Lisa: Welcome to the IRF and LTCH
Virtual Training Program.
My name is Lisa Newton
and I'll be presenting the training program overview
which focuses on the expectations
for each of the training components part 1 and part 2.
I'm a registered nurse with experience
in direct patient care, clinical education
and executive level administration in both the acute care
and LTCH settings.
Currently, I'm a senior staff associate
at Econometrica in Bethesda, Maryland.
Let's begin with an understanding of the objectives
for this session.
At the conclusion of this training
participants should be able to understand the design
of the IRF and LTCH Virtual Training Program part 1 and 2.
Describe the framework for the standardization
of patient assessment data elements
in the post-acute care or PAC setting.
And summarize the training and implementation objectives
for your facility related to the new and revised guidance.
I'd like to take a moment
and review the disclaimer for this training.
The presentations in this training
were current at the time they were published
or uploaded onto the web.
Medicare policy is subject to change.
So links to the IRF and LTCH program web pages
have been provided as supplemental resources
for your reference.
This training program was prepared
as a service to the public
and is not intended to grant rights or impose obligations.
The training content may contain references or links
to statutes, regulations or other policy materials.
The intent of the information provided
is to be a general summary
and not to take the place
of either the written law or regulations.
We encourage readers to review the specific statutes,
regulations and other interpretive materials
for a full and accurate statement of their contents.
Next, let's review the structural design
of the IRF and LTCH Virtual Training Program.
It is highly recommended that this overview presentation
be reviewed first.
The overview provides a basis for your understanding
of the entire program and contains foundational material
that is not provided in other presentations in the training.
Reviewing this material first
will provide you with key insights that are necessary
for a more complete understanding of the program content.
The IRF and LTCH Virtual Training Program
consists of two components.
The first, part 1, is a series of recorded presentations
that provide the didactic component of this training.
An explanation of the new and updated guidance
for the IRF-PAI Version 4.0
and the LCDS Version 5.0 was presented.
Item intent, rationale, steps for assessment,
coding instructions, and coding tips
for select data elements are also explained.
These presentations are available for review
at your own pace and can be viewed
as many times as you would like.
It is essential that the presentations in part 1
are reviewed in advance attending
the coding workshop sessions in part 2
of the training program.
Here is a list of the recorded presentations
that provide the didactic component of this training.
As noted, we recommend that the overview presentation
be reviewed first.
The other presentations include:
Social determinants of health and new revised items
A, B and D.
Section C, cognitive patterns.
Section D, patient mood interview and total severity score.
Section GG, summary of guidance changes.
Section J, health conditions.
Section K, swallowing/nutritional status.
And Section H, bowel and bladder.
Section M, skin conditions.
Section N, medications, new item and revisions.
Section O, special treatments, procedures and programs,
and the case study.
We also recommend that the case study be completed last
as it provides you with an opportunity
to apply the coding concepts
presented in the other recorded sessions.
And the remaining presentations may be completed
in any order.
Part 2, the second component of the training program
is a live virtual event consisting of
a series of coding workshop presentations
corresponding to the training topics presented in part 1.
During this event
you'll have an opportunity to apply concepts
related to the new and updated guidance
for the IRF-PAI Version 4.0
and the LCDS Version 5.0,
by reviewing a variety of clinical coding scenarios
and responding using a live polling format.
In addition, a recorded version
of each coding workshop presentation
will be made available for your review and reference
after the initial workshops are held.
This is a list of the coding workshop presentations
that will be reviewed during the live virtual event.
As I noted earlier
these topics correspond to the didactic recorded sessions
in part 1 of the training program.
Part 2 of the training program
does include two additional sessions,
the question and answer session
which will be based on questions submitted from providers
and the listening session with CMS.
Let's move on and talk about
one of the foundational elements of this training.
That is an understanding of standardized
patient assessment data elements,
what they are and why they are important in post-acute care.
The basis of this is the Impact Act of 2014.
The Impact Act is also known as
the Improving Medicare Post-Acute Care Transformation Act,
which is its formal title.
This is a bipartisan bill that was signed into law
by President Obama on October 6th, 2014.
This act requires the collection and reporting
of standardized patient assessment data
with regard to quality measures
and standardized patient assessment data elements
across post-acute care.
As you may be aware, each PAC setting
uses a different data collection instrument.
Here we see not only the IRF-PAI and LCDS represented,
but also the Minimum Data Set or the MDS
for the skilled nursing facility setting
and the Outcome & Assessment Information Set or OASIS
for the home health setting.
Historically, the post-acute care settings
collected similar information
on their respective assessment instruments.
However, variation between settings
has made cross-setting comparisons
and interoperability of data difficult.
This slide demonstrates this concept
by depicting different types of fruit for each PAC setting.
So for example, the item eating
has been assessed in each setting, but done so differently.
The collection of data in a standardized manner
facilitates outcome comparison, data interoperability,
and comparison of quality within and between PAC settings.
Here we see the example of the item eating
that is now collected in a standardized manner
in each PAC setting represented uniformly
by the same piece of fruit.
Standardization is very important for a few reasons.
It enables cross-setting data collection,
outcome comparison, data interoperability,
and comparison of quality within and across PAC settings.
Standardization also improves outcomes
from Medicare beneficiaries
through shared decision-making, care coordination,
and enhanced discharge planning.
So what does this mean
in relation to the IRF-PAI Version 4.0
and LCDS Version 5.0?
