LUPA WOUNDS AND SUPPLY MANAGEMENTLink Healthcare Advantage November - PDF document

1 ϭϬ/Ϯϴ/ϮϬϭϵ LUPA, WOUNDS AND SUPP
ϭϬ/Ϯϴ/ϮϬϭϵ LUPA, WOUNDS AND SUPPLY MANAGEMENTLink Healthcare Advantage November 2019 ObjectivesLink Healthcare Advantage November 2019 Identify steps in LUPA Management Identify top reasons for LUPA Identify how evaluate wound care Identify how to develop a supply management program LUPA MANAGEMENTWhat can be done and who is responsible?Link Healthcare Advantage November 2019 ϭϬ/Ϯϴ/ϮϬϭϵ LUPA –Refresher Each PDGM payment group (432 different ones) have a separate LUPA thresholdLUPA threshold determined by the 10percentile value of visits LUPA visit range is from 2 to 6 visitsLUPA threshold is determined each 30 day billing periodLink Healthcare Advantage July 2019 LUPA FactsLUPA thresholds are based on clinical groupings and episode timingClinical groupings with highest LUPA % Complex NursingMS RehabWounds (2–30 day period)One clinical grouping could have two different LUPA threshol

2 ds based on comorbidity or functional st
ds based on comorbidity or functional statusExample MMTA –Surgical Aftercare –High Functional with No comorbidity –4MMTA –Surgical Aftercare –Med. Functional with 1 comorbidity -5Link Healthcare Advantage May 2019 Where to Start?Start with analysis 2019 LUPA data Last quarter or year to date Percentage of episodes with LUPA Is it less than 10%LUPA by diagnosis LUPA occurs a) 1 to 30 days -b) 31 to 60 days –(c) Recert.Initiate 2019 LUPA dashboard Timing of LUPA (early/late; Reason for LUPA Patient refused further visitsMD ordered dischargeNot homeboundNo skill needLink Healthcare Advantage May 2019 ϭϬ/Ϯϴ/ϮϬϭϵ Sample LUPA Dashboard Link Healthcare Advantage November 2019 Sample Drill Down Link Healthcare Advantage November 2019 Link Healthcare Advantage November 2019 What conclusions can you make from this data?What other information would you need or want? ϭϬ/Ϯϴ/ϮϬϭϵ LUPA AuditsLUP

3 A 130 day periodWas there skill need and
A 130 day periodWas there skill need and homebound established on SOC Timing of SOC/evaluationsWere there missed visits –documentation of attempts to reschedule Did patient refuse -documentation to support attempts to continue sits UPA occurring in 230 day period Evaluate what patient goals not met 130 day periodWere visits in 230 day period justified to meet outcomes Could these visits have been done in 130 day periodWas visit frequency in 230 day period –managed to meet patient needs and avoid unnecessary LUPAsLink Healthcare Advantage May 2019 LUPA: QAPI Performance Improvement ProjectLUPA rate �10%Use analysis to identify risk areas and consider followingDo you have staffing issue causing delayed visits or missed visits?Are you having case conferences or care coordination within first week?Are you frontloading visits/contacts first two weeks to avoid ACH?Educate clinical managers and clinici

4 ans on LUPA management / PDGM impactEduc
ans on LUPA management / PDGM impactEducate clinicians on:Assessment on SOC for Key words for patient refusal further visits Scheduling of visits Link Healthcare Advantage May 2019 LUPA Management: Clinical Manager RoleClinical Manager Oversite -ProactiveLUPA number needs to be determined and communicated early in episode Monitor delays in SOC/EvaluationsAre SOC appropriate Homebound status questionable at SOC?Skilled services questionable at SOC?Agency policy for admissions with questionable status?All questionable admissions should be reviewed prior to admitting patient Visit frequency and tapering Days between visits Link Healthcare Advantage November 2019 ϭϬ/Ϯϴ/ϮϬϭϵ LUPA Management: Clinical Manager RoleCommunication tips to continue services if appropriateScheduling of visits Case ConferencesRecertification appropriateWhat goals/interventions have not been metWhat are you going to do diffe

5 rent next 30 daysEarly discharge appropr
rent next 30 daysEarly discharge appropriate Patient refusal further visits Goals met Link Healthcare Advantage November 2019 WOUND & SUPPLY MANAGEMENTLink Healthcare Advantage November 2019 Wound Clinical Grouping OverviewHighest average reimbursement in clinical grouping$1972.00 per pay period10.5% of episodes in 2017 grouped into this categoryCo-morbidity with skin (4 subsets) includes 355 ICD-10 diagnosis codesNo longer supply add on Link Healthcare Advantage July 2019 ϭϬ/Ϯϴ/ϮϬϭϵ Wound Management GoalsPrimary Goal: Improved wound healing timeOther goals:Reduce number of unnecessary dressing changesImprove patient comfort with dressing changesEducate family on wound careReduce number of skilled nursing visits Reduce cost (REMEMBER QUALITY FIRST, COST SECOND)Link Healthcare Advantage July 2019 Wound Management ProtocolsAssess wounds each visit with minimum weeklyMeasure wounds weeklyNot

6 ify MD immediately for signs of decline/
ify MD immediately for signs of decline/infectionNotify MD if no decrease in measurements within 2 weeksAssess for comorbidity impacting healingAssess for environmental items impacting healingWound PhotographyMust have policy/procedure/patient consentMust maintain HIPAA compliance for transmissionWound/Ostomy consultsComplicated woundsWounds not healingMultiple comorbidities impacting healingLink Healthcare Advantage July 2019 Product Selection Choose the right product based on:As wound moves through healing process –reassess for best productRequest reports from supplierProduct utilizationTier pricing optionsNew product optionsLink Healthcare Advantage July 2019EtiologyTissue TypeExudateLocationDepthInfectionPotential for Infection ϭϬ/Ϯϴ/ϮϬϭϵ Analyze WorkflowWho and when are supplies ordered? Drop ship vs supply closet?Do you have a formulary? Do you have quantity/cost rules in place?How are no

7 nformulary items approved?How is car sto
nformulary items approved?How is car stock handled?Quality ControlWho reviews and approves supply invoices?If supply closet –do you have stock list with quantity? Who is responsible for monitoring supply wastage?Frequency of review of utilization and cost reportsLink Healthcare Advantage July 2019 Supply Management: FormularyA Formulary reduces inventory by limiting selection based on quality & costDevelop Formulary & reassess annuallyEvaluate current product usageIdentify other dressing options in each categoryEvaluate other productsAssess product performanceListen to feedback from staff and patientsChoose one or two products in each categoryDevelop approval process for over-riding Formulary Should be manager level with nursing experienceEducate Staff on FormularyLink Healthcare Advantage July 2019 Diane Link RN, MHAdiane@linkhealthcareadvantage.com443-340-4646Link Healthcare Advantage November 2019