The Top Four Headlines of 2018 Impacting Your Acute Rehab Program

By Kindred Hospital Rehabilitation Services

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 Top Four Headlines of 2018 Impacting Your Acute Rehab Program

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.

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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).

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3. Rehab Business Model Will Change ‘Substantially’ Under PDPM

The Top Four Headlines of 2018 Impacting Your Acute Rehab Program

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.

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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.

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The Top Four Headlines of 2018 Impacting Your Acute Rehab Program

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.

By Kindred Hospital Rehabilitation Services