2018 was full of often-conflicting healthcare news. Despite the noise, what truly matters for your rehab program as you look ahead to 2019?
1. CMS finalizes 2019 payment rules for skilled
nursing facilities, inpatient rehabilitation
and psychiatric facilities
The Move Away from FIMs and Why It
Matters – In the CMS final payment rule for inpatient
rehabilitation facilities (IRFs), one of the greatest changes
for the industry will be the elimination of the FIM®
Instrument for Fiscal Year 2020. CMS believes the rule will
“reduce both administrative and documentation burden for
IRF providers
by well over
300,000 hours,
allowing for
more time
spent on direct
patient care.”
However, IRF
providers remain
concerned
that the new measurement system is not as robust as the
long-standing and validated FIM tool in measuring patient
outcomes and improvement. Therefore, providers will need
to implement appropriate training for staff to ensure they
are fully prepared for the change and can best capture the
clinical progress of patients.
Learn more
2. Disputed Report Claims Medicare Paid
$5.7B for ‘Not Reasonable and Necessary’
Inpatient Rehabilitative Care
Inpatient Rehabilitation Facility OIG Report
and Why It Matters – The U.S. Health and Human
Services Office of the Inspector General (OIG) issued a
disputed report on inpatient rehabilitation hospitals. While
there are many flaws with the report, it highlights the need
for the IRF industry to remain vigilant in maintaining quality
outcomes and in appropriately documenting medical need for
IRF care. It is important to remember a few key points when
evaluating the OIG Report:
Small Sample Size Contributes to Irrational Error Rate
– The OIG selected 220 claims to review – less than 0.05%
of IRF claims in 2013 – and concluded that 84% of all IRF
claims were not payable. This assertion is inconsistent with
a Comprehensive Error Rate Testing (CERT) audit which
determined that the nationwide error rate for IRFs in 2013
was 17.2%. The OIG arrived at an error rate that is nearly
five times greater than CERT.
Extrapolation Fails to Consider Appeals – When the
OIG calculated its savings of $5.7B, it failed to consider
that 86.8% of the dollars denied by Medicare contractors
were reversed at some level of appeal (results from a recent
AMRPA survey).
Learn more
3. Rehab Business Model Will Change
‘Substantially’ Under PDPM
Eliminating Therapy as Payment Driver
and Why It Matters – In 2018, the Centers for
Medicare and Medicaid Services (CMS) finalized
significant reforms to the skilled nursing facility (SNF)
and home health agency (HHA) payment systems, thus
eliminating therapy volume as a driver in Medicare
reimbursements. The payment reforms are set to go into
effect in October 2019 for SNFs and January 2020 for
HHAs. According to CMS, the changes seek to better
align reimbursements
with patient needs
and address payment
incentives found within
the current system.
The reforms will not
eliminate Medicare
beneficiaries’ need
for rehabilitative
therapies. However, it
may have an impact on
the patients that SNF and HHA seek to admit, and patients
requiring intense rehabilitation services for recovery may
choose to receive therapy in inpatient rehabilitation facilities
(IRFs) or through outpatient services.
Learn more
4. Democrats Capture Control of House; G.O.P.
Holds Senate
Increased Congressional Oversight and Why
It Matters – With the recent shift in control
of the House of Representatives, it is likely that
committees may, once again, take up additional healthcare
oversight and investigative hearings. In the past, these types
of hearings have focused on abuse, neglect and substandard
care across nearly all acute and post-acute settings. In 2019,
it is anticipated that a specific focus will target improper
Medicare payments. Further, policymakers have indicated
that they will specifically focus on high-risk providers.
This means that in a new environment, all Medicare
providers need to enhance their efforts to manage their
online reputation and strong positive presence in the local
community to combat potential negative media coverage
from a disruptive oversight process.
Given the new regulations and oversight, operating a
successful acute rehab program is more complicated than
ever. Due to these challenges, many hospital systems are
opting to partner with proven experts in acute rehab.
For more information about how Kindred Hospital
Rehabilitation Services (KHRS) helps health systems across
the country overcome rehabilitation hurdles and drive
greater success, contact us today.
Learn more
Given the new regulations and oversight, operating a successful acute rehab program is more
complicated than ever. Due to these challenges, many hospital systems are opting to partner with
proven experts in acute rehab.
For more information about how Kindred Hospital Rehabilitation Services (KHRS) helps
health systems across the country overcome rehabilitation hurdles and drive greater
success, contact us today.