understand the new education schedule for cah swing bed ... · cah pps fall under ltc regulations...
TRANSCRIPT
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Based upon Center for Medicare and Medicaid (CMS) Swing Bed Providers guidelines, and hospital based skilled nursing and swing bed program best practices, participants will be able to:
Understand the new education schedule for CAH swing bed programs in
2018-2019
Define CMS October 2018 changes to the MDS
Reproduce best practice suggestions within the facility's swing bed
program
State Office of Rural Health◦ The support of Swing Bed Programs and training is unique in
the industry
◦ Separation of PPS and CAH on webinars that are more specific to your setting
◦ Increased sharing of best practices
◦ New courses as CMS continues to make major changes
Involving a pharmacist to discuss medications issues with the elderly
Nursing documentation to cover all therapy diagnoses
Activities for swing bed programs
Additional information on Compliance issues
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Always watch for updates
◦ CoPs
◦ Medicare required documents
CAH PPS fall under LTC regulations for survey and audits
◦ Impacts documentation
◦ Impacts basics: diagnoses, therapy appropriateness
◦ May be your future . . .
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Impact Act of 2014
SNF Quality Reporting Program
Requirements of Participation (RoPs) for SNFs and Conditions of
Participation (CoPs) for PPS SWBs
Additional clarifications by CMS
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CMS has invested years in the MDS
It is the only place CAH SWB programs can see and understand the
“language” of skilled nursing
◦ This is not acute – no rule outs
◦ This is post-acute – no unnecessary testing
◦ This is a step from sending a co-morbid and/or injured individual home
It is payment for PPS – when does it impact CAH?
Think like the MDS, write like the MDS, follow the rules of the RAI
Manual = CAH SWB “safety”
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Some of those changes include:
◦ Section A
◦ Section C
◦ Section GG
◦ Section I
◦ Section J
◦ Section M
◦ Section N
◦ Section O
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This is changing the “skilled” way of showing improvement = functional
gain
This comes from:
◦ IMPACT Act of 2014
◦ SNF QRP requirements and new measures
◦ Risk Adjustments
◦ Additional options needed for activity not attempted
THIS IS PAC – LTACH, IRF, SNF AND HH GETTING GRADED ON SAME
STANDARDS LOOKING FOR BEST OUTCOMES AT LEAST AMOUNT OF $
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SNF QRP
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1. Share this presentation handout with your IDT
2. Download the NC (Comprehensive) Item Set. Review the MDS for
SWING BEDS
3. Review the new and changed items in Section GG
4. How will you collect the data?
5. What’s your plan for collecting the data if therapy is not involved/not
ordered?
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Time for your program to figure out ASAP how to track
◦ Medicare Spending Per Beneficiary (MSPB)
◦ ALOS by Diagnosis
◦ % of Medically Complex vs Therapy Admissions*
◦ Discharge Disposition
◦ Readmissions within 30 days
◦ Patient Satisfaction (separate from hospital stay and hospital reporting systems)
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* All SWB admissions should
have a “nursing” need
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Version V1.16
October 2018
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Review your process for monthly drug regimen review. 1. How is the physician notified of potentially clinically significant
medication issues at present? 2. Does he/she respond by midnight of the next calendar day? If not,
how can you effect the needed change to be compliant? (Hint: include your Medical Director in this step.)
Watch for then download/purchase the RAI User’s Manual for Version 1.16 – that’s your guidance for coding any/all of the MDS items. ◦ You won’t be able to use your current RAI Manual on/after October 1,
2018◦ Does every member of the IDT that works with the MDS have access to
the current copy of the RAI Manual? ◦ How will you ensure they have access to the v1.16 manual?
Review the new and updated sections with your IDT to ensure they know the guidelines for coding.
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Consistent with the symptoms or diagnoses of the illness or injury under
treatment
Necessary and consistent with generally accepted professional medical
standards (i.e., not experimental or investigational)
Not furnished primarily for the convenience of the patient, the attending
physician, or the family
Furnished at the most appropriate level that can be provided safely and
effectively to the patient
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Based upon Center for Medicare and Medicaid (CMS) Swing Bed Providers guidelines, and hospital based skilled nursing and swing bed program best practices, participants will be able to:
Understand the new education schedule for CAH swing bed programs in
2018-2019
Define CMS October 2018 changes to the MDS
Reproduce best practice suggestions within the facility's swing bed
program