Adult Learning Principles: Influencing Patient Outcomes Through Education, CMS Issues CY 2012 Rule Proposed, Start Preparing NOW for ICD-10 Coding
Adult Learning Principles: Influencing Patient Outcomes Through Education
Understanding the Principles of Adult Learning can assist clinicians to improve patient learning and can result in improved clinical and quality patient outcomes. The brain governs more than memory alone. The brain and mind allow humans to cope with stimuli, creativity, immune responses, language, reasoning, planning, analyzing, and dreaming. It allows the human to feel a myriad of emotions, store experiences, while shaping the capacity to alter behavior and thinking through awareness expansion and critical reflection. The brain is, according to Caine, 2009) biologically designed to learn and learning is a matter of building rich neural networks, but how? Each individual learns a bit differently than their neighbor yet there are 12 strong underlying principles:
1. All learning is physiological
2. The brain/mind is social
3. The search for meaning is innate
4. The search for meaning occurs through patterning
5. Emotions are critical to patterning
6. The brain/mind processes parts and wholes simultaneously
7. Learning involves both focused attention and peripheral perception
8. Learning always involves conscious and unconscious processes
9. There are at least two approaches to memory
10. Learning is developmental
11. Complex learning is enhanced by challenge and inhibited by threat associated with helplessness
12. Each brain is uniquely organized
(Caine, Caine, McClintic, and Klimek, 2009 and Caine and Caine, 1994)
The principles assist us, as clinicians, leaders, managers, to understand that there are several different processes involved. Yet, we all tend to print up some teaching materials and have the nurses leave them with the patient “for reinforcement”. Many people believe, “If I told you, you have had education”.
The best selling education books, Tellin’ ain’t Trainin’ (Stolovitch, 2011) and Sit and Get Won’t Grow Dendrites (Tate, 2004) help us to better understand Brain-Compatible strategies. Some patients may learn well with the written word, while others are spatial and auditory learners.
Future Select Data articles will explore the constructs further but here is one sample activity.
If a patient treatment has changed or is being compared or contrasted, consider using a Venn Diagram. Draw two circles that have an overlapping center like below:
Information that is overlapping in the center is that information that is alike. The information outside that space identifies differences.
A spider chart with the new treatment or new topic in the center of a circle should be drawn. Then draw “spider-like” lines coming out of the circles. These can be goals to be achieved. As the patient articulates each goal they desire to achieve, linking it to the treatment or med in the center of the chart dramatically diagrams the importance of that treatment or medication.
A pie chart can be used to classify the careplan components. Breakdowns can make the plan seem more manageable. Each component or “piece” of the pie can appear to be managed at a setting, much like a tasty lemon pie.
We will look at this topic with more depth in the future. There is a PowerPoint Presentation on the topic of Learning and Brain Compatibility that is based on the Twelve Adult Learning Principles. This presentation was presented at two state association conferences and it could be shared with clinicians.
Having trouble downloading Learning and Brain Compatibility PowerPoint?
right click on the link > Then choose “Save Target As” > “Save”
As a reminder, you can find all of our new blog entries and industry information at http://www.selectdata.com/what-you-care-about
Select Data’s new Seminar Series coming to your town soon. Click here for details.
CMS Issues CY 2012 Rule Proposed
CMS recently issued the proposed rule (CMS-1353P) regarding 2012 payment rates. The proposal includes an estimated net decrease of $650 million compared to Home Health payments in CY 2011 as well as revisions to the hotly discussed face to face rule and the therapy assessment rule.
Here is a brief list of the proposed rule:
1. Proposed 2012 payment base episode rates are updated to $2112.37 from the current $2192.07. This is a rate negative of approximately 3.50%.
2. The rate changes are due to a proposed 2.5% market basket index inflation update, a 1.5 point reduction in the Market Basket Index and wage update under the Affordable Care Act, and a 5.06% case-mix creep adjustment.
