPA) as well as the new Optional State Assessment (OSA).
• Chapter 3 contains instructions for completion of new or revised MDS items that impact PDPM and SNF QRP, including new Sectikon J2100-J5000 surgery items and I0020B primary reason for the SNF stay ICD-10 diagnosis code.
• Chapter 6 is a complete rewrite of the SNF PPS resident classification process and other policies including the new IPA, interrupted stay, and late assessment/default payment policies.

AHCA PDPM Academy Therapy Staffing/Contracting Considerations Under PDPM Toolkit

Purpose & Intent: To develop a baseline care plan within 48 hours of admission to direct the care team while a comprehensive care plan is developed that incorporates the resident's goals, preferences, and services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being.

This tool kit provides an overview of how PDPM differs from RUGs IV from a compliance risk perspective.  The document also offers:  a) a model high risk assessment form; b) analysis of PDPM high risk areas (list not exhaustive); and c) a Framework for Addressing Risk Through Monitoring & Auditing.  A Version 2.0 will be released following additional CMS guidance in particular the RAI Manual Guidance due out in May 2019.  

This is a tool that you have paid for as a part of your PDPM Academy registration.  This tool is for your facility use only and should not be distributed.  It is a copyrighted document.

An important feature of your PDPM Academy participation is access to monthly live 90-minute webinars on recently announced CMS information, AHCA PDPM training resources, and transition updates. Access to the monthly calls will require a specific login for each individual. If you need assistance with your login information please email educate@ahca.org

The webinars also include at least 30-minutes of question and answer.  Additionally, the webinars will be recorded and FAQs and related materials posted with the video file. Please note we anticipate large participant numbers. If we are unable to respond to your question due to the number of participants, please direct questions to the pdpm@ahca.org email address. We incorporate questions submitted at the email address into our FAQ documents.