»» Good morning everybody.
How are you?
How is everybody doing?
Good?
Good.
I was wondering if I could just take a quick poll to kind of get a sense of who's here today.
Can I just have a show of hands of people who are therapists?
How many people in the room are occupational, speech or physical therapy?
Okay, a large number of you guys.
Great.
How about nursing?
Do we have a lot, Oh.
We have an equal number of nursing.
How about folks maybe in administration or -- and let's face it, some of you are doing this? Right.
Yeah, yeah.
Okay, good.
Well, welcome.
Hopefully we're live with the web streaming soon.
And we'll try to do our best to keep you engaged this morning and introduce some new items
and some exciting times for us in IRFs.
So let's hope the slide advancer is working.
So my task for the next fiftheen minutes or so is to do a quick introduction into the
IRF-PAI version 1.4
By now most of you I'm sure are familiar with the tool and what it looks like.
You happen to have one in your packets.
And so as the speakers are speaking today, it might be helpful to kind of pull it out
and follow along so that you can see where the coding is, and how that all works.
So let's talk a little bit about implementation for October 1.
So beginning October 1st, we're going to need to provide information on the new items.
We're going to be transmitting those items on October 1st.
So when we submit our items on October 1, those are based on our discharges.
So it's important for us to remember that if we're discharging people in October, that
those are our patients in September, right.
So we're going to need to be doing our assessments and collecting our information so that we
can complete the IRF-PAI v1.4 trasmission on October 1.
And each of you knows what types of patients you have in your facilities, so you kind of
have a sense of what your lengths of stay are, and what lead time you may need in your
facility.
For us, in the facility where I work, we have decided to begin to collect the item information
now.
We did some of our training the last couple of weeks.
And we are collecting our information now.
When my colleague and I go back, we're going to sort of look at things and see where we
stand, and see if we need to do some more training or some tweaking so that we're really
feeling confident by October 1st.
So it's important to remember, you do need to have that information for those patients
being discharged.
Additionally, completion of the IRF-PAI in the new items are for those Medicare Part
A patients, what I always call "traditional Medicare."
For your Medicare Part C patients your managed Medicare, and then for any Medicare secondary,
if you're anticipating that you're going to get some payment from Medicare on those.
So it's required for those patients.
Again at the facility where I work, we've decided to collect the information on all
our patients.
We think it great information.
It's great data.
You know, I'm a nurse, and I work in quality.
So we love data.
We love data.
And it's kind of a joke around the facility because I always -- I'll say things at a meeting
and say, oh, we never, whatever.
Then I go back to the data and I say, you know, we actually do sometimes.
And so data can be really helpful and I encourage you to use it whenever you can.
One of the first things that I would recommend you doing if you haven't already is really
determine which of your clinicians are going to be responsible for which items.
So again, as an example, what we did was we met awhile ago and went item by item, each
of the new items.
And we identified which clinicians would be assessing that information, or have primary
responsibility for assessing that information.
And for us, that was really helpful because it allowed us to set a plan that required
training for less people, rather than training everyone on everything.
We were able to do our training and our education for those folks who really needed each piece
of information.
And we found that that felt a lot easier to do, and was well received by the clinicians.
You know, if you haven't already started your training, you know, it's a good time to start
now.
It's not too late.
You can certainly go back after the training the next couple of days and start implementing
some training.
And there's a lot of great fun ways to do it.
You guys, I'm sure you have folks at your facility that you have different ways that
people learn.
We've played Jeopardy during lunch.
We've had a fish bowl, you know those little candy Smarties, we attach a question to the
Smarties.
So when they take a candy out of the fish bowl they have to answer the question but
they get the little candy.
Little different things that can kind of engage people and make it a little more fun for them.
Again if you haven't already started collecting information, it's a good time to go ahead
and start.
It gives you some opportunity to sort of regroup and start over, or make some adjustments as
you need to do.
Now,some of the key differences, I think this is a important piece to kind of keep in mind
over the next day and a half, is that there are some key difference to the items that
we will now be assessing, in comparison to the ones that we currently assess.
And that is, you're going to want to make sure that you understand what it is that you're
collecting, and that you know what those data collection instructions are.
They are different.
So for your training, you're going to want to make sure you know the difference is.
The rating scales used for the new measures are different than the ones we currently assess.
So it's important that people understand the differences, so that they're not confused.
And you want to know what the item definition is.
They're all clearly defined in the training manual and it's a great idea to have some
training manuals out on your units, and have them around for staff to refer.
And one of the things we always say at our facility is, when in doubt, you talk it out.
So if you have a question about something, you want to make sure that you run it by someone
else, or just kind of talk the scenario out with a colleague, and we find that it really
helps with learning and consistency for staff.
One of the things that you'll also hear us talk about over the next couple of days is
we're going to refer to "coding" these items.
So when I first heard about coding, we got involved in the project, you know, nine, ten
months ago.
When they first started talking about coding for me, you know when I thought about the
term coding, I thought of like the medical coder, you know, those people that go through
your records and look through the H&P and kind of assign ICD-10 codes, you know what
I mean, coders?
