Submitted by Lisa Brook, DOR/PT, St. Joseph Villa, Salt Lake City, UT
St Joseph Villa in Salt Lake City, Utah, has embraced the PDPM process and developed a daily technical and weekly skilled system that optimizes efficiency in their operation. The system they have adopted is one where individuals have accepted specific roles in the process and then those individuals come together as an interdisciplinary team to determine appropriate capturing of each patient’s specific medical condition.
IDT Members: BOM, nursing unit manager of sub-acute unit, DON of rehab unit, DOR, RN discharge planner/case manager, MDS coordinator, ED
- ED ensures that the right people are in the room, that time is built in the day for the process, gives process oversight, helps to investigate inconsistencies and facilitates collaboration.
- BOM verifies insurance information and projects daily technical spreadsheet from her computer. Enters information on the spreadsheet. Keeps team on track when determining primary medical diagnosis, NTA, SLP comorbidity, or if any other “rabbit hunting” needs to occur outside of the daily technical meeting.
- DOR is responsible for having section GG information from therapy evals, SLP comorbidity, and speech related swallowing assessment for swallow disorder and mechanically altered diet. Assists with discussion and searching for NTAs.
- DON/Unit manager completes medical record scrub for primary medical diagnosis and NTA’s for skilled patients on their unit. Determines necessary medical record inquiries and delegates to medical records. Utilizes paper section GG from staff to collaborate with therapy findings.
- RN discharge planner/case manager has PCC open looking for nursing documentation and reports the discharge plan to the team.
- MDS is involved with GG collaboration, reports BIMs and PHQ9 findings to the team, medical record review for NTAs
To start the meeting, the BOM projects the daily technical spreadsheet. She reads off insurance information including current length of stay, number of days left, and last covered day, if determined. She utilizes the spreadsheet to guide the process and asks questions to the IDT member responsible. This facilitates discussion with primary medical diagnosis, non-therapy ancillaries, section GG collaboration, speech case mix, and nursing case mix.
Primary Medical Diagnosis
Primary medical diagnosis is presented to the team by the DON/UM and is discussed and agreed upon as an IDT.
NTA and Nursing Case Mix
The patient’s active medical condition, in addition to the primary medical condition, is discussed to determine ability to capture NTA’s and to determine appropriate nursing case mix.
When section GG is discussed, the DOR has section GG in Optima and the PDPM calculation worksheet open. Nursing utilizes a paper GG document and collaboration occurs. While they discuss each section, the MDS coordinator is entering the information in the MDS. Once the PDPM portion of GG is completed, the DOR and MDS coordinator finish discussion with PLOF information, assistive devices used, discharge goals and other non PDPM related GG information and it is added into the MDS.
The BIMs is completed by OT on a paper form, which is given to the MDS coordinator upon completion. The MDS coordinator relays the score to the IDT. There are cases where this triggers discussion around the patient’s cognition that potentially wasn’t captured on the BIMS.
PHQ-9 is completed by one of the other MDS coordinators and reported to the team in daily technical.
Discussion around all of these items is thorough and concise. If an item needs to be tabled due to lack of documentation available or lack of IDT understanding, the item is logged as a follow up item and the team member responsible is identified according to the role this item fits.
Weekly Skilled Review
The St Joseph team has determined that it makes more sense, for their operation, to have their weekly skilled review ongoing throughout the week. The discussions being held around all PDPM items correlate with what is discussed in a weekly skilled review format. As the PDPM discussion continues and follow up items are completed or listed, the discharge planner has the weekly skilled review progress note open and the IDT completes the discussion for weekly skilled review progress note. What has already been discussed is documented as appropriate and additional items are included as needed to ensure accurate and thorough patient discussion and review. The DON tracks the patients that have been discussed and informs the team of patients that will be discussed during the next meeting to ensure timeliness of the weekly skilled review progress note.