Working session on identifying entry-level competencies in value based reimbursement models

2. Working session on identifying entry-level competencies in value based reimbursement models bit.ly/aota19alc

3. Download the Slide Deck Working session on identifying entry-level competencies in value based reimbursement models bit.ly/aota19alc

4. bit.ly/aota19alc bit.ly/aota19alc

5. bit.ly/aota19alc

6. Solutions to Challenges • We’ll review challenges for OT in value-based systems • We need your help! bit.ly/aota19alc

7. Solutions to Challenges • Look for the challenge banners. • We’ll have time for small group discussion to: • Draft specific & actionable entry level competencies • Brainstorm teaching & learning strategies that you could use to develop the competencies • We’ll take the information you all provide today, develop summaries, and distributevia the list servs Challenge bit.ly/aota19alc

8. previous chapter bit.ly/aota19alc

9. OT Services & Medicare Payment Today Organization Reimbursement ⇡ Dollars • Incentives for Health Systems • Hire more OT Practitioners • Maximize productivity • Focus on defensive documentation to minimize negative audit findings ⇡ Audit Activity OT Services ⇡ staff ⇡ hours ⇡ productivity

10. Future of OT Services & Medicare Payment OT Services ⇡ staff ⇡ hours Organization Reimbursement Dollars ⇣ Net Revenue

11. Future of OT Services & Medicare Payment ⇡ Consumers d/t ⇡ QRP Measures • Incentives for Health Systems • Maximize staff that have an impact on quality measures • Minimize staff that have little or no impact on quality • Focus on collaboration and documentation that identifies value • Identify gaps and improve care using quality measures ⇡ VBP Measures Organization Reimbursement ⇡ Dollars OT Services staff hours

12. What is Value? + Q V = S (Quality) (Service) $ (Value) (Cost)

13. Medicare A Quality Programs Value Based Purchasing Quality Reporting Program VBP Payment changes based on Quality Measure performance QRP Public Reporting of Quality Measure performance

14. section gg

15. GG Data Elements Gain Importance • Eating • Oral hygiene • Toilet hygiene • Shower/bathe self • UB dressing • LB dressing • Footwear • Roll left and right • Sit to lying • Lying to sit • Sit to stand • Chair to bed/chair tf • Toilet tf • Car tf • Pick up object • Walk 10 ft • Walk 50 ft w/turn • Walk 150 ft • Uneven surface • 1 Step; 4 Steps; • 12 Steps • Wheel 50 ft • Wheel 150 ft

16. Section GG Template & Info at www.aota.org/value

17. Used for Payment • Eating • Oral hygiene • Toilet hygiene • Shower/bathe self • UB dressing • LB dressing • Footwear • Roll left and right • Sit to lying • Lying to sit • Sit to stand • Chair to bed/chair tf • Toilet tf • Car tf • Pick up object • Walk 10 ft • Walk 50 ft w/turn • Walk 150 ft • Uneven surface • 1 Step; 4 Steps; • 12 Steps • Wheel 50 ft • Wheel 150 ft

18. Used for 2 Self Care Outcome Measures • Eating • Oral hygiene • Toilet hygiene • Shower/bathe self • UB dressing • LB dressing • Footwear • Roll left and right • Sit to lying • Lying to sit • Sit to stand • Chair to bed/chair tf • Toilet tf • Car tf • Pick up object • Walk 10 ft • Walk 50 ft w/turn • Walk 150 ft • Uneven surface • 1 Step; 4 Steps; • 12 Steps • Wheel 50 ft • Wheel 150 ft

19. Used for 2 Mobility Outcome Measures • Eating • Oral hygiene • Toilet hygiene • Shower/bathe self • UB dressing • LB dressing • Footwear • Roll left and right • Sit to lying • Lying to sit • Sit to stand • Chair to bed/chair tf • Toilet tf • Car tf • Pick up object • Walk 10 ft • Walk 50 ft w/turn • Walk 150 ft • Uneven surface • 1 Step; 4 Steps; • 12 Steps • Wheel 50 ft • Wheel 150 ft

