Using The Six W’s To Assess Approaches For Achieving Functional Goals
Daniel Ciolek
12/1/2019
After much anticipation of—and preparation for—the transition of the Medicare Part A Skilled Nursing Facility Prospective Payment System (SNF PPS) from the Resource Utilization Groups, version 4 (RUGs-IV) to the patient-driven payment model (PDPM), providers now have had several weeks’ experience in this new payment world.
So how is it going? How has your center’s story progressed since Oct. 1? As I think of these questions, I reflect on the Six W’s that students learn in school. According to a Google search, the six words: Who, What, Where, When, Why, and hoW when posed as questions “constitute a formula for getting the complete story on a subject.”
I pose the following questions to stimulate self-reflection as you assess if you are where you wanted to be under PDPM in assuring that your residents’ functional needs are best met.
- Who is the most important person under PDPM? Obviously, it is the patient. However, as your facility has implemented PDPM, how often have your conversations drifted from resident care needs as the primary focus, to discussions about how any PDPM-related changes in procedures impacted your department or you personally? PDPM offers new opportunities for innovative care delivery, but change can create tension that can distract individuals from their main mission. How are you recognizing and addressing that tension to return the focus to addressing the resident’s functional needs and goals?
- What are you trying to achieve clinically? Under the RUGs-IV payment model, providers often focused on scheduling a resident’s day so that planned amounts of therapy were delivered to achieve functional goals. Is that the best approach? Have you made any changes to better incorporate the resident’s desired outcomes and personal preferences in their care plan, so the day is scheduled around the resident?
If so, has this changed your focus on how function-related care is offered?
- Where are a resident’s functional needs addressed? If anybody in your center answers this as “in the therapy room,” you are very likely missing a great opportunity to optimize care and make movement a positive experience. No one discipline “owns” a resident’s function, and care approaches to function should address all resident locations within the center as well as the expected residence once the Medicare stay has ended.
Do you feel you have a “culture of movement” with care plan functional goals integrated seamlessly across all caregivers? Are family members involved?
Do residents’ goals include an integrated approach of therapy, flexible restorative nursing programs, and personalized goal-directed activities such as gardening, needlework, games, hikes, and others that are outside of the therapy treatment areas?
- When are a resident’s functional goal needs addressed? Again, opportunities to use PDPM flexibilities to offer person-centered care could be lost if staff believe that functional goals are addressed only during therapy treatment sessions.
Studies show a 24/7 focus on facilitating movement that is meaningful to the patient is the best approach to recover lost function after a health event, or to delay functional loss related to chronic conditions.
Resident engagement and staff reinforcement of meaningful movement throughout the day is essential.
Since PDPM has started, have you evaluated whether changes you have made have impacted when and how much time your residents are engaged in movement throughout the day? Have you also seen changes in resident mood, progress toward goals, safety (such as falls and skin integrity) at different times of the day?
- Why is this a good time to reassess how PDPM has impacted your center’s care delivery approaches to function? The Centers for Medicare and Medicaid Services has made it clear that the motivation to change from RUGs-IV to PDPM was to encourage providers to refocus care on the patient needs and preferences, rather than on the services themselves.
Leading up to the PDPM implementation you may have made many changes in clinical and communication processes as well as trained frontline caregivers in anticipation of the new SNF PPS world. Now that you have had some real-world experience, are you comfortable with your progress, or are there process or training shortcomings that may require different strategies before they become entrenched and harder to adjust later?
- And finally, hoW will you assure follow-through with implementing the new ideas you have generated during this reflection of the six W’s of your PDPM approaches to achieve functional goals?
Daniel Ciolek is associate vice president, therapy advocacy, for the American Health Care Association.