[Cindy Johnston]

[Cindy Johnston]

ooooops ! I hit the enter key prematurely...I went to a PPS seminar today in Buffalo and I am in awe as to what the Balanced Budget Act has done to Medicare...I am really interested in stirring up some conversation around the country about PPS and how everyone is coping and sharing ideas, brainstorming- how we can all come out better for it all....what do ya'll have to say out there?

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[karol]

I wouldn't mind having someone outside my facility to visit with regarding pps. My main concern right now is getting the information and making sure it is correct for the mds. What kind of assessment froms does your facility use? My facility is also having major problems with our computers. We just had some hardrive changes and man what a pain. Some of the changes are a plus, but half the terminals don't work part of the time. Karol

[Gloria Blackmon]

The PPS documentation and changes in computer systems to adapt will cause everyone a few maalox moments. From a legal nurse consultant view, I want to remind you to document, document, document. This is a fabulous time focus on this isssue. Try to get some outside speakers into your facilities for an inservice. Not only is the PPS now tied to the MDS, LTC facilities are under even more scutinity regarding fraud. So it is imperative that your MDS, careplan and narraitvie notes paints the picture of the patient that I would see if I came there today. But please don't allow yourself to get swollowed up in the crazies because the whole country is struggling with this and the glitches in the computer software. Read as much as you can and visit the HCFA website for updates and the review the Q&A section often. This will help you keep a pulse on what is happening across the country. Also you can get some free newsletters from OPUS communications on line about the PPS system and other issues in LTC.

Happy Holidays!

[Cindy Johnston]

Gloria - thanks for the insight...your points are well taken and are being applied...

Karol - we are using the MDS from Elliott Press for our process...we use a number of methods of collecting the data (I&O board, CNA flow sheets, toileting records and so on) for completion of the MDS. When we start PPS in Jan, on my unit there will be 3-6 people still on Medicare (everyone else funded otherwise) and it is about the same on our 2nd floor unit, so we won't have a huge amount to start out with, but we understand that we have to start them all out as Day 1 on Jan 1. Our dilema is scheduling the completion of the MDS so quickly (5d, 14d, 30d...) and having time for the disciplines to do their parts...we still do all parts on hardcopy and then data enter...ANY hints or helps you have from your beginnings would be most helpful...Please consider what you guys learned by trial and error and pass it on...also, is your agency allowed to share documents? I would love to get some ideas on what the rest of the world is doing because we are a small town snf who still has some archaic methods and we want to blast at least into the present, maybe into the future
!!!! Many thanks, cindy

[karol]

We are doing a trial and error method right now. We have decided,at this time anyway, to have the floor nurses fill out assessment forms on the medicare residents the first 14 days. That will give us a 5-day assessment and the 14-day assessment. It's our company policy to fill these out, but getting better forms is a must. We've got a new one coming from Briggs with three shifts per sheet. The old one had seven days on it for just one shift. The new one is going to take up more chart space, but hopefully better info. FYI, there is a newsgroup starting up for SNF's in the near future. If I hear where and when I will let you know.
karol

[louise]

To make a long worry short, What is going to happen to all of the patients that get turned away from skilled facilities because they are to expensive to care for under the new PPS guidlines? Of course that won't be how they are told, it will sound more like "we are unable to meet your needs." My concern is increased because of all of the other changes that have already taken place with DRG's, Home Health Agencies and Hospice services. I won't bore anyone with my soapbox issues because I have several, but I would like to here others ideas of how this problem may be resolved befor it ever happens.

The other question I have is how does the Nurses Practice Act and other nursing orginations view what will take place with those people that are turned away from getting care they so desperately need and using their medicare benifits they have worked so hard for for so many years?

[yzermiss]

PPS is certainly a challenge for the Interdisciplinary team;our facility received software 2weeks before starting and passed transmission tests the day before on 7-01. After the first 2 weeks everyone settled down and now we have found that a posted list for due dates keeps everyone on track. The most important issues start with an available Therapy team 6-7 days a week and using the available windows for due dates. The internet offers very few sites right now but they are growing.Here are two:
[url]www.ltc-casemix.com[url] and
[url]www.longtermcare.com[url]
The suggestions offered by Gloria are excellent.

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[This message has been edited by yzermiss (edited 12-23-98).]

[Beck]

I am noticing that with the PPS, some residents may have to be turned away because of the expense their care costs. I am beginning to wonder if this will affect resident care. It probably will. I don't totally understand the whole PPS idea, but I have figured out that care may suffer.

[Terra]

I, too am very concerned about the ways PPS will affect pt care. there are some changes our facility is making that frankly have me worried... our Rehab and Respiratory departments have been dramatically reduced, and their tasks have been handed over to our nurses and CNT's. We are already stretching our physical resources to the limit, and often do not have the background education to give care in these areas as it should be given...I am afraid that terrible errors may be made in these areas, simply because of our lack of knowledge. I know that this program was begun for good reasons, but I'm afraid that our patients are going to suffer terribly for it.