CMS Revises Medicare Manual

The Medicare Benefit Policy manual has been revised to clarify that skilled care and skilled therapy may be covered by Medicare even for conditions that will not improve.  The revision was brought upon by the high profile Jimmo v. Sebelius case, where Jimmo plaintiffs contended that Medicare was unjustly denying claims based on an “improvement standard” which would allow beneficiaries to only receive coverage for skilled care that would improve their conditions.

Section 20.1.2-Determination of Coverage has been revised to state, “Coverage of skilled nursing care or therapy to perform a maintenance program does not turn on the presence or absence of a patient’s potential for improvement from the nursing care or therapy, but rather on the patient’s need for skilled care.”

The manual revisions explain that skilled care may be needed to maintain a current condition or prevent or slow a patient’s deterioration.  The revision also includes that providers must prove that skilled care was needed, as opposed to non-skilled care.  In order to substantiate their claims, providers must include appropriate documentation.

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OIG Report Examines Hospitalizations of Nursing Home Patients

A new OIG report reviews the extent to which Medicare nursing home residents are hospitalized.  The report discovered that in FY 2011, one quarter of Medicare residents in nursing homes were transferred to hospitals for inpatient admissions where Medicare spent $14.3 billion. The OIG states that the higher than average resident hospitalization rates can be avoided through better care and recommends that CMS develop a quality measure that describes hospitalization rates and then assess this measure during surveys of nursing homes.  CMS agrees with OIG on the recommendations and is working on developing a hospitalization measure for nursing home residents and a re-hospitalization measure for Medicare SNF residents.  In addition, CMS will add these measurers to the quality measures surveyors review.

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Medicare Looks to Cut Spending on Post-Acute Care

Researchers have discovered huge discrepancies in how much Medicare spends on nursing homes, home health services, and other post-acute services around the country.  For example, in Louisiana, Medicare spends $8,800 per patient for home health care as opposed to $3,300 per patient in New Jersey.  Because of discrepancies like these, Medicare is seeking to gain more control over what it spends on services patients receive after leaving the hospital.

Medicare spent $62 billion last year- one out of every six dollars on traditional fee-for-service programs.  Experts agree that this “hodgepodge of payment methods” encourage “unnecessary and disjointed” care which wastes taxpayer money and makes fraud easier.  They also agree that hospitals usually don’t take costs into account when discharging patients.

Medicare is now experimenting with new payment methods such as bundled payments where hospitals and post acute providers work together to treat patients for a fixed sum (rather than getting paid for each service). Also, President Obama has proposed reducing payments for certain conditions to post-acute providers and paying the same rates for similar patients. Experts warn that the transition to a new payment method will not be an easy one.

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New Quality Measure Needed to Track Hospital Admissions

According to a new report from the Department of Health and Human Services Office of Inspector General, one in four nursing home residents on Medicare was hospitalized in 2011, costing Medicare $14.3 billion.  The OIG has recommended a new quality measure for tracking hospital admissions.  Quality measures (QMs) are normally used in the government’s Five-Star Rating System and are correlated to hospitalization rates; low staffing levels, especially, are related to higher hospitalization rates.  CMS was urged to create a QM for hospitalization rates and is now developing a 30 day readmissions measure for skilled nursing facilities to submit to the National Quality Forum by the end of the year.

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Social Media for LTC Facilities

Imagine living thousands of miles away from a loved one living in a long term care facility yet still being able to see daily or weekly updates of them.   Imagine being on your lunch break and seeing live-tweeted pictures of your mother doing crafts in her nursing home.  Well, situations like these are no longer fantasies because for many long term care facilities, this is a reality.  Through the utilization of social media, LTC facilities have been able to keep communication at the forefront of their agenda.  People no longer have to wait to see their family members because social media has made it possible for them to be part of their everyday life.  Having social media for your LTC facility adds value to your organization and differentiates you from your competitors.  Also, any unsolicited posts praising your facility for outstanding care and treatment of a family member is marketing that you cannot buy!

LTC facilities can utilize many of the most popular social media outlets to expand their online reach.   We recommend Facebook, Twitter and/or a blog to share information, news, events, multimedia (like YouTube videos).  Many senior living facilities have even used YouTube to provide virtual tours of their facilities, testimonials from residents, and some have made videos solely for entertainment purposes!  Click here to see one made a couple years ago.  Twitter and LinkedIn can be used to build professional relationships with other organizations and leaders in the LTC industry.

However, one must keep in mind that social media must be used with extreme caution.  There should never be pictures posted that would cause viewers to lose faith in your services or facility.  The following are a few tips to ensure proper use of social media: patient information should always be kept private unless you receive written permission, certain posts should come with a disclaimer, medical advice should never be offered, and online postings need to be monitored regularly to make sure they do not violate any policies.  But, if you choose HMS as your social media consultant, you will never have to worry about any of these privacy violations-we know the ins and outs of both healthcare and social media.

We understand nothing will ever replace face to face communication.  Still, social media can help you, your staff, your patients, and their families all stay connected.  Keep relationships alive and thriving! If you want more information on how to successfully integrate social media into your facility, please don’t hesitate to call us at (203) 294-6659.  Let’s connect!

Medicare Managed Care Plan Beneficial for Residents with Advanced Dementia

A new study analyzing the data of more than 300 nursing home residents has found that residents with advanced dementia on the Medicare managed care plan were less likely to be hospitalized.  They were also more likely to have primary care visits in the nursing home and more nursing home-based nurse practitioner visits.  Researchers believe better care for advanced dementia patients is linked to higher numbers of nurse practitioners a facility has, as well as better reimbursement rates from insurers such as the rates the Medicare managed care plan offers.

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Connecticut Judge Dismisses Observation Care Lawsuit

On Monday, a federal judge in Hartford, Connecticut dismissed a lawsuit which was filed by 14 Medicare beneficiaries seeking nursing home coverage.  The Medicare beneficiaries, who stayed in nursing homes following a hospital stay, had to pay tens of thousands of dollars in nursing home bills because they stayed in the hospital under observation status.  Under current Medicare rules, patients must be admitted to a hospital for at least three consecutive days to be eligible for follow up coverage in a nursing home.  The primary goal of the lawsuit was to change the observation classification for Medicare beneficiaries.  Medicare beneficiaries staying in hospitals under observation status has increased by almost 70 percent in five years, while admissions under the inpatient status have decreased.

The lawsuit is timely considering CMS finalized the “2-midnight rule” which aims to change Medicare beneficiaries’ status as inpatients.  The new rule, according to CMS, “improves value and quality in hospital care and provides clarification about when a patient should be admitted to the hospital and responds to recent concerns about extended Medicare beneficiary stays in the hospital outpatient department” (click here to read more about the rule).

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