Medicare Compliance & Reimbursement

Following one facility's lead could help boost outcomes and payments.

Providers may see their revenue margins suffer this year if their staff isn't acing patient assessment.

Sunshine Terrace Foundation Rehabilitation Center, a skilled nursing facility in Logan, UT, works as a team to ensure that both outcomes and payments stay on track under Medicare's new Resource Utilization Group payment system.

"We look at reimbursement ... but the [treatment] decisions are driven by the resident's clinical needs," relays Inne Taylor, the facility's MDS coordinator.

During a weekly meeting, team members provide assessment data to develop a complete picture of the resident's rehab potential, as follows:

Rehabilitation therapy. The rehab team evaluates the resident and makes an initial decision about how many minutes of rehab to provide for the MDS assessment period, says Taylor. But if the initial plan doesn't work, the therapists consult with the rest of the team to assess the resident's therapy needs.

Social work. "The social worker comes with the understanding of the residents' and his/her family's dreams and goals for the rehabilitation therapy--that is, the optimal outcome or situation in their view," says Taylor.

The social work domain also includes an assessment of mood and behavior, says Wendi Shurtleff, the medical social worker for the facility.

Behavioral symptoms can also interfere with therapy. A resident might be combative or resist care, for example. A person with dementia may have difficulty following cues or directions due to short-term memory loss. "We identify those issues and report them to the team," says Shurtleff.

Dietary. The dietitian discusses the resident's nutritional status, intakes and weight and helps evaluate the resident's speech therapy needs. Nutritional deficits can prevent the resident from progressing in therapy, notes Cheryl Connors, the facility's consulting dietitian.

Here's a documentation tip: consider coding anemia on the MDS (I1oo). Look for anemia as a reason people are refusing therapy due to lethargy, fatigue--or because they feel depressed, advises Garry Woessner, principal of Woessner Healthcare Consulting Group in Edina, MN.

Nursing. The resident's unit nurse shares information about any barriers the resident might face in terms of achieving rehabilitation goals, says Taylor. Examples include pain, depression and lack of motivation.