Blog

September 9, 2021

The transition to the patient driven payment model (PDPM) over the last two years has not been without its challenges. COVID-19 shifted SNFs’ priorities away from the PDPM transition during year one to an all-hands-on deck approach to prevent the spread of the virus. Year two continued to bring fresh challenges, including the ongoing pandemic…

August 31, 2021

We all want better outcomes for our patients accompanied by a lower cost of care. As healthcare becomes ever more complex, it is often difficult to tell where we need to focus our changes to achieve this desired outcome. This is especially true for Accountable Care Organizations (ACOs) that work to optimize value across a…

August 3, 2021

Providing patients or members with the highest-quality care while ensuring you have a handle on your high-cost drivers and liability risks is key to delivering the best in outcomes and realizing the benefits of value-based payment. To do this, Health Systems, ACOs, and REITs have the difficult task of collecting and interpreting the right data…

July 21, 2021

Coming off the rollercoaster that has been the last 17 months, we are breathing a collective sigh of relief with most of our staff and patients vaccinated. And, while the pandemic isn’t entirely in the rearview mirror yet, taking that breath sure feels good. As we think about getting “back to business as usual,” it…

July 9, 2021

Back in 2019, the Centers for Medicare & Medicaid Services (CMS) rolled out the Patient Driven Payment Model (PDPM) with the goal of better aligning payment rates with the costs of care by taking a value-based approach to reimbursement.1 And since reimbursement is now primarily based on the medical complexity of the patient, it’s imperative…

May 3, 2021

No matter what a SNF’s goals are, data has the potential to help them meet and exceed those goals. However, the operative word here is ‘potential.’ Many SNFs are fully aware they need to collect and leverage targeted data to drive decision making. But when it comes to executing on that, there may be issues…

April 19, 2021

No matter what specific discipline you’re in, being in the medical field teaches you the importance of using data to treat patients better. But what sometimes gets overlooked is that data can also be used to help our businesses be healthier and more successful. Properly leveraging the power of business analytics and the right key…

April 1, 2021

We’re now well past the one-year mark of the shift from RUGs to the patient driven payment model (PDPM), which means it’s probably time for an annual checkup. And if you’ve already been researching ways to fine-tune your efficiencies and maximize your results, you’ve probably come across terms like MDS scrubbers and data audits. Effectively…

March 17, 2021

Do Intentional and Unintentional Increases in Patient Acuity Present a Problem for SNFs in 2021? One of the best ways to educate ourselves and prepare to plan for success is by studying the data we have available to look for trends and opportunities to grow and preempt potential pitfalls. For those of us in the…

March 10, 2021

Ask any middle school student in a science class how many variables you should change when testing something new and you’ll get a resounding chorus of the right answer—one. In 2020, SNFs and the Centers for Medicare and Medicaid Services (CMS) were collectively excited to follow this guidance with the transition to the Patient Driven…

March 5, 2021

Though I live in Massachusetts today, my childhood and early college years were spent in Maryland. It has a special place in my heart and many of my family still live there. The other reason Maryland is special to me is we collaborate with a great group of health systems and providers there who have…

January 25, 2021

A year ago we thought PDPM would be the biggest challenge of 2020. But COVID is not a compliance smokescreen and the devil is in the details and the details are in the rate driver data. As you reflect on 2020 and plan for 2021, the analysis of your Patient-Driven Payment Model (PDPM) data must…

November 11, 2020

You get what you pay for. For years, CMS paid for volume and that’s exactly what they got- lots of rehab, lots of tests, lots of specialists; lots of volume. But despite paying a lot for healthcare, our national outcomes remained mixed when compared to other similar countries, particularly in the areas of life expectancy,…

October 26, 2020

This is the final blog in our 3-part series focused on looking back at PDPM data thus far so you can plan. Part 1 focuses on key SNF data; Part 2 focuses on compliance and risk.  The final blog in our PDPM “Looking Back/Planning Ahead” series focuses on strategies to address the unfavorable data patterns…

October 12, 2020

This is the second blog in a series focused on looking back at PDPM data thus far so you can plan. Part 1 focuses on key SNF data; Part 3 focuses on developing strategies to address unfavorable trends. In the first blog of this series, we shared key data patterns and trends that every SNF provider…

