PPS final rule increases agencies’ payments for 2019, finalizes PDGM

CMS has finalized a plan to launch a budget-neutral payment model for home health that utilizes 30-day payment periods and stops using the number of therapy visits to determine payment. That’s according to the 2019 PPS final rule posted Oct. 31 on the Federal Register website.

SNF QRP and What the Data Means

Yesterday, CMS began posting the first elements from the Quality Reporting Program. There are five elements that contain data, compared to the national average.

CMS final rule makes changes to how physicians are paid, delays E/M coding reform

As part of a final rule published by CMS yesterday to reduce provider burnout, the implementation of coding reforms for physician services known as “Evaluation and Management” (E/M) visits–requirements that haven’t been updated in 20 years–were delayed until 2020 to allow for continued stakeholder engagement. For CY 2019 and CY 2020, CMS will continue the current coding and payment structure for E/M office/outpatient visits and practitioners should continue to use either the 1995 or 1997 E/M documentation guidelines to document E/M office/outpatient visits billed to Medicare, according to a CMS fact sheet. Additional policies for CY2019 and beyond are listed in the fact sheet.

CMS gives itself one-year extension to publish a new discharge planning rule

CMS has just given itself an additional year — until Nov. 3, 2019 — to finalize its proposed rule involving discharge planning.

Is your facility committing these 7 readmission risks?

As of October 1, 2018, the Skilled Nursing Facility (SNF) Value-Based Purchasing Program (VBP) rewards SNFs with incentive payments for reducing hospital readmissions. To receive incentive payments for this quality measure, make sure these seven readmission risks don’t exist in your facility:

1. Inadequate staff. Staff are ill-prepared and not equipped to deal with the acuity of patient referrals (principally comorbidities).
2. Insufficient advance care planning. SNF does not conduct adequate communication between the patient and family regarding hospitalization issues.
3. Poor care coordination. SNF is not in sync with referring hospital upon discharge regarding medication reconciliation, assessment, equipment needs, etc.
4. Lack of tools to manage patient acuity. Not enough or no diagnostic tools, radiology services, lab services, IV pumps, pharmacy coverage, etc.
5. Inadequate physician coverage/support. SNF doesn’t have a strong medical director and/or physician staff.
6. Lack of or ineffective QAPI. Facility isn’t doing quality assurance tracking/trending on transitions and thus doesn’t identify root causes.
7. Ineffective electronic health record systems. Information and access is not readily available to diagnosis and treat preventable conditions in-place.