Mds/pps Q&a 002

Specialties Geriatric

Published

Specializes in ER CCU MICU SICU LTC/SNF.

Scenario:

A new resident, very healthy 81 y.o. male s/p ORIF Right Hip, was admitted on 12/20/01 and was eligible for Medicare Rehab.

The 5-day Medicare was also an Initial Adm. MDS assm't. The resident was scheduled to receive daily Physical therapy (no OT needed) @ 30 mins/day. The facility's Rehab. is closed on holidays and weekends. Hence the resident would miss out therapies on 12/25/01 and 1/01/02 and also the weekends in between.

Using the ARD window for the 14-day, between 12/30/01 to 1/07/02 (incldg. the 5-day grace period), the maximum PT days captured will only be 4 days. Since resident has no skilled need, he will fall off Medicare eligibility. He's private pay. What would you do to avoid interruption of Medicare coverage and still be paid at same RUG score?

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We ran into that problem at our facility, the exception being the therapist did come in at some point (usually on the week end at this time of year )so we could provide a min of 8 days of therapy. Or our residents would of fallen off also. Why only 30 min of PT espically with a new ORIF? Tex

By the way I am enjoying your cases, questions.

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Specializes in ER CCU MICU SICU LTC/SNF.

Hi Tex...

Do you know that the RUG score of a 60-min rx 5X a week is exactly the same as the 30-min's? Hence, if you give 30-min rx you can treat 2 residents.

But don't get me wrong. The minutes in this scenario is just a sample. The facility I'm in is non-profit. Therapy mins. are determined accdg. to individual residents full potential. Besides, our salaried therapists don't know that this is the case either (30 & 60 min rx). Imagine all the "for profit" facilities out there gobbling on this situation -- 2 residents for the price of an hourly paid therapist?

BTW Tex.. did you have to pay overtime to the the therapist to come in on a weekend?

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No our therapist do not get overtime. They are salaried. We a for profit facility. Tex

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How can you get consistently decent reimbursements if you don't have therapies in the building 7 days a week? What happens when the resident refuses therapy on Tuesday, or is too sick on Wednesday, or can't always handle therapy from two disciplines on the same day? I'm surprised your facility hasn't made arrangements for weekend therapy coverage.

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Specializes in ER CCU MICU SICU LTC/SNF.

So far Catlady since the inception of PPS, our Rehab reimbursments are going smoothly, never experienced a loss.

Illness and refusals are common occurences but definitely not a deterrent to get a Rehab. RUGs. Afterall, they can occur at any day including weekends, too. I guess this is were a good RN Coordinator play a critical role. Knowing the ARD window, use of grace days, and utilizing Rehab nsg. programs. Camaraderie with the therapists to provide therapies at bedside come very handy too.

Most of all, being aware of the number of therapy minutes in each Rehab RUG categories is very crucial. Cost effectiveness is the key. More minutes require more staff time. UNLESS you're facility is a dedicated short-term Rehab, paying add'l staff time for a higher RUGs is not always cost effective. As in our case, we are only 15% short-term Rehab. Using the wage index for the PPS Rates dated July 2001, more minutes + add'l staff time doesn't add up.

Do you guys know the minimum and maximum minutes for EACH Rehab. RUG Score? Assuming you've determined your client's Rehab. RUGs, which number of mins would you place a client in that particular RUG - the minimum or maximum?

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My understanding is that grace days are *not* to be used because the therapist isn't there to provide therapy. It's to help get the resident into a higher category or to account for the first couple of days where the resident may not yet be physically ready for intensive therapy. In this building, the pressure is on from corporate for rehab to maximize RUGS scores at all costs.

I don't have any control as nursing over the rehab department. They are the ones who are setting the ARD--although there are times I've told them that day 11 is unacceptable because I'm not prepared to complete the admission assessment/RAPS/care plan/RCC using that timeframe. The program manager has a very bad habit, however, of giving me an ARD, then changing the date *after* I've completed the entire assessment. I've complained to the administrator, but nothing has happened.

FWIW, I've been offered a position as MDS/RNAC in an ICF. No rehab, no Medicare, no PPS, no therapy, no clinical responsibilities. Would I be nuts *not* to take this?

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Ready for your next question r/t MDS............Thanks Tex

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Our PPS Coordinators meet daily w/ PT/OT to discuss PPS observation periods, reference dates w/ the people who are providing the therapy. PT/OT gives great info regarding many aspects (can't use their input to code ADLs). It only takes about 15 min./ day; therapy sets their treatment schedule according to OUR dates.

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georgiegirl, sounds like you have it right. Unfortunately we don't all play well with others, which sounds like Catlady's problem with the therapists at her facility.

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Catlady, didn't mean you don't play well with others. let us know how your new job is coming.

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I have called the therapist a few names. His favorite trick was changing the ARD after I'd completed the assessment. Complaining to the administrator got me nowhere.

I'm officially unemployed until Monday. If this MDS job doesn't work out, I think I'll go back to agency nursing. At least then I'll know how to chart Medicare residents, which I never did until I started doing the MDS/PPS/care planning.

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