September 28, 2020

This is the first blog in a series focused on looking back at PDPM data thus far so you can plan. Part 2 focuses on compliance and risk. Part 3 focuses on developing strategies to address unfavorable trends. Most of us have been chomping at the bit to look at the first PDPM era data…

September 25, 2020

Ah, September…the days are getting shorter, the weather is getting cooler (in the North, at least) and the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) has opened their portal for the AHCA/NCAL National Quality Award Program!  Whether you are new to the program and applying for a Bronze award, continuing your quality journey…

September 22, 2020

PointRight began assisting customers in California with QASP in 2017 but the QASP program has been around for over 5 years. The impetus came from our relationship with California Association of Health Facilities (CAHF) and an effort to help both their members and our customers manage their performance in this state-based quality program. QASP Best Practices…

September 17, 2020

For decades, companies behind large, integrated transactional systems such as Enterprise Resource Planning (ERPs), Electronic Health Records (EHRs) and Managed Care Applications have disseminated the notion that having all data in one database brings multiple benefits. At the transactional level, this argument is supported by benefits ranging from infrastructure cost avoidance to higher data integrity…

August 17, 2020

UPDATE Summer 2021: Looking for the most recent proposed changes for SNFs? Check out Ten Tips to Get Ready for the October 1 Proposed Rule for SNFs. As with most things that happened before COVID-19, it seems like the MDS item set updates for October 1, 2020 (FY 2021) happened in the mists of the…

August 3, 2020

By Theresa Edelstein, MPH, LNHA New Jersey Hospital Association By  Pam Kaiser, MSN, RN PointRight As states are moving through the different phases of reopening, hospital groups are looking to the future, and many believe in that future looms a resurgence of the new SARS-CoV-2 (COVID-19). Hospital strategists are planning their way forward by addressing…

July 29, 2020

Throughout history, world events have impacted society and significantly altered our daily life. World War II, for example, created an opportunity for women to work in factories and other traditionally male jobs and broke down long standing barriers out of dire need. When the war ended, it never really “went back to normal.” More recently,…

June 23, 2020

CMS announced plans for expansion of enforcement activities to improve provider accountability and sustained compliance of infection control practices in a June 1 CMS Memo. The memo also reinforced their expectations for state survey agencies and the timely completion of infection control focused surveys. CMS’ concerns about provider compliance with infection control practices is certainly…

June 11, 2020

Those within the nursing home community “bubble” understand that skilled nursing facilities are delivering the best care under these extreme circumstances just as their acute care partners are doing. So why the villanization or sensationalized headlines instead of first seeking to understand facts over fiction? Historically SNFs have had a tough public image.  Just like…

June 4, 2020

In May we opened up our Advanced Training session, “COVID-19: MDS Coding and Documentation FAQs,” to the public and we received a volley of great questions that we didn’t have enough time to answer thoroughly.  Below are my responses to the questions submitted during our live session. You can also check out the session recording…

June 2, 2020

What’s in a name? Well, sometimes your name can define your calling. For me, it’s no coincidence that my initials are SNF.  I’ve been working within or directly supporting Skilled Nursing Facilities (SNF) for the past 25 years.  I learned how important it was to create relationships that educated hospital based medical teams as well…

April 22, 2020

With so many waivers and flexibilities being released by CMS in response to the COVID-19 pandemic, keeping current with those that impact your provider setting can be challenging. Sometimes those that impact you might be designed for another setting altogether! The Centers for Medicare and Medicaid (CMS) can authorize waivers when the President declares a…

March 30, 2020

CMS’s rapid fire memos on COVID-19 over the last two weeks surely leave many facility staff confused and overwhelmed. Finding time to sit, read and interpret these memos may be rare so here’s what you need to know. If you’re in your survey window right now, CMS may be giving you some much needed breathing…

March 25, 2020

The COVID-19 pandemic is hitting skilled nursing facilities (SNFs) hard.  Along with the potential health impact on your residents, staff, and families, there have been several regulatory updates issued by CMS after a State of Emergency was declared on March 13th.  Here are five things that nurse assessment coordinators (NACs) should know. New ICD-10 code…

