Mediware Rehabilitation Blog

Defining Resource Utilization in Post-Acute Care

Every year at this time, CMS issues its proposed rules for how providers will operate and get paid under Medicare. Changes are inevitable and this year’s issue continues to drive home the requirement to submit additional information to feed Congress and policy makers the data needed to figure out exactly what they are paying for in post-acute care.

Comment On the IRH/U Proposed Rule- it is Your Prerogative!

Each year, Inpatient Rehabilitation Hospitals/Units (IRH/U) can be presented with a new set of regulatory challenges and presented those with a relatively short time to prepare yourself and staff to meet those requirements. Fortunately, CMS publishes a 'PROPOSED RULE' when they plan to implement change. During that time, facilities and knowledgeable persons are invited to comment on the proposals made in order to help mold a FINAL RULE expectation. If you are the type to wonder how your facility is always caught up in these changes, you may be the type that wants to review the proposed changes and make comments to CMS so your ideas are considered in addition to or instead of a present proposal. IF SO, please join us for the Inpatient Rehabilitation Hospital/Unit Proposed Rule review...

Quality IRH/U Reporting Deadline: May 15, 2015

Non-Participation in quality reporting in an IRF reduces the standard payment by two percent in a future payment year. The deadline for quarter 4 CAUTI data and Influenza vaccination of your healthcare personnel are due THIS WEEK (May 15) ! There is no time to spare; validate your submissions have or will occur before May 15 to the National Health Safety Network on these two items!

This is so disturbing, CMS has created a new MedLearn Matter on the subject, along with the course of events for how the 2% reduction and appeals can occur. 

Alternative Payment Model Coming to A Healthcare Provider Near You

If you haven't heard much about 'Alternative Payment Models' at all, or all until recently, it is a concept that all healthcare workers need to embrace, acknowledge and understand as soon as possible. Bundled Payment and Accountable Care Organizations have been referenced as Alternative Payment Models (APMs); however, this concept is just beginning and CMS, in their quest to guide payment away from fee-for-service toward 'paying providers based on the quality, rather than the quantity of care they give patients', is entering on a whole new horizon. It's time to take a peek and define when, where and how you feel APM fits into your book of business.

Ending Therapy Cap Rationing; Could a Merit-based Payment Incentive System Work?

If the Sustainable Growth Rate formula for physician payment in the Medicare program has been the object of criticism for unacceptable value-based methodologies, its repeal is certainly a positive step to providing some rationale for paying for needed healthcare. The Merit-based Payment Incentive System (MIPS), announced last month, will change Medicare payments under Part B. Could this new legislation provide insight to how outpatient therapy providers could be paid in the future?


Forge Ahead, Every Path Leads to Tumultuous Healthcare Change

Each year, healthcare brings new challenges as regulations change; documentation requires more specificity and the push to do more with less climbs to even higher levels. If you work in healthcare, you are certainly feeling the pinch. This year, as I attended the AMRPA Spring Executive Forum at the end of February in Washington, D.C., and learned more information on the multitude of changes facing healthcare executives and workers, I could not but wonder how many people are truly keeping up with the possibilities and how those areas will affect their daily routine.  

In an effort to place some urgency into your sails,  I want to present a short list of the blueprints being worked into our healthcare models at top-notch speeds. DO NOT think you will not be affected. Change is occurring and you need to lace up your marathon sneakers because a simple hike will not get you to the milestones you need to reach right now!  This is what we are facing in the very near future...

SGR - The House Weighs In While the Senate Goes on Vacation

A big push from the House of Representatives to present the first possible permanent fix to the Sustainable Growth Formula and avoid a 21 percent reduction in payment to the Physician Fee Scheduled as early as April 1, 2015, came to a grinding halt when S. 810 was left to discuss after the Senate's spring break.  Having all possibilities covered, CMS acted early and released a statement on what they were prepared to do should a final vote not be completed in time.  

How ‘Peter Says Lion Eats Snails’ Helps Rehab Nurses

In the absence of obvious issues that require immediate redress, where does the nurse leader go with the data? How should the nurse leader prioritize? Using the acronym ‘Peter Says Lion Eats Snails’ (PSLES), the nurse leader can look for areas of prioritization. As the reader may recall, this is the same acronym used to memorize Maslow’s hierarchy of needs. In this case the concept is the same, we move from lowest priority to highest, but the words are different.

MedPAC March 2015 Report Clings to Recommended Site Neutral Payment

The Medicare Payment Advisory Commission (MedPAC) is an independent congressional agency established by the Balanced Budget Act of 1997 (P.L. 105–33) to advise the U.S. Congress on issues affecting the Medicare program.  MedPAC publishes and shares their recommendations with Congress each March and June in hopes that the 17 member commission imparts wisdom to guide regulatory process and change.   There is no better time than NOW for inpatient rehabilitation hospitals and hospital units to refute MedPAC's continued insistence that resources and care are equal between an IRF level of care and SNF level of care. If this were true, long ago specialty management and concentrated rehabilitation programs with a 24/7 emphasis on nursing, medical management and therapy interdisciplinary care would not have been supported at a hospital level of care. 

If we are not careful in demonstrating the differences, a commission like MedPAC, who has informed congress that care is the SAME and should be paid the same, will support a notion that site neutral payments will solve Medicare short falls and everyone, including the beneficiaries, will have access to appropriate levels of service.  

Documenting the Pattern to Defend the Issue at Hand

In part 1 of this 3 part series, we examined the 4 big challenges nursing leaders need to take into account when looking at data on productivity, quality measures, census data and trends, fall rates, turnover rates, patient satisfaction scores and more. Once the nursing leader has the numbers, considered the rates and benchmarks, established a pattern rather than making generalizations on short term data, and determined causation, what next?  How should a nurse leader prioritize?  Looking at the data, there may be one piece of information that is so far off the benchmark that it creates cause for alarm that cannot be ignored.  When those events happen, they force nurse leaders to pay attention to that issue and make it the highest priority.

Making Sense of the Data – How to Prioritize

I have all this data, but I do not know what to do with it.”  This is a direct quote from a nurse manager at a rehabilitation hospital several years ago.  Have you ever felt this way?  Nurse Managers are usually inundated with data on productivity, quality measures, census data and trends, fall rates, turnover rates, patient satisfaction scores and more.  Increasingly, numbers are used by payers, hospital leaders and the public to make decisions about where, how and when to provide care.  It is, therefore, of paramount importance that the nurse leader understand what the numbers mean, and how to prioritize.

Continuing Thoughts about Site-Neutral (Parity) Expectations

“Site-neutral” may have been replaced with “efficient care in the most appropriate setting” language in the President’s FY2016 budget, but it was prominently discussed in Washington this past week as the American Medical Rehabilitation Providers Association (AMRPA) hosted its annual Spring Executive Forum. Presentations, followed by visits to the Hill to meet with Congressional leaders, drove focus upon how the care and result of managing impairment and functional restoration differed in settings where rehabilitation services are provided.