Long Term Care Facility-SNF Flashcards
what is a SNF?
a healthcare institution that provides comprehensive nursing care and rehabilitation services to patients who need medical, nursing, or rehabilitative care but do not require hospitalization
what care is provided in a SNF?
24-hour care by RNs and licensed practical nurses - administering medications, managing intravenous therapies, wound care, and monitoring vital signs
PT/OT/SLP
physicians and other healthcare providers regularly visit to monitor patient progress, adjust treatment plans, and address any medical issues
what is the PT’s role in management?
clinical management
administration
interprofessional collaboration
d/c planning
continuing education
what is involved in clinical management?
assess and treat pts
what is involved in administration?
compliance and documentation
what is involved in interprofessional collaboration?
team meetings/case rounds
and family/caregiver education
what is involved in d/c planning?
build relationships with referral sources
what is involved in continuing education?
pursuing specializations
who is involved in the interprofessional team?
Administrator
Director of Nursing Services (DNS)
Social Worker
Nurse Practitioner (NP)
Registered Nurse (RN)
Licensed Practical Nurse (LPN)
Certified Nursing Assistant (CNA)
Registered Dietician
Physical Therapy
Occupational Therapy
Speech-Language Pathologist
what are examples of managerial roles in SNFs?
traditional director of PT services (rarely seen bc discipline specific managers has decreased0
interprofessional director
area manager for rehabilitation services
the director of rehab
manager of contract therapy services
what is the role of the area manager for rehab services?
responsible for several staffs and patient care in multiple facilities of a national chain of SNFs
regional managers may have similar duties as area managers but for more buildings
what is the role of the director of rehab?
the larger the organization, the more likely it will be that unit supervisors will manage the day-to-day operations of these units
they may have some flexibility in shifting staff among units, as staffing needs demand
what is the role of the manager of contract therapy services
negotiate contracts for assignment of physical therapists
what are the biggest hurdles for PTs in SNFs?
lack of staffing and resources
burnout
ineffective maintenance programs or transition programs from skilled care
over utilization
productivity standard issues
billing and coding issues
lack of appreciation of the unique skills of a PT or PTA
expectation for performance of tasks just because they have always been done by therapy such as wheelchair cleaning or inventory
what is revenue management?
making sure revenue exceeds expenses
budgeting revenue properly to account for staffing, new equipment, fixing equipment, etc
what gives the SNF operators the tools to address financial challenges, monitor revenue streams, and identify any areas of potential improvement?
revenue cycle management
t/f: RCM strengthens the financial stability of healthcare organizations by avoiding unnecessary costs, optimizing revenue collection, and minimizing claim deals, allowing SNFs to get through economic uncertainties
true
what is the payment system for SNFs?
the patient-driven payment model
what is the goal of the patient-driven payment model?
to improve payment accuracy by attending to each individuals circumstances and to classify them into payment groups in regard to specific data-driven patient characteristics
what is the patient-driven payment model?
reimbursement is based on resident activity, rather than volume of services provided
what are the concerns with the patient-driven payment model that the APTA addresses?
the level of therapy does not change because the payment model has changed
the amount of therapy a patient receives should be determined by the different health care professionals (interprofessional collaboration)
the amount should also be based on the patient’s needs and how they present.
in order to make the adjustment to this payment system, PT’s were advised to do what?
conduct workflow analysis, identify opportunities for interprofessional collaboration, proactively address changes in plans of care, follow clinical practice guidelines, assess their knowledge of different regulatory aspects and their understanding of Medicare Part A, Medicare Part B, Medicare Advantage, and 3rd party payer rules
what is required for Medicare part A coverage of SNF?
admitted to hospital for 3 days (counting day of admission but not d/c day)
transferred to SNF within 30 days of d/c (if more then you need another 3 day hospital stay)
requires skilled nursing services or rehab on a daily basis
what is the cost to the pt for SNF day 1-20?
$0 (possible co-pay if on Medicare Advantage plan)
what is the cost to the pt for SNF day 21-100?
$204
what is the cost to the pt for SNF day 100+?
all costs
what are the rules for Medicaid coverage of SNF?
must be in a medicaid-certified facility
available when other payment options are unavailable and the person has qualities for Medicaid
no limit to the number of days covered
t/f: there is a limit to the number of days in SNF converted by Medicaid
false, the limit does not exist (iykyk)
will private insurance typically cover the cost of short term care?
yes
will private insurance typically cover the cost of long term care?
no
what are the requirements to receive benefits from long term care insurance?
2+ ADLs must be limited or cognitive impairment
elimination period- must self pay for services for a predetermined number of days
what is the coverage of long term care insurance?
will cover a predetermined daily limit until overall limit reached
will pay a set amount each day of admission
depends on plan
