Let’s face it. Despite the fact we in the Long Term Care market tend to talk and focus on our Medicare A, Advantage and, more recently, private insurance patients…most of us still financially depend on our Case Mix rates. Except those relatively few specialty SNF providers in larger metro markets, the rest of us need our Medicaid (TennCare, Medi-Cal, etc.) dollars as a large portion of our revenue base. When that goes down? Well, no one’s happy.
So…now what?
You’ve had nurse consultants look at the MDS, conducted trainings, added staff to address the growing time and effort it takes to manage and track the ever-changing quality measures, and pharmacy is looking at potential pitfalls in medication types and tracking. So…now what? It becomes time to think outside of the box, while simultaneously going back to the basics of yesteryear and adding all of the ever-increasing mechanisms and timing structures that seem to change almost yearly in each state. Some states, such as Tennessee and California, have changed more than others.
I do have several helpful pointers. Some you will like, while with others I can hear your groans already. I’ll start with the worst and let us end on a more positive note and easier route of addressing our case mix woes. Please be forewarned, unless you care to read a dissertation smacking more of a thesis than a helpful article, I’m keeping this very basic and idea-based only. Please do not hesitate to contact me directly with questions, and I am available for onsite consultations (initial is free, and for current and new clients, the entire training package is always free). I will provide all of my contact information at the end of this article.
First, download the latest version of your state health plan and at a bare minimum scan it for changes and hidden gems (or hidden grenades, take your pick). This is task number one and the very worst. If you have a consultant (or are one of our clients), we’ve done this part for you and you are partially off the hook. You still need the knowledge, but someone explaining it is much less of a headache than weeding through pages fraught with enough bureaucratic language to turn you into stone.
Second, seek assistance from the specialists in each area. Your vendors, especially therapy vendors or therapy departments, should be able to do most if not all of this groundwork for you. I can generally spend a bit of time looking through your third and final case mix report and most often find several glaring factors that may be an indication of the proverbial phrase “leaving money on the table,” even in those with good and financially acceptable case mix scores.
Third, no two facilities are alike, and there is never a one-size-fits-all campaign that completely addresses all issues. There are just way too many variable in this game. Yes a game, as that is what it often feels like, but the impact to your finances is no game. I’ve listed for you a number of areas or ideas that will hopefully prompt an epiphany for some of you to aid in your path toward improving your case mix scores and your overall reimbursement. This list is by no means completely inclusive, it’s simply the items I most commonly find when I complete a study and consult with specific plans for a building or buildings.
Common Pitfalls to Identify and Address:
- Has your market of available patient types changed but your admitting process and clinical services have not? If so, are you documenting well enough to give yourself credit for what you are doing in this changing patient type?
- Restorative Nursing: Are we maximizing this, without calling them to work the floor and potentially losing that last day? Are our programs adequate to ensure credit is given? Are the programs written reasonable and attainable? Are we getting credit for the services provided to patients who come off restorative and are handled on the floor or through other departments? Sidebar…these still must be nursing supervised and driven, of course.
- Cognition and Behaviors: Are we properly addressing this in routes that facilitate exceptional patient care and case mix enhancement? There are multiple routes to accomplish these areas. Your therapy team, along with nursing and restorative nursing interventions, should always be an integral part of this area.
- Therapies: Your rehab department is perhaps the single largest catalyst that can move the case mix index dial significantly upward (or downward, if done poorly) in a very short amount of time. There are tools of the trade which can ensure the highest quality-driven timely patient care needs, while leading to enhanced scores by maximizing timing and congruency with ARDs.
There are Several Questions to Ask Regarding Your Therapy Program:
- Are they screening residents? If so, how often and by what process? (Remember OBRA? It still applies.)
- Are they discharging to restorative nursing, nursing in general, or home? Do they provide specific, documentable programming on all three?
- Are these restorative nursing and/or nursing recommendations reasonable, obtainable and contain all the necessary components to allow capturing of restorative services?
- Is your therapy department reviewing restorative programming every 3-6 months for upgrades/downgrades? Are you capturing these minutes?
- Quality assurance/patient satisfaction/outcomes are playing a larger role in the case mix matrix of many states now. How is your facility handling this? Is your therapy department taking a leading role in this plan and implementation, including tracking and reporting?
While there are so many of us suffering from the “case mix blues,” I think we can all benefit from a review and enhanced thought process. It always pays to review what we are doing to ensure our patient needs are being met and exceeded, and to ensure that our revenue potential is maximized in this changing health care environment.
I hope this has given at least a few new ideas or strategies that you find useful and helpful. Please feel free to contact me with any questions or comments.
Best Regards and Prosperity,
Kerry C. Wright, OTR/L
Executive Director of Business Development
TN Director of Operations
Healthcare Therapy Services, Inc.
Kerry@htstherapy.com
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