Blog from May, 2019

Continued review of the spreadsheet with data elements, it is now accessible from Google sheets.

Once we complete the general analysis, we will re-evaluate the need for specific sections, entries and document types.

Working on the spreadsheet for data elements for SNF transfer request.

Based on oncreased activity, and upcoming demos and associated testing, we will have weekly call. Starting with next week, May 31, we will have SNF transfer related calls every other calls, and general 360X calls startig June 7. 

1. BSeR Ballot - comments were submitted to HL7. Per Vassil, they were received very positively.
2. SNF Transfer/Referral use case
   
   1. Data in first message – should highlight red flags/conditions SNFs may want to know about in their decision to accept a patient.
   2. New Payment model coming starting October 1 – CMS Patient Directed Payment Model (PDPM) changes the way SNFs are paid from current formula of calculating therapy minutes to higher payment for more medical complexity. Will likely change the information SNFs may want to know in first messages, with more comprehensive list of conditions for treatment at facility. May be harder for hospitals to anticipate what info SNFs are looking for, but 360X could help facilitate.
   3. Facilities have built PDPM calculators to determine cost of treatment vs payment received for patient. 360X should help provide necessary info to enter into PDM calculator. Likely similar to previous information, with some more added. Higher clinical complexity = higher reimbursement.  See attached slide from Terry that includes some of the points for various treatment/conditions. CMS also provides a detailed worksheet for calculation of reimbursement
   4. Certain conditions have higher payment in first 3 days of stay at SNF, which further declines beyond 18 days. HIV/AIDS significantly higher than previous/other conditions. May be difficult to include/highlight due to privacy concerns/patient consent.
   5. SNFs will also need to start using ICD-10 codes in MDS submissions. If hospitals don’t include ICD-10 codes to each diagnosis, adds another burden for SNF staff. Might be good to recommend hospital ICD-10 code use to simplify on SNF end.
   6. For 360X, a reasonable approach could be to specifically call out/highlight anything 2 points or higher from calculator to show patient may be higher reimbursement value. Likely these would be in diagnosis list or in treatments (e.g. IV meds, IV feedings). If called out explicitly, could be helpful in faster decisions from SNFs on accepting patients.
   7. Internal processes may also change at SNFs – MDS specialists currently scour charts for record review within 7 days. Under PDPM, needs to be clinician documented in initial note. Needed by day 5 from initial admission and physical.
   8. More to discuss here for future
3. ONC Interoperability Forum
   1. Registration likely opening in next few weeks. Brett will notify group when open.
   2. No additional updates on session/demo of 360X, but planning work should continue as agenda is still being finalized.