Surviving the Medicare adjustments in FY2012 has been a major topic of discussion and debate in most SNF's throughout the US. To maintain a viable Medicare program in the SNF you must analyze the admission and discharge process for the Medicare Part A caseload. A component of this analysis critical to successful clinical outcomes and preserving the integrity of the program is the clinically anticipated Medicare length of stay. Case management by the Rehab professional is one of the primary factors affecting length of stay. Generally, when a patient is admitted for short term rehab their underlying medical conditions stabilizes before they have met their functional potential. Therefore, it is very likely that the Rehabilitation Department is the driving force behind the patient's discharge plan.
Medicare supports providing rehabilitation services to help the patient achieve their prior level of function. This should be thoroughly investigated and considered when discussing the patient's potential discharge. The following is a brief list of questions to consider before discontinuing therapy services:
- Is the patient going home with an assistive device they did not previously use? Does the patient have the potential to progress to a less restrictive device?
- Are we asking caregivers to assist the patient with any of their BADL or IADL tasks that the patient was able to do before? Does the patient have the potential to do these tasks on their own with further training?
- Is the patient able to resume their prior leisure activities? Would further therapeutic interventions allow the patient to resume these activities?
- If the patient is returning to an assisted living facility, did the patient utilize all of their services before or will they be using services that they previously did not? Do they have the potential to resume their prior routine?
- Even though the patient has assistance available (ALF, spouse, etc.) do they want to rely on their caregiver or are there activities the patient would like to be able to do on their own?
- Does the patient enjoy making their bed every morning?
- Would the patient prefer if other people did not wash their undergarments?
- Does the patient like to make their own afternoon tea?
If yes is the answer to any of these questions it is clinically appropriate to continue the therapy program and further progress the patient to their highest functional ability. It is important to update the therapy plan of care to include new goals specific to these higher functioning tasks and ensure that it is documented that these goals directly relate to the patient's prior level of function.
Daily and weekly meetings conducted by facility managers, direct care nurses and therapists should spur discussion to reveal the patients community living situation and allow for further customized treatment planning.
Billers, MDS Coordinators, Rehab Managers and Nursing Managers Please click the link below and Join Us........
NOVEMBER 2, 2011, 9:00AM - 1:00PM