Stay informed to get ahead of the PPS game
Learn from SNFs, field testing of rehab tool
It's too soon to know exactly what the prospective payment system (PPS) for rehab will be like, but you can take steps now to be ready when the Health Care Financing Administration (HCFA) rolls out its new reimbursement system beginning Oct. 1, 2000. The system will be similar to the PPS for skilled nursing facilities (SNFs), which went into effect July 1, 1998.
Rehab providers should keep up with what's happening in the SNFs and how things are going in the field tests of the rehab PPS patient assessment tool, the Minimum Data Set for Post-Acute Care (MDS-PAC), advises Doris Reinhart, principal of Chesapeake Consulting Inc. in Alexandria, VA. Chesapeake is a health care consulting firm specializing in post-acute providers.
Let SNFs be your scouts
It's also too soon to tell how things are going with the SNF PPS, but those facilities can be a good source of information for your facility as they gain experience with the MDS-Resource Utilization Groups (RUGS), used to assess patients and calculate resource use. "Experience is your best teacher," Reinhart says. She advises rehabs to find out what their colleagues are doing in the SNFs and see how it works for them.
Since HCFA's goals are to have a uniform data collection instrument across all the post-acute venues, the SNF experience is likely to mirror what will happen in rehab. "We have time to gather that data and understand it and be ahead of the game," Reinhart says.
The SNF field did find out during the demonstration projects that they needed to devote at least one full-time employee to the MDS, and sometimes more depending on how big the units were and how complex their cases were, she adds.
The assessment system for post-acute care is being developed and tested at the Research and Training Institute at Hebrew Rehabilitation Center for the Aged (HRCA) in Roslindale, MA, through a contract with HCFA in Baltimore.
HCFA will use data from the MDS-PAC tests to establish inpatient rehab hospital patient classifi ca tion groups. Other projects will establish payment rates for patients in each classification. (For details on HRCA's field testing schedule, see Rehab Continuum Report, August 1998, p. 101.)
Reinhart doesn't advocate trying the current versions of the MDS-RUGs for rehab because they are still in the testing stage and are likely to change over time. For instance, testing began in July on draft seven of the MDS-PAC. The report to HCFA in February will be based on draft 10 of the assessment tool.
Providers can stay ahead of the game by keeping up with what is going on with the MDS demonstration projects for rehab. As the new MDS versions come out, look at them and determine what questions are being asked and what data they are collecting. "Be aware of what is going on, and don't wait until the end to find out," Reinhart advises.
Providers who participated in the SNF PPS are far ahead of their counterparts, she says. "It's not surprising. They know the things they need to be working through."
Even if your facility wasn't chosen to participate in the field testing or doesn't participate in the demonstration projects, you can remain familiar with the process by being involved in your professional organizations. The American Medi cal Rehabilitation Providers Association includes the latest public versions of the MDS-PAC through its fax information line: (888) 632-8023.
Here are some other tips that will help you prepare for the rehab PPS:
o Be familiar with the kinds of data requested and the focus of the minimum data sets. This will help you understand what's important to HCFA in terms of determining reimbursement. If HCFA follows the reimbursement basis for the SNFs, rehab providers will be reimbursed on a per diem basis, determined by the resources that are utilized. "It's not an aggregate. You get what you get for that day," Reinhart says.
o Stay current on what is happening with the demonstration project and with the modifications of the MDS-PAC.
o As the instrument being tested gets closer to the final stages, start testing it on your patients to see how you will come out. "They are in the really early stages and still don't know what elements they need to be using at this point," she says. For instance, instead of calculating costs under units of therapy, MDS-RUGS in its current form calculates under minutes of therapy. "Don't turn your unit upside down at the moment. You still have time."
o Start to cue your staff in to changes that are likely to be coming. Hold inservices to let all staff know what's happening. That way, whatever PPS HCFA decides on, staff won't be surprised. "Administrators know what is happening, but the people who will have to carry it out are the ones on the floor. They need to be involved from the beginning," Reinhart says.
o Get a handle on the total resources used for each diagnosis and each level of acuity. "Under a PPS, rehab providers are going to be working with resource utilization in some way, shape, or form, and they must have a handle on what their resources cost," she says.
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