The Beauty of PDPM – What MIGHT Be There

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By Lori O’Hara, MA, CCC-SLP, PDPM Resource

One of the miraculous things about PDPM is that we are incentivized to go learn things! And … we have the patient with us, 24/7, sometimes for weeks! There is no other provider — not the acute, not home health, not outpatient, not anyone who gets to have their arms around the patients as closely as we do and who are also told to go learn absolutely as much as we can.

Just us, baby!

So this presents an incredible opportunity to be the best assessors, the best investigators and the best, most impactful providers a patient will come into contact with.

This means that we if work superficially — if we’re content with just the diagnoses on the transfer list and just the treatments that come to us — that we’ll miss out on the potential for incredible impact to a patient, which, super conveniently, is pretty reimbursable when we do it.

So part of being a PDPM Ninja is knowing where the arrows are pointing. What conditions tend to come in clusters? What treatments should we be advising the MD that we can do? What low-impact, non-invasive interventions could have a big payoff for this patient if we just think about doing them?

So here’s an exercise for you. Look at the diagnosis list below. And before you scroll down, think through all the “maybes.” What might related conditions be? What treatments should be considered? What condition might mask another where you should take a close second look?

So what did you find?

Here’s what I found:

        • Sepsis and Bacteremia = Need records to confirm or r/o septicemia
        • Diabetes and insulin = Check for diabetic retinopathy and proactive management of insulin regimen in case order changes are needed
        • Diarrhea = Investigate source (radiation, infection, c-diff?) to confirm or r/o inflammatory bowel disease
        • Convulsions and seizures = Investigate control status (25% of seizure disorders are poorly controlled/intractable)
        • Klebsiella PNA and sepsis = Query for labs for drug resistance status
        • Alzheimer’s disease and encephalopathy = Cognitive impairment
        • Obesity = Score BMI, assess if patient’s weight warrants morbid obesity diagnosis
        • PNA = Assess for need for RT interventions
        • UTI = Assess voiding and s/s of retention for straight cath medical management
        • Multiple malnutrition markers present (infections, dementia, diarrhea, dysphagia)
        • Dysphagia = Should trigger on Section K, which should then correlate to altered texture diet trigger for altered texture diet

Did you spot any others? You can also do this exercise with medical documentation from the upstream provider. And the more clinical brains, the better! Each clinician carries their own training and experience into the room, so one brain might pick up on something another brain might not spot. And when you find four or five “maybes,” you know that not every one of them will result in a new condition to code and care for. But you’ll probably find a thing or two, and maybe find something else — completely unrelated to payment — that will have a big impact on your patients’ health and recovery.

Like I said — miraculous!

 

What Makes a Good Leader?

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Submitted by Jennifer Sowers, DOR, McCall Rehabilitation, McCall, ID

I believe leadership is a position earned and appointed by those who have taken recognition of your ability to follow, listen, try harder to be a better person, think outside the box and be willing to learn.

Jocko Willink, a retired Navy Seal Commander, has written several books on leadership that are all worth the read if you want to be a better leader. Several truths to live by jump out in his books and podcasts, and the one that speaks loudly is: Discipline equals Freedom. What does this mean? First, why do we need discipline as a good leader?

In a leadership role, we are being watched. Our team is watching us; even those not on our immediate rehab team are watching us. The cooks, the CNAs, the Activity Director, not to mention our ED and the DNS. They are watching our attitude, our behavior, how we react in conflict or under pressure. Are we late for meetings? Do we roll our eyes? Did we yawn? How are we dressed? A full-time employee in our facility told me recently, “The rehab team is like the cool kids in high school — everyone wants to be like them and hang out with them.” At first it was a compliment, but then I started to think, why are we a separate “click” outside the big team? Do other employees think we are above reproach in the building? That’s when it really struck me how important it was that we as a team, and especially me as a leader, must demonstrate excellent leadership. We are in a spotlight. And we all know that with great power comes great responsibility, and as a leader, we are in a position of power.

And that is where ownership comes into play as a leader. If you make a mistake, don’t cover it up; admit mistake and then make a plan to do better. If your team makes a mistake, take ownership. When are we not responsible for the performance of our team? Never. If our team is not performing, then maybe they need more training, more assets, more support, more mentorship. Ask your team what they need and then follow up with them. That’s when a job will get done. Is the mission clear, concise and understood? Make sure professional expectations are clear and don’t compromise standards. As a leader, lead by example and take responsibility for your team. The other day a patient got extremely upset about a new RA not doing a specific exercise as she expected. The RA came to me, warning me this patient was mad and going to complain to me. I listened to the patient and then apologized to her, saying I had instructed the RA incorrectly and it was my fault she did not understand the specific exercise. The RA came to me later, smiling, and told me the patient had apologized to her and their relationship was restored. She was relieved and the patient was happy. If you make a mistake, own it. Don’t make excuses or cover it up. Neither the RA nor the patient were mad at me for not doing thorough training. It was amazing how quickly me taking ownership dissolved the conflict.