For here, for the purposes of these new items you're going to be coding these items, that's
the term that we use.
So we currently have other items that we score.
And now we're going to have new items that we code.
So one of the things that was helpful for us was we talk that language when we we're
in the facility.
So if a employee comes up to me or a clinician comes up to me and says, you know, Karen I
have a question about bladder.
My first response back to them, is this a coding question, or is this a scoring question?
So that way, I'm sure we're talking the same language.
We're talking the same data definition.
We're talking the same assessment instructions and the same rating scale.
So over the course of the next day and a half, we're going to be talking about coding these
items.
One the things that we do at our facility again is, every morning we still do breakfast
trays.
Do you guys do breakfast trays in your facilities?
Patients get their breakfast on a tray?
So each of -- every day, the patients are brought their breakfast and there's a tented
card, an inspirational card to help them start their day on a positive note.
And this was one that was on their trays a couple of months ago.
We thought it was an important thing moving forward because it's important for all of
us to embrace the changes that we're facing over the next years in healthcare.
And there are people who embrace change better than others in our facilities.
We all know who they are and how people respond.
But I think there are some things that we can do to help folks to make changes easier.
And I think we need to sort of set the environment for some success.
So if you want to create an environment that is a successful environment, I think there
are some key things that we can do in order to be able to do that.
And the first thing is, you know, set the example.
And what I always say is, you know, things are received better when they're presented
in a positive note.
So I think, you know, we've presented this as a great opportunity to improve post-acute
care transitions.
And if you look at what the IMPACT Act, the acronym "impact" that's what it is.
It's improving Medicare post acute care transitions.
And I don't think anybody in this room isn't excited about the opportunity to improve transitions
from the hospitals to us, from us to home care or to nursing homes.
So it's important to set forward what it is that we're attempting to do.
Break up the project into smaller pieces.
Again, I mentioned we went item by item and went through and assigned a clinician for
each item set.
What we actually did was, we got a group of people in a room the head of therapy, our
nursing directors, myself, and we brought in our IT person.
And what we did was we went item by item and we identified who's going to be doing that.
And where does it make sense for them to document things?
So that we then used our electronic medical record to help us collect the information
that we are assessing so that we could retrieve it from our medical record easier.
And we created what we're calling sort of an IRF Report and that will pull in items
that we know we are assessing.
And it will allow the person who will be doing our coding to look at that report, and identify
where she may need to query individuals, where she may need to get some clarification, but
it's an easier way to retrieve the information.
So get a group of people together and identify how you can work together to get the project
done.
We also were surprised at how much people wanted to help.
We brought in our preadmission folks.
As Mark had mentioned, part of our department is admission, case management and quality.
So we pulled our preadmission folks in and said based on our assessments you guys spend
a lot of time in the hospital and talking with the patient before they come and their
families.
What pieces of information that we are now going to be assessing and collecting can you
guys help us with?
So one the questions we always ask was, have you fallen prior to the hospital?
We made a clarification on our preadmission assessment to include have you fallen in the
last 100 days?
So they're helping us gather the information, even before the patient's come to the facility.
So it's important to share with all your team members and find out where they might be able
to help you out.
Again begin training early.
That's, as soon as you can when you get back if you haven't started would be great.
Identify how you're going to use the data and make sure people know how we're going
to be using the information.
It's much more meaningful and purposeful for me if I know what it's being used for.
If I'm just collecting information and I don't know what's happening to it, it's hard for
me to engage in that.
So I think it's important that you share with them how we're going to be using the information.
You want to practice.
You want to give people the opportunity to practice coding so that they feel very comfortable
when you have to begin transmitting the data on October 1st.
One of the other things that we've done is included something called an Action Plan.
It's in your packets here.
And for those folks who are live streaming as, Mark had mentioned, it is available on
the training site and can be downloaded there.
And I think this is one the greatest things ever.
I've sort of stolen this and we use it all the time now.
And it gives you the opportunity at the end of each of the speakers to kind of look at
what was presented, and sort of do a self assessment of where are you guys at with this
portion of the measure?
What pieces of information do you still need to cover when you go back to your facility?
Who might be able to help you with that?
And develop a real action moving forward.
Rather than coming to the conference, learning it yourself, sometimes we go back to the office,
you get sort of tied up in stuff.
This will give you a really roadmap to what you want to do next.
And I think it will be really helpful if at the end of each of the speakers that you utilize
that.
The example, you have one in your packets.
And it just kind of goes through how to use it.
Personally, I think it's great.
And I would encourage you to use it.
Thank you everybody.
That's the end of my little introduction.
And I look forward to presenting later to you guys.
And again, if there's any questions, you know, I'm a provider.
I'm one ofyou.
So if I can be of any help, and I certainly would encourage you to talk amongst yourselves.
We all have great ideas.
You know the IRF community is such a great one as far as sharing things, you know, if
you have a great idea, tell the folks at your table.
If you're struggling with something, talk with folks in the room because maybe they've
figured out something that can really make your life easier when you head back the to
the office.
So thank you and I look forward to talking to you later.