Post-Acute Inpatient Flashcards
Criteria for IRF
Reasonable and necessary care and significant rehab potential
Require the coordinated care of at least two therapy disciplines (PT, OT, SLP)
Required to participate in minimum of 3+ hours therapy per day, at least 5 days per week
PPS Payment
Based on FIM scores, other demographic and diagnostic data to determine which case-mix group (CMG) the patient will be assigned to.
This provides a set payment that the patient will receive for the entire admission in IRF.
Payment is based on an average length of stay for that particular CMG.
If patient is moved to another health care facility, the payment is prorated.
VERY important to understand why getting someone better and discharged to community is important
What is payment in IRF based on?
Payment is based on data gathered: diagnoses, comorbidities, and demographic data and FIM scores»_space; Case Mix Group (CMG)
Each CMG is associated with a specific payment amount for the entire length of stay.
Payment is based on an expected or average length of stay for that particular CMG.
Average length of stay in SNF?
26.4 days
Payment to SNF for Medicare Advantage?
Medicare Advantage plans typically pay a flat fee per day. Typically case managers to determine level of care, including amount of therapy based on diagnosis
Medicare payment to SNF?
Calculated per diem, determined by the amount of rehab services provided.
Categorizing the resident into “resource utilizing group” (RUG) for payment purposes
When are minimum data sets required?
Day 1, 14, 30, 60, 90 and if there is a significant change in status
Ultra High Rehab:
720 min/ week + 1 discipline 5 days/ week + 1 discipline 3 days/ week
Very High Rehab
500 min/week + 1 discipline 5 days/ week
High Rehab
325 min/ week + 1 discipline 5 days/ week
Medium Rehab
150 min/ week + 5 days any combination of 3 rehab disciplines
Low Rehab
45 min/ week + 3 days any combination of rehab disciplines + restorative nursing 6 days/ week
What does Long Term Care include?
includes assisted living, adult day care, home care or sitter services (non-skilled care under Medicare Part A
Services provided at LTC?
administration of medication, provide ongoing restorative, recreational, social activities
Leading cause of LTC admission?
decreased cognition, incontinence, increased falls, decreased functional status
Payment of LTC?
out of pocket, by private insurance, or by Medicaid if residents qualify based on their income
Average LOS of LTC?
341 days
Characteristics of frailty: (3 or more considers patient as frail)
Unintentional weight loss (10# or more in a yer)
General feeling of exhaustion (self-report)
Weakness
Slow walking speed
Low levels of physical activity
Modified Physical
Performance Test
test for frailty
Domains of Modified Physical Performance Test
Book Lift Put on and take off coat Pick up a penny Chair rise Turn 360 50 foot walk One flight of stairs (10 stairs) Four flights of stairs Progressive Rhomberg
Modified Physical Performance Test
Not frail
32-36
Modified Physical Performance Test
mild frailty
25-32
Modified Physical Performance Test
moderate frailty
17-24
Modified Physical Performance Test
no longer independent within community
<17
What is a predictor of stair climbing ability, balance and general functional decline?
self efficacy
When is gait training considered a skilled intervention by CMS?
When a therapist needs to give specific instructions, verbally or manually, to improve the gait pattern
A gait assessment needs to be made to determine the impairments causing any abnormalities
Recommendations need to be made for assistive devices.
When can it be presumed that a patient has lost 75% of their reserve strength?
If a resident cannot walk without using his arms to support the body because of leg weakness
Homebound Status
Required by Medicare A and B for treatment
Leaving home would be extremely difficult
Occasional excursions outside the house allowed
OASIS
Outcome and Assessment Information Set
Home health assessment instrument, used to justify care and determine episode rate of reimbursement
PT, Skilled Nursing, and SLP qualified to collect data at start of care (SOC)
Components of OASIS
Consent and emergency plan/advanced directives Emergency Planning Medication Reconciliation Health Risk Screening Home Safety Assessment Functional Assessment and Musculoskeletal Assessment Goal Setting Physician Verbal Order
OASIS-C2
Effective January 2017
3 new standardized items (M1028, M1060, and GG0170c)