Leadership is all on you but it’s not all about you. The team is way more important than you are. Keep your team’s interests above your own, and use all the tactics you can to make your team better, not yourself. If your goal as a leader is to help others and your team, then you will accomplish the mission. If your team succeeds, then you win as a leader and your people will win. That is true leadership. But, it does start with you and that is where the truth that discipline equals freedom rings so true to the core of leadership. Here is a quote by Jocko Willink regarding the application of discipline:

Discipline starts with waking up early, it really does. But that is just the beginning; you absolutely have to apply it to things beyond waking up early. Is it working out, every day, making yourself stronger and faster and more flexible and healthier? Is it eating the right foods, to fueling your system correctly? Is it disciplining your emotions, so you can make good decisions? Is it about having the discipline to control your ego, so it doesn’t get out of hand and control you? Is it about treating people the way you want to be treated? Is it about doing the tasks you don’t want to do, but you know will help you?

Discipline is about facing your fears so you can conquer them. Discipline means taking the hard road, the uphill road. To do what is right. For you and for others. So often, the easy path calls us: to be weak for that moment. To give in to desire and short-term gratification.

Discipline will not allow that. Discipline calls for strength and fortitude and Will. It won’t accept weakness. It won’t tolerate a breakdown in will. Discipline can seem like your worst enemy. But in reality, it is your best friend. It will take care of you like nothing else can. And it will put you on the path to strength and health and intelligence and happiness. And more important, discipline will put you in the path to Freedom.

I think about freedom equaling discipline as a leader and a lot comes back to doing the right thing even when we don’t feel like it. Freedom for me is getting all my progress notes done on time, getting my discharges done on time so when I do closeout I don’t get a screen of red. Freedom is showing up for work early so I have good numbers to present at stand-up and my team has their schedules ready when they arrive. I have a running calendar, and the other day I flipped the page and it said, “I love running because it’s the one thing I do every day and never regret.” I’ve never said, gosh, I’m sure bummed I got up and ran this morning. Wish I hadn’t made my bed today. Or, I’m sure bummed I got all my notes done on time, or I’m sure disappointed I took a shower today, or ran my metrics, or did some continuing education. We’ve never said that. When we’ve had the discipline to go on the run, finish the progress note, pack a healthy lunch, we have freedom and we can lead our team to have the same freedom by example.

Lastly, a leader will never ask their team to do something they will not. As a leader, we need to care about our team. Advocate for your team, whether it’s new equipment, continuing education, time off, negotiating with nursing. Have their back and they will have yours. If your team knows you have their best interest in mind as their leader, you will have their respect. And, then when you need to give criticism, it will be accepted more easily. And celebrate! Set goals and celebrate with your team! Don’t forget to recognize victories and show them how much they are appreciated.

A lot goes into being a great leader, and these are just a few but they are the ones that have hit home with me lately. Take ownership, discipline equals freedom, lead by example, your team comes first, and show them you care.

Birds of Different Feathers

Building Therapy Leaders Learn

Improving Work Relationships

Are you objective, analytical, and logical? Are you a natural team player? Are you lively and entertaining? Are you a natural born leader? The answer to these questions and more may help you to better understand your work style, but more importantly, the work style of your coworkers.

We all have unique personalities and different learning styles. What you appreciate about your work may be different from what others appreciate about their work. What do you think a lot about, value in others, enjoy or dislike? What you have trouble dealing with may be unique to your work style. Knowing and understanding what makes you and your coworkers unique may better strengthen your relationships.

Recently at Premier Care Center, we began a distinctive training style to identify ourselves and our work style. We then share with our coworkers each other‘s work styles in an attempt to strengthen our work relationships. The therapy department took on a fun adventure to better understand our own traits and those of us on our team and how we may improve. We were introduced to a training course called “Birds of Different Feathers”. It is a quick Personal Work Style Self-Assessment. Once everyone has completed the assessment they use the score on the assessment to identify their own ‘Bird Style’. Once you know your bird, you may read the course information that identifies your unique characteristics. Knowing more about yourself is only half the fun. Once everyone shares their own unique ‘Bird Style’ with the group, then we were all able to discuss and learn about each other.

Some don’t like to be micro-managed. Some are natural ‘cheerleaders’ and thrive on the creative energy of groups. Some will respond well when they can be given autonomy and the opportunity to exercise their best professional judgment. Some prefer not to be criticized or embarrassed in front of other people. They are sensitive and care deeply what others think of them.

It was quite enlightening to learn about our teammates. We now use this ‘Bird Style’ terms when we speak to each other and it has given us deeper insight into how better to communicate together. We even presented the course to the Premier Care Center Leadership Team, and they have fully embraced it as well. More recently it was presented to the Ensign Therapy Resources as a culture training piece. So what kind of a bird are you?

Are you an Owl – a data collector? Are you a Dove – a collaborator? Are you a Peacock – an artist/creator? Are you a Hawk – a decision maker? Find out your own unique ‘Bird Style’ and how are you may better influence your communication with your team or coworkers by taking the training on ‘Birds of Different Feathers’.

So what kind of a bird are you?

Assessment: Personal Work Style Assessment (pdf file)
Training: Birds of Different Feathers (pdf file)

Be sure to take the assessment first, then the training.