March 20, 2020

Thank you for taking care of the most vulnerable among us – our parents, our grandparents and many other loved ones in all our families. We are so incredibly fortunate that we can count on you and your team to be there in this time of turmoil and uncertainty. The PointRight team is leveraging our…

March 12, 2020

Hospitals and REITs must proactively communicate and perform their due diligence to manage risk and support partners and stakeholders. Skilled Nursing facilities (SNFs) find themselves under the magnifying glass as the first cases of Coronavirus COVID-19 appeared within the walls of a Washington SNF. It’s not surprising as these facilities provide services to individuals most…

March 10, 2020

What do top-level athletes, no matter what sport they play, have in common?  They never stop drilling the fundamentals of the game.  As COVID-19 (a.k.a. coronavirus) continues to spread into our most vulnerable populations, skilled nursing facilities (SNFs) are reeling from the impact.  While the risk for survey citations is apparent (see CMS’ latest memo,…

Like many healthcare professionals, our PointRight team is hard at work educating and preparing to meet the challenge of COVID-19. We are committed to doing everything within our reach to help those that we support meet that challenge, too. Here are a collection of resources and news to help you stay up to date. Centers…

March 5, 2020

Asking More Questions, A New Year’s Resolution One of our mantras here at PointRight is “So What?” Whenever a colleague brings up an issue, observation or factoid in a meeting, invariably someone asks the big “So What?”  It’s not intended to be the dismissive retort of your typical teenager, but a call for all to…

March 3, 2020

The latest news from McKnight’s and Skilled Nursing News covering the Leading Age report Nursing Home Closures and Trends June 2015-June 2019 was disheartening. All the work that goes into improving your star rating, delivering quality care, and you still cannot get ahead of the cost of doing business. If a stellar star rating can’t…

February 13, 2020

Take a crash course in post-acute data and network management best practices for Hospitals and ACOs. All stakeholders in a collaborative or network need to work as partners and use data to speak a common language concerning performance and goals. This means that there are a lot of people along the care continuum relying on…

February 3, 2020

UPDATE Summer 2021: A lot has changed since this blog was published in February 2020, including the planned MDS updates for October 1, 2020 (FY2021). Now here we are preparing for FY2022. Get the most recent proposed changes in our blog, Ten Tips to Get Ready for the October 1 Proposed Rule for SNFs.  You…

January 16, 2020

By Paola DiNatale, MSN, RN, NHA Why is it important for Accountable Care Organizations (ACOs) to understand the connection between clinical documentation and key performance metrics? — ‘If it hasn’t been documented, it hasn’t been done.’  Lessons learned and forever rooted in our clinical training.  Clinical documentation must meet level of ‘attention to detail’ to…

November 14, 2019

In the 80s we wanted our MTV; now in 2020, QAPI program managers want their pain quality measures. The Centers for Medicare & Medicaid Services (CMS) announced in October that it has removed the Short-Stay Pain and Long-Stay Pain Quality Measures from the Five-Star program and from being reported on the Nursing Home Compare (NHC)…

November 11, 2019

  This year on Veteran’s Day, on behalf of the PointRight team, I wanted to take a moment to recognize the people who serve veterans every day. We’re a proud supporter of the National Association of State Veterans Homes (NASVH) and work with several veterans facilities as clients. What is the NASVH? The National Association…

November 5, 2019

How does the new hospital discharge planning rule impact relationships between hospitals and skilled nursing facilities (SNFs)? Ignoring key regulatory changes in other health care provider settings is a dangerous practice. Although you may be tempted to focus only on your internal challenges with the rapid-fire changes from CMS, many of the regulatory changes that…

October 31, 2019

If you were unable to attend this year’s AHCA/NCAL Convention & Expo, check out our observations and favorite moments from this year’s event. The show’s theme centered around healthcare ‘superheroes’ and many of the keynotes touched on the more personal side of healthcare. “Caring defines what we do every day.” Outgoing AHCA Board Chair Michael…