While new and revised data elements are being implemented
in their IRF and LTCH settings
toward the ongoing goal of standardization
and cross-setting alignment.
And these changes will become effective on October 1st, 2022
with the implementation of this new guidance.
In addition to the standardized patient assessment
data elements, several other changes have been made
to the IRF-PAI 4.0 and LCDS 5.0.
Content has been updated with gender-neutral language,
minor updates were made to the wording
to enhance understanding, coding examples have been modified
to improve clarity.
The acronym QIES was changed to iQIES in the LCDS manual
and references to the LTCH care data set
were simplified to LCDS.
Throughout the IRF and LTCH Virtual Training Program,
we've established and used a variety of conventions
to enhance the training.
Let's review how these can be helpful
in guiding your review of the material.
First, all the acronyms used throughout the presentations
in both part 1, and part 2 of the training
are available in a companion PDF
that can be downloaded from the training platform
and used as a reference throughout the program.
Also, throughout the presentations
different formatting conventions are used
to identify changes to guidance.
Blue text is used to identify guidance that has been revised
and blue strikethrough text is used
to identify words or short phrases
that were removed from the guidance.
And on the last bullet on this slide
we have an example of both conventions
being used to demonstrate this.
Reference icons are strategically placed
throughout the presentations
to assist you in more easily understanding
how to apply the content.
A star-shaped icon with the word New in the center
is used to indicate that the guidance on the slide is new.
We also use setting-specific icons
to identify whether the new or revised guidance
is applicable to a specific setting.
Throughout the training program,
coding scenarios, examples, video vignettes,
and a case study are used to assist participants
in applying the concepts
related to the new and revised guidance.
For instructional purposes only,
gender has been designated to represent facility patients,
family members, and staff in the case study,
and any coding workshop presentations
that use video vignettes.
We have also provided additional supplemental materials
to assist your understanding of the presentations.
These materials are available
by selecting the respective tab in the event platform.
The materials include slides for each presentation
the acronym list, the action plan template
which will be reviewed shortly,
documents to complete the case study,
the IRF-PAI 4.0 and the LCDS 5.0 item sets,
and a list of training resources and links
that are specific to IRF and LTCH.
Now, let's talk about how you can make this training
as meaningful as possible for your specific facility.
Action planning is one way to help translate
the training materials into action steps for your setting.
We've created an action plan template
that corresponds to each section in the training.
You can use it to take notes
and record your thoughts and ideas
and identify processes that may need to change
at your facility in response to the new or revised guidance
in the IRF-PAI Version 4.0 or LCDS Version 5.0.
And this may include things like authoring
or revising policies and procedures,
training and education for your staff,
and possible enhancements to information technology
at your facility.
Here's a screenshot of the action plan.
We've pre-populated an example with some ideas
to get you started using the tool.
The action plan is set up as a template
with a separate page for each training session
and columns that are blank for your notes.
So if we look at moving left to right on this tool,
the first column on the left
identifies the training topic or session.
In the second column,
you can list any policies, procedures, processes,
or documentation systems and tools
that may be potentially impacted at your facility.
In the third column you can record any action steps
that may be needed for new guidance implementation.
The fourth column identifies any education needed
and that includes both the topic and the audience.
And the last column outlines the target dates
and timeline for completion.
This tool can be personalized
in whatever way is most meaningful for your organization,
and we hope that you find it helpful.
Another way to look at your implementation strategy
is to see it on a linear timeline
as a series of action steps.
So moving from left to right,
you would review the finalized IRF-PAI 4.0
or LCDS 5.0 guidance.
Identify the new and revised data elements
and the implications for your PAC setting.
Identify any impact on IT at your facility.
Develop an implementation plan
to introduce the changes to your staff.
And revise policies and provide education and training
to ensure facility readiness for implementation
on October 1st, 2022.
Now let's take a moment to briefly review
the Quality Reporting Program or QRP training resources
that are available to you.
The IRF and LTCH Virtual Training Program
is based on your new guidance.
So either the IRF-PAI 4.0 or the LCDS 5.0
assessment, instruments and manuals.
Resources for both settings are available
by selecting the links on this slide.
As noted earlier, we have also provided a resource document
for both IRF and LTCH that is available for download
from the event platform
containing additional helpful resource links for providers.
Beyond this presentation,
another helpful resource to you
is your setting-specific Q&A that is released quarterly.
This is a very important resource to access
and ensures that you have the most current information.
The quarterly Q&As are located in the Download section
on the QRP Manual Page for your setting
and links are also provided on this slide.
In summary, new and revised data elements
are being implemented in the IRF and LTCH settings
with the goal of ongoing cross-setting alignment.
These changes will be effective October 1st, 2022.
We encourage you to utilize the training materials provided
in the IRF and LTCH Virtual Training Program part 1 and 2
to assist your staff in preparing for
the new guidance implementation.
This presentation was designed to provide an overview
of the IRF and LTCH Virtual Training Program
and help you understand the training
and implementation objectives for your facility
related to the new and revised guidance.
We have covered a lot of information in this session
and you may find that you have questions about the content.
If you would like to submit a question,
please send it to PACTraining@EconometricaInc.com
by June 3rd, 2022.
As a reminder, a practice coding workshop
will be held in June, and we encourage you to attend that.
Select questions will be answered in a Q&A session
during the June, 2022 virtual live event.
Thank you for reviewing this presentation
and we look forward to your attendance
at the coding workshop.