3. The increase in the case-mix creep adjustment is due to the evaluation of 2009 coding weight changes. CMS found that ¾ of the coding increases were a result of increases in therapy visits above the 14 and 20 visit thresholds. (A $950 million decrease is projected)
4. The 3.56% rate reduction will unevenly impact individual providers. CMS proposes to make significant changes in coding weights by eliminating two hypertension codes as a factor in the calculation (as had been proposed in CY2011), reducing the payments on therapy episodes, recalculating the Home Health PPS case-mix weight yet increasing weights on non-therapy episodes. Providers with high volumes of therapy cases could see greater net rate reductions. A provider-specific analysis using the provider’s particular case mix is the only reliable way to assess impact to a specific agency.
5. CMS proposes to change the face-to-face rule and allow physicians who care for patients in acute and long term care to do the encounter and report the information to another physician who completes the certification and plan of treatment documentation.
6. CMS proposes to clarify the therapy assessment standard where more than one discipline is involved.
Summary
Though provisions of the Affordable Care Act (ACA) mandate that CMS apply a one (1) percentage point reduction to the CY 2012 home health market basket amount; this would equate to a proposed 1.5 percent updated reduction for HHAs next year and many agencies had hoped it would be postponed. Home health payment rates have been updated annually by either the full home health market basket percentage increase, or by the home health market basket percentage increase as adjusted by Congress. CMS uses the home health market basket index, which measures inflation in the prices of a specific mix of goods and services included in home health services. The Deficit Reduction Act of 2005 requires an adjustment to the home health market basket percentage update depending on HHAs submission of quality data. The proposed home health market basket increase for CY 2012 is the 1.5 percent.
“CMS’s proposal reflects our commitment to ensure that we pay accurately for Medicare home health services as we improve the structure of our payment system and decrease incentives for upcoding,” said Jonathan Blum, Deputy Administrator and Director of the Center for Medicare.
In a separate proposed rulemaking filed (CMS-2348-P), CMS would require comparable face-to-face (F2F) encounters for people receiving Medicaid home health services to adhere to the unifying nature of these provisions made under the Affordable Care Act. The proposal aligns the Medicaid time frames with the Medicare time frames while providing some flexibility to individual states to determine the content and expected documentation. The proposal also reaffirms CMS’s position that a homebound requirement in Medicaid home health is not permitted. The proposal also offers clarifications on the coverage of medical supplies and equipment.
Sources:
The proposed rules can be found at: http://www.cms.gov/HealthPPS/HHPPSRN/itemdetail.asp
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Start Preparing NOW for ICD-10 Coding
In this session, Select Data is including a link to the PowerPoint Presentation presented by teleconference, nationally, on July 27, 2011.
ICD-10 PCS and ICD-10 CM are being actively discussed, especially since CMS stated in their recent online training that the transition from ICD-9 to ICD-10 “Requires changes to almost all clinical and administrative systems and requires changes to business processes.”
As we all are aware, ICD-10 will replace a 30 year old system that has not kept up with modern terminology and clinical practices. ICD- 10 offers detailed information on the patient’s condition through specific diagnoses. It is expected to allow upgrading of current data analysis of both diagnoses and procedures with improved care management for patients/clients as an outcome.
Because of increased specificity, the expectation is that interventions for chronic diseases will occur sooner. ICD-10 will allow tracking of disease severity and progress measurement as well as design educational programs for disease clusters identified. It is also expected to identify disease groupings that “may merit special attention” as well as the designing of new care management programs.
Because there is more specific information tracked sooner, it is expected to provide an opportunity to determine procedural and process cost-efficiencies. More specific information presents an opportunity for coverage and policy revisions. Programs will be expected to make decisions based on more dynamic information.
For an overview of ICD-10 including the differences in number of codes, documentation requirements, differences between ICD-9 and ICD-10, please review the attached Power Point presentation. Contact Select Data Chief Compliance Officer with questions regarding ICD-10.
To download a copy of this PowerPoint presentation click here.
As a reminder, you can find all of our new blog entries and industry information at http://www.selectdata.com/what-you-care-about
Select Data’s new Seminar Series coming to your town soon. Click here for details.