20. Used for Function Measure • Eating • Oral hygiene • Toilet hygiene • Shower/bathe self • UB dressing • LB dressing • Footwear • Roll left and right • Sit to lying • Lying to sit • Sit to stand • Chair to bed/chair tf • Toilet tf • Car tf • Pick up object • Walk 10 ft • Walk 50 ft w/turn • Walk 150 ft • Uneven surface • 1 Step; 4 Steps; • 12 Steps • Wheel 50 ft • Wheel 150 ft

21. an example:snf & pdpm

22. RUGs Today • Determined by Resources Used PT minutes ST minutes OT minutes

23. RUG Example 1 • Assessment Period 668 minutes OT 312 minutes PT 233 minutes ST 123 minutes

24. RUG Example 1 • Assessment Period 668 minutes Rehab portion of RUG = RV OT 312 minutes PT 233 minutes ST 123 minutes

25. RUG Example 2 • Assessment Period 748 minutes Rehab portion of RUG = RU PT 332 minutes ST 263 minutes OT 143 minutes

26. RUG Example 2 • Assessment Period 748 minutes Rehab portion of RUG = RU PT 332 minutes ST 263 minutes OT 143 minutes RU > RV

27. OT as a Commodity

28. PDPM Overview

29. PDPM Overview MDS is Completed at Admission

30. PDPM Overview NTA Nursing Daily Rate OT PT MDS is Completed at Admission SLP Non Case Mix

31. PDPM Overview 2 NTA factors from the MDS determine payment for OT portion Nursing OT PT MDS is Completed at Admission SLP Non Case Mix

32. PDPM Overview Diagnosis is Selected based on primary reason for SNF NTA Nursing OT PT MDS is Completed at Admission SLP Non Case Mix

33. PDPM Overview Diagnosis is Selected based on primary reason for SNF NTA Nursing OT PT Function is Scored using Section GG MDS is Completed at Admission SLP Non Case Mix More at www.aota.org/care

34. Diagnosis The Primary Diagnosis Maps to 1 of 4 OT Clinical Categories Diagnosis determines PDPM Clinical Category

35. OT & PT Functional Score • Items are scored from 1 (Dependent) to 6 (Independent) • The scores of 10 items are converted into points which make up the functional score • Download all self-care & mobility items at www.aota.org/care Section GG determines the OT & PT Functional Score aota.org/care

36. The OT Portion of the Daily Rate

37. Example Client s/p CVA

38. Example Client s/p CVA

39. Case Mix for OT Determines OT payment for the entire stay… Regardless of how much OT is actually provided.

40. The Value of OT Determines OT Involvement S + Q = V (Quality) (Service) $ (Value) (Cost)

41. OT as Partner to Achieve Outcomes

42. Articulating our Distinct Value • Identify who needs occupational therapy & who does not need occupational therapy. • Clearly and concisely advocate for the right clients at the right time to the interdisciplinary team. • Why does this person need OT? • Could someone else achieve the same outcome more efficiently? Challenge #1

43. High Value:Occupational Profile • Occupational therapy should epitomize client-centered care • OT and the client must be partners • Do our clients understand the purpose of our interventions? • Are our interventions based on their goals?

44. High Value: Analysis of Occupational Performance Psychosocial / BehavioralSkills ADLs Fear of Falling IADLs Functional Cognition Habits, Routines, Roles Safety Screen Vision

45. Why is this important? Best Possible Outcomes for Clients Top-Down Evaluation that Identifies Key Outcomes Consistent & Complete Occupational Profile Occupation Based Practice

46. Evaluation Checklists • www.aota.org/value • Skilled Nursing & Med B Outpatient • Occupational Profile • Core Areas to AddressAnalysis of OccupationalPerformance

47. ? What are you doing that someone with less skill (less expensive) could do instead? What do you bring to the client and the interdisciplinary team that is unique & achieves optimal outcomes?

48. LOW VALUE What are you doing that someone with less skill (less expensive) could do instead? What do you bring to the client and the interdisciplinary team that is unique & achieves optimal outcomes? ?

49. LOW VALUE What are you doing that someone with less skill (less expensive) could do instead? What do you bring to the client and the interdisciplinary team that is unique & achievesoptimal outcomes? ? HIGH VALUE

50. Value Forget what you’ve always done.If you are paid for what you do best—better than anyone else, what would that be?