By Shelby Donahoo, Bandera Therapy Resource, & Tonya Haynes, DOR, Mountain View Care Center, Tucson, AZ

L to R: Heather Stiles, DON; Talitha Thrasher, Med Records; Jessica Ganz, ADON; Della Richardson MDS; Juanita Skidmore, BOM; Tris Rollins, ED; Tonya Haynes, DOR

Mountain View Care Center in Tucson, Arizona, has been an “all team on board example” of how to manage and succeed with PDPM. Here are some reasons why:

  • Consistent IDT team participation: DON, ADON, MDS, Medical Records, Business Office, DOR, Case Manager and ED!
  • They have a system in regards to timeline of PDPM components to investigate starting day of admission, day two, day three and so on.
  • Day one, they start looking for missing hospital documents; if not present, they are requested immediately in the PDPM meeting. They keep a log of documents and labs requested, reviewed and followed up on daily.
  • They keep looking — not just once, but repeatedly through the five-day assessment process, adding or altering diagnoses, comorbidities, NTAs; daily floor and rehab updates included.
  • They create fun competition — challenging each other to find patient PDPM components first. “We sound like an auction during PDPM meeting!”
  • Their goal is to stay one step ahead; their tracker is color-coded for followup. Red: urgent; yellow: missing info; green: ready to submit
  • They do a full team MDS review to ensure score matching before submission

Success is in the data and feedback from staff, patients and providers.

  • Mountain View processes the most PDPM assessments in their market (54 monitored in November); daily rates are up 7.6% with PDPM
  • Average nursing rate is highest in the market
  • Section GG outcomes remain strong and are building
  • Mountain View group/concurrent is 19.6%, highest in market
  • “I actually love the group approach for our patients. They help engage our patients more, help lower-level patients perform ‘up’ and encourage participation.” — James Reyes, PTA
  • “Our patients love coming to group. Some get more out of it than individual treatment, and they get more treatment overall. The opportunity to treat patients from low to high level at the same time with individualized goals during group supports their overall outcome. Groups open up a lot of room for creativity and thinking outside of the box.” — Roger Reyes, COTA
  • Mountain View is opening another skilled unit in January.

Success Is in That CAPLICO Moment

Knowing Mountain View was excelling with PDPM, a cluster facility requested to come observe their PDPM meeting process. But instead, Mountain View came to them. The entire PDPM team drove over to their sister facility and spent two hours offering PDPM support and assisting with transitioning patients. Now that’s culture!