October 23, 2019

PointRight Helps Hospitals Comply September 26, 2019, The Centers for Medicare & Medicaid Services (CMS) issued a Final Rule addressing acute care to post-acute care (PAC) discharge planning. There are many complex and detailed requirements and prohibitions in this Final Rule that aim to improve patient engagement and decrease hospital readmissions. It calls out several…

October 14, 2019

Keep What Your Teams Are Working Hard to Achieve In one of my past roles, I was a Corporate Compliance Officer for a long-term and post-acute care provider. I still maintain my CHC (Certified in Healthcare Compliance) credential through the Healthcare Compliance Board and stay connected to the LTPAC compliance community.  Understandably, there is a…

September 30, 2019

Have you cut the cord with your cable provider yet? If you are like most of us, the answer is no. If anything, your cable company is finding more ways to lock you into their service through price promotions and bundling that make it harder to switch later if they raise prices or change service….

September 24, 2019

Over the last 12 months, skilled nursing facility (SNF) providers spent considerable time and resources preparing interdisciplinary teams for the anxiously awaited Patient Driven Payment Model (PDPM). PDPM is the most dramatic change to hit skilled nursing facilities in two decades and shifts payment for caring for Medicare beneficiaries from a therapy services-based method to…

September 4, 2019

By Paola DiNatale Healthcare providers understand too well that the patient’s clinical record documentation is based on the clinical situation, however too often we get trapped in the mindset of ‘when it’s too much or too little reporting’. Long passed are the good ole days when the clinical record documentation meant ensuring that the correct…

July 30, 2019

As Skilled Nursing Facilities (SNFs) prepare for the implementation of the Patient-Driven Payment Model (PDPM) on October 1, 2019, much of the focus of training has been on diagnosis coding.  Rightly so, since ICD-10 coding can make or break a facility’s capture of the correct PDPM Clinical Categories and Non-Therapy Ancillary (NTA) comorbidities.  But what…

July 14, 2019

In the past, changes to the payment system for Skilled Nursing Facilities (SNFs) impacted other health care sectors. When the Balanced Budget Act of 1997 (BBA) went into effect, many hospital dialysis patients had a hard time getting places in SNFs. Under Consolidated Billing at the time, the SNF was responsible for transportation to the…

May 21, 2019

Since the CMS Final Rule announcing the Patient-Driven Payment Model (PDPM) was released, there has been much speculation among SNF providers and industry experts about what compliance will look like under the new reimbursement system. Under RUG-IV, compliance primarily depends on one key metric: medical necessity for therapy services. Due to the high percentage of…

March 14, 2019

CMS is “thawing out” the freeze on Five-Star Ratings effective April 2019. We were all expecting the thaw this spring, and CMS doesn’t disappoint! Remember that spring showers bring May flowers, and for some of you, “flowers” will take the form of an improvement in your Five-Star Rating. CMS did more than just unfreeze the Five-Star…

January 15, 2019

by Steven Littlehale December 2018 marked Five Star’s ten-year “birthday.” When you read its birth certificate, you’ll see its given name is: “Five-Star Quality Rating System,” though interestingly enough, the only direct measures of quality (the CMS quality measures) carry the least weight. Over the last ten years Five-Star has certainly matured considerably and if…

January 9, 2019

If it seems that hospitals have been focused on readmission rates for years, they have. Starting in fiscal year 2013, hospitals have been penalized for readmission rates for Medicare beneficiaries with certain diagnoses. Those penalties have been increasing with each year until the penalty cap of 3% was reached. Progress has been made, though, with…

December 18, 2018

Thank you PointRight clients, partners and friends for a great 2018. It’s been quite a year for our industry to say the least. Wild fires in California turned hero care-givers into hero rescuers, CMS’ continued its commitment to value-based reimbursement with the announcement of PDPM and Five Star turned 10. Looking to 2019, PointRight is preparing our clients to…

December 12, 2018

We are celebrating Five-Star’s 10th year birthday this December 2018. Over the last ten years, Five-Star has certainly matured considerably, and if you believe it measures quality, then you also must accept that nursing home quality has also improved.  [We at PointRight believe that quality has improved but choose other ways to validate the industry’s improvement.]…