Wednesday, October 23 | Legislative/Policy, Thought Leadership, Post-Acute Care, Care Coordination

Why Treating Depression Under PDPM Is More Important Than Ever 

The circumstances that bring most elders to nursing homes often include loss of function and mobility at home. Those issues combined with chronic pain, loss of loved ones and the stigma associated with depression heighten the need to screen for and treat depression among residents in nursing homes.
 
Consider these statistics: 
 
Approximately 40% of residents in nursing homes have symptoms of depression.
 
Elderly individuals who suffer from chronic pain are between 2.5 and 4.1 times more likely to experience depression.2
 
Approximately 68% of adults aged 65 and over know little or almost nothing about depression.3
 
What’s more, 15% of persons aged 65 years or older are readmitted to the hospital with depression-related symptoms. Those with high depressive symptoms are more likely to be readmitted than those with low depressive symptoms.4
 
However, for a variety of reasons, skilled nursing facilities (SNFs) haven’t always been proactive about identifying depression in residents. Historically, SNFs have often under-diagnosed and undertreated depression. They’ve often also under-documented or miscoded for signs of depression. Studies show depression management is correlated with lower rehospitalization and lower length of stay.  
 
With the launch of Medicare’s new Patient-Driven Payment Model (PDPM) – aimed to drive the best outcomes for individuals and reward providers based on outcomes – it becomes more important than ever for SNFs to properly identify and care for people with depressive symptoms.  
 
Caring for people with depression costs more and is reimbursed more under PDPM. When SNFs properly identify and treat depression as part of a resident’s overall care plan, reimbursements can increase up to 17% in the nursing component, according to The Centers for Medicare and Medicaid Services (CMS) final rule for the SNF prospective payment system. 
 
The question becomes: How can you ensure you have the right staff to conduct depression assessments, particularly in elderly residents with multiple complex conditions? What steps can you take now to successfully manage depression among your residents? 
 
Below are some suggestions from McBee Clinical Consulting Manager Peter von Mechow.

Invest in training and education 
 
Make sure frontline caregivers, especially your social workers, are trained in recognizing depression. Ask your medical director, psychologist or psychiatrist to consult with staff on how to spot depression. Equally important is helping staff overcome the barriers of being afraid to discuss depression with residents. 
 
Once depression is recognized in a resident, the chart should be reviewed by the physician so it can be properly diagnosed and treated. Depression should be in every clinician’s assessment with some type of review process to determine whether a resident verbalizes depression or shows signs of depression. Furthermore, it needs to be documented in all disciplines. 
 
Conduct quality chart reviews 
 
After education and training, it’s important to conduct quality chart reviews to see if there is any indication of depression. In the review, ask, was depression recognized? Was it treated? If depression was documented appropriately and diagnosed by the primary physician, did staff appropriately capture it on the Minimum Data Set (MDS)? 
 
Do a live chart review with the interdisciplinary team within five days of an admission to see if all data, including depression, is properly documented and coded before the 5-day MDS is complete.    
 
Keep focused on care planning
 
Everything you are diagnosing or capturing in the notes as a problem needs to be included in the care plan. Because care plans help assign the correct and most qualified staff to provide the care outlined in the plan, it’s critical that you document accurately and completely. 
 
With recent CMS updates on regulations, care planning is a new focus for compliance. The significance of depression adds to the clinical complexity score of the nursing component, creating an even greater importance in proper care planning.
 
PDPM offers a huge opportunity, both clinically and financially, for SNFs who can properly capture, identify and treat depression. But the most important beneficiaries of this new patient-focused care model are the elderly who are served.   
 
 
To learn more about how Netsmart and McBee can help you succeed with PDPM, click here.
 
 
Sources
 
 


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