Maximizing Quality Care:

PDPM & Restorative Nursing Programs in Skilled Nursing

by admin

Maximizing Quality Care:

PDPM & Restorative Nursing Programs in Skilled Nursing

by admin

by admin

Understanding the Patient-Driven Payment Model (PDPM)

In recent years, the healthcare industry has seen significant changes in the way care is provided and reimbursed, particularly in skilled nursing homes. The introduction of the Patient-Driven Payment Model (PDPM) has shifted the focus from quantity to quality of care. In this article, we will explore the impact of PDPM on restorative nursing programs in skilled nursing homes and how it encourages a more resident-centered approach to care.

PDPM implemented by the Centers for Medicare & Medicaid Services (CMS)

The Patient Driven Payment Model (PDPM) replaced the Resource Utilization Group (RUG) system for the Medicare Part A payment model. Recently the PDPM payment model is being implemented in many state Medicaid reimbursement systems as well.  The PDPM payment model takes into account the specific needs and characteristics of each resident, promoting specific levels. Among the levels of care is Restorative Nursing Services.

PDPM considers five case-mix adjusted components:

  • Physical Therapy (PT) component
  • Occupational Therapy (OT) component 
  • Speech-Language Pathology (SLP) component
  • Nursing component
  • Non-Therapy Ancillary (NTA) component

By focusing on these components, the PDPM aims to allocate resources more effectively, ensuring that reimbursement is aligned with the actual care needs of patients. PDPM Bootcamp I will be a great option for detail training workshop

In the ever-evolving landscape of skilled nursing and rehabilitation facilities, the integration of Restorative Nursing and the Patient Driven Payment Model (PDPM) can transform how resident care is delivered and reimbursed. The synergy promises not only to improve resident outcomes but also to streamline care services ensuring a sustainable model for the future.

Understanding Restorative Nursing 

Restorative nursing is a specialized area of nursing focused on assisting residents maintain or improve their maximum level of function and independence.  This approach goes beyond basic care, incorporating activities and programs designed to maintain or improve the physical, mental and psychosocial well-being.

Restorative nursing encompasses a variety of interventions such as Bed Mobility, Ambulation, Range of Motion, and Selfcare training all aim to promote resident autonomy and quality of life.

It is essential for individuals in long-term care who may have chronic conditions or functional limitations that require ongoing attention. Restorative nursing programs are tailored to the individual’s needs and are typically established in collaboration with the therapy team or a restorative manager to ensure a holistic approach to resident care.

Restorative nursing services often encompass various aspects, including:

  • Bed Mobility
  • Transfer
  • Range of Motion (ROM)
  • Dressing & Grooming
  • Ambulation 
  • Various other programs

The Intersection of Restorative Nursing and PDPM

The nursing component has an alignment or hierarchy of care services arranged according to weighted case mix categories. Restorative nursing services is among the list of weighted categories. In contrast the older version of the Medicare part a SNF reimbursement program focus more of rehab services which would trump nursing care services. Meaning, when a resident would receive rehab services.

SNF would get reimbursed according to therapy services and information recorded on the MDS for section G Activities of Daily living without nursing care services as a factor in the overall reimbursement unless no skilled therapy services are warranted. 

Therefore, depending on the captured nursing services on the MDs, starting restorative nursing care in conjunction with skilled rehab may be beneficial for reimbursement is assessed to have a need for both skilled rehab and restorative care. In some cases, there is another skill that is captured on the MDs that is worth more payment points. Regardless of payment skilled facilities are to provide the necessary services residents are in need of. 

Determining if Restorative care services will be beneficial during the Medicare Part A Skilled Stay?

  • Is there a need for Restorative Care Services?
  • What other reimburse able nursing skilled and be capture in the initial Medicare MDs?
  • What will be the chosen ARD?
  • Have you considered documentation requirements

 Consider the following strategies:

  • Collaborative Approach: Establish close collaboration between the restorative nursing team and the therapy team. Regular communication and goal-setting sessions are crucial to aligning efforts and achieving the best possible outcomes for residents. Identifying qualifying nursing PDPM capture upon admission will be critical especially for Medicare Part A services.
  • Individualized Care Plans: Tailor restorative nursing programs to each resident’s specific needs. Develop and document individualized care plans that outline the objectives and the role each discipline plays in achieving these goals.
  • Documenting Progress: Accurate documentation is critical. Regularly assess and document progress, detailing the services provided by both restorative nursing and therapy teams. This documentation should reflect the resident’s functional improvements, as this can directly impact PDPM reimbursement.
  • Education and Training: Invest in ongoing training for staff in both restorative nursing and therapy disciplines. Ensuring that all team members understand the goals and the collaborative nature of their roles is essential for success. Restorative Nursing Navigations Workshop is for SNFs interested in learning how to ensure Restorative Programs are aligned. Restorative Nursing Partners Program is for SNF needed hands on assistance with updating Restorative Programs. 
  • Compliance and Auditing: Regularly review and audit documentation to confirm compliance with PDPM requirements. Address any inconsistencies or gaps promptly to avoid reimbursement challenges.

As Such:

The integration of restorative nursing services into the PDPM framework represents a significant shift in the skilled nursing and rehabilitation field. It emphasizes the importance of a resident-centered, collaborative approach to care that includes both restorative nursing and therapy services. By working together to develop individualized care plans, documenting progress accurately, and ensuring compliance, skilled nursing facilities can successfully capture restorative nursing and therapy services concurrently while delivering the highest level of care to their residents. This not only benefits residents but also helps maintain financial sustainability in the evolving healthcare reimbursement landscape.

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