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Winners and losers of this battle are not yet clear

Written by: Dennis Stevenson Jr., MBA on Tuesday, January 26, 2016 Posted in: Inpatient Rehab

It’s no secret that Medicare wants to standardize payments across different types of providers. The concept, known as site-neutral payments, will soon be coming to inpatient rehab (IRF) and skilled nursing (SNF) providers near you. It’s not yet clear who will win and who will lose in this impending showdown.

Historically, it has been difficult to determine whether IRFs and SNFs were providing the same care to the same types of patients. Each provider collected different data about patients, their conditions, the treatments provided and the outcomes achieved. This difference is embodied in the IRFPAI 1.3 and MDS 3.0 instruments currently used by IRFs and SNFs respectively.

Effective October 1, 2016, the barrier between data sets will be partly demolished. CMS has significantly expanded the IRFPAI, requiring version 1.4 to be used for all patients. This change to the IRF reporting and prospective payment systems brings IRFs and SNFs reporting requirements much more in line with each other. Effective October 1 of this year, the data will allow a much more direct comparison between the two provider types.

IRFs should sit up and take notice!

Because the IRFPAI is being expanded, IRFs are coming late to the game. Many of the components that have been added to IRFPAI 1.4 have been incorporated into the skilled nursing MDS for many years. This means that the skilled nursing providers have a head start in understanding how this data works in their clinical settings. They also have trained assessors who know how best to use the data in these assessments to optimize their care.

Here’s an example:  The Brief Interview for Mental Status (BIMS) has been in the MDS since 2010. This means that skilled nursing providers have at least six years of experience using this instrument and understanding how to score it. It doesn’t take a rocket scientist to figure out that this gives them a definite leg up in the head-to-head comparison sweepstakes.

Don’t let this big change catch your IRF off guard. Now is the time to begin planning and preparing for the big change, which will be on top of you before you know it.

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