THE CMS IRF-PAI AND YOU. UF Health Rehab Hospital. UF Health Rehab Hospital 6/8/2016. Lee Starling, BS, RHIT HIM Manager, UF Health Rehab Hospital

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1 THE CMS IRF-PAI AND YOU Lee Starling, BS, RHIT HIM Manager, UF Health Rehab Hospital UF Health Rehab Hospital Located in Gainesville, FL 40 bed inpatient facility Stroke Brain injury Spinal cord injury Burn Joint Replacement Amputation UF Health Rehab Hospital Accreditations CARF The Joint Commission Florida Brain and Spinal Cord Injury Program Magnet Recognition 5 Star Award Winner for Patient Satisfaction 1

2 UF Health Rehab Hospital Types of Therapy Occupational therapy Physical therapy Recreational therapy Respiratory therapy Speech language pathology What is an IRF-PAI Inpatient Rehab Facility Patient Assessment Instrument (IRF-PAI) Contains patient clinical, demographic and other information Classifies the patient into distinct groups based on clinical characteristics and expected resource needs Separate payments are calculated for each group What is an IRF-PAI Must be submitted on all Medicare patients within 27 days of discharge Primary and secondary Failure to submit can result in 2% penalty on all Medicare cases 2

3 How is Payment Determined? Rehabilitation Impairment Categories (RIC) Case Mix Group (CMG) Based on the motor skill scores (FIM) on admission Also determines LOS How is Payment Determined? CMS reimburses for resources needed to care for the patient Tier 1 Tracheostomy Dialysis dependent Tier 2 Dysphagia Enterocolitis secondary to C. diff Tier 3 Morbid obesity Type 2 diabetes IRF Criterion for PPS Payment Classification Criterion 60% rule Minimum percentage of a facility s total inpatient population must require treatment in an IRF for 1 or more of the 13 medical conditions These include: 3

4 IRF Criterion for PPS Payment Stroke Spinal cord injury Congenital deformity Amputation Major multiple trauma Fracture of femur (hip fracture) Brain injury Neurologic disorders Burns Active polyarticular RA Systemic vasculidities with joint inflammation Severe or advance OA Knee and/or joint replacement (specific criteria must be met) Current IRF-PAI Process Begins with patient admission Nurse liaison completes the PAS (Pre-Admission Assessment Screening) tool PPS coordinator extracts the 3-day initial period FIM scores from the Epic record PPS coordinator extracts the etiologic diagnosis Etiologic diagnosis may differ from admission/discharge diagnosis CMG and IGC is determined Case Management notified for LOS Current IRF-PAI Process IRF-PAI is currently 8 pages Takes approximately 30 min to complete Report built to extract data from flowsheets Some items default to zero (0) score PPS coordinator must follow up with therapist/nurse to verify 4

5 Current IRF-PAI Quality Measures New IRF-PAI Quality Initiatives IRF-PAI increases to 18 pages Approximately 90 minutes to complete Payment determination in FY 2018 New IRF-PAI Sections Hearing, speech, vision Cognitive patterns Bladder and bowel Active diagnosis Health conditions Swallowing/nutritional status Skin conditions 5

6 New IRF-PAI Admission Items Must be assessed within 3 days Expression of ideas and wants Understanding verbal content Brief Interview for Mental Status (BIMS) Temporal orientation (year, month, day) Recall Bladder continence Bowel continence New IRF-PAI Admission Items Combines PVD and PAD Falls History of falls in the past year (Admission) Number of falls during hospital stay (Discharge) Include near misses Major surgeries Swallowing/nutritional status New IRF-PAI Admission Items Pressure ulcers Skin conditions were re-organized Based on 1 st skin assessment within the 3 day window Unhealed pressure ulcers (admission & discharge) Staging ulcers Wound specialists or nurse trained in wounds conducts wound assessment within 3 days of admission Do not have physicians stage ulcers Can query physicians 6

7 New IRF-PAI Admission Items Special treatments Influenza vaccine 10/1 3/31 Prior functioning (everyday activities) Prior device(s) used New IRF-PAI Adm & DC Items Self care (Adm & DC) Mobility (Adm & DC) Goals (Admission only) At least one goal for either self care or mobility Capturing Information for IRF-PAI Creating navigator specifically for new quality indicators, split into sections, which will include Nursing Occupational Therapy Physical Therapy Speech Therapy Physician 7

8 Capturing Information for IRF-PAI Arrange items in order of IRF-PAI Implement BPA system Build abstract report Automatically calculate therapy minutes Attend team conferences Capturing Information for IRF-PAI Post grad day information Celebrate with patient & family Ensure grad day documentation Educate nursing and therapy on importance of documenting FIM scores accurately and timely Began quarterly education sessions Providing details from erehabdata Therapy & Nursing must work closely with providers to ensure complete documentation IRF-PAI Submission Must be submitted within 27 days of DC erehabdata Data warehouse for CMS Reports compare facility to region & nation FIM scores recently added QIES Extracts specific elements for reporting Influenza CDC Pressure ulcer CMS Run Casper reports to check your reporting status 8

9 CMS Auditor Findings Make sure FIM score is appropriate on admission How much resource will it take to care for patient? Make sure medical documentation covers all conditions patient is being treated for All tier diagnoses must be documented by the physician if present Make sure to capture Tier 1 Diagnoses Future Wishes Interface EHR documentation directly into IRF- PAI CMS Currently looking at this option Result in real-time submissions Decrease manual resources needed Currently takes ~ 30 minutes to complete IRF-PAI New measures will increase time to ~ 90 minutes to complete IRF-PAI The CMS IRF-PAI and You THANK YOU!!! QUESTIONS??? 9