[Talino]

To all who responded... thank you!

Now, test your ability to calculate a RUGs score by just using a few crucial data.

Scenario: During the last 10 days, a resident has a short-term memory problem, moderately impaired w/ decision-making, and is sometimes understood. He has stage II ulcers on 2 sites w/ treatments; was seen by MD twice w/ 2 order changes in different days; and an ADL sum = 7.

In addition to the above, which of the following skilled care will deliver the highest CMI (Medicare PPS). Which is second, and the lowest? Provide the RUG code.

1. receiving IV antibiotic rx daily, or
2. receiving Physical therapy daily 6x/week @ 80 mins per rx, or
3. receiving tracheostomy care daily

Feel free to throw yours.

[catlady]

1. SE3--extensive services due to the IV abx: impaired cognition, IV abx, Special care for the two decubs, and clinically complex for the order changes/doc visits gives a score of four.
2. RHA for 1 discipline over 5 days, 325-499 minutes.
3. SE2--extensive services due to the trach care: impaired cognition, special care for the decubs, and clinical complex for the order changes/doc visits gives a score of three.

I'd be going for that SE3. (I'd also be surprised to see someone that medically compromised with an ADL score of 7. No OT needs???) I am not at work so I don't have my CMI cheat sheet in front of me. I don't think RHA is higher than SE3 on CMI; I know for sure that it's a lower reimbursement. If I were stuck with an RHA, I'd be looking really closely at the therapy and nursing documentation to see if I could raise the 7 to an 8 and RHA to RHB.

[Talino]

At the time of this reply, I see 351 views, and one reply.
'guess it's just you and me catlady

Based on the New York City wage index (your city/town may score differently)...

#1 =receiving IV antibiotic rx daily >SE3 = $457.00

#2 =receiving tracheostomy care daily >SE2 = $396.84

#3 =receiving Physical therapy daily 6x/week @ 80 mins per rx >RHA = $391.46

Considering there was an acute medical condition, a decline in cognitive abilities can be evident, but not necessarily an extensive loss of ADL independence. Yup, in a real scenario you would look into raising the ADL sum, but, this is just a test.

[catlady]

We don't get NYC rates. I wish.

I know what you are saying about the ADLs, but if we're talking a 5-day assessment (rarely do we get SE3 or SE2 beyond the 5 day, because of therapy), they're almost never making an ADL score of 7 so early in the game.

I didn't say it couldn't be done, just that it would catch my attention. I'd be looking at the therapy documentation and nurses' notes to see if I could raise that ADL score. Not to mention that my company expects no more than 22% of my Med A days to reflect "A" level ADLs, and I am required to raise at least one assessment from A to B or B to C per month, or show what I'm doing about it.

OTOH, just today I was trying to *lower* an ADL score--I need to take credit for an SE3 by using an ARD of day 4 (can only get SE2 if I use day 1) on a resident who will only make high on the 5 day assessment, but I need my ADL score below 13 so that my SE3 will trump rehab high. RHB is a lower CMI than SE3, but RHC is higher than SE3, even though the reimbursement is lower. I squeaked it to 12--legitimately.

[CaliforniaRN]

You guys are good! I wish I could call the shots like you do! I am pretty much alone out here in rural California! I have my 2.0 and that 's about it! NO training on how to get my ADL scores up! And if I had reimbursements like you have in NY I'd be screaming with joy! Do you have a softwre program that helps you with predicting your RUG/ADL scores? Or do you have a handy cheat sheet that you use? Would like a copy, if you do!

[Talino]

... sent you a pm. It should provide you with an excellent ammunition. 'am sure you can get plenty of help here too. Good luck!

[harley girl]

I believe the highest pay would come from the Physical Therapy. 2nd-Trach and 3rd-IV Abx. ?

[AlixCoastRN]

Sorry - I do ICF, not skilled folks and most are Medicaid so we get a flat rate. We can do whats called an add-on for stuff like tube feeding, Stage III, 5 days of therapy, IV etc; but then its a flat rate. No matter how you look at it, we get the same no matter the RUGS score. Such is life.

[catlady]

Originally posted by harley girl
I believe the highest pay would come from the Physical Therapy. 2nd-Trach and 3rd-IV Abx. ?

Nope. See my previous answer. It all depends on where they fall in the case mix index, and in the examples Talino gave, the IV abx case brings an SE3, which is reimbursed at a higher rate than either the resident receiving the PT or the one receiving trach care.

[harley girl]

Yeah, I saw your answer after I posted my "guess". Sometimes the reimbursement amount does not make a lot sense (cents ). It seems like some of our patients that require so much assistance are not accurately reflected in the RUG.