A: Those quality measures are worth 50 percent—so they’re worth 10, 20, 30, 40 or 50 percent of the weight of that specific quality measure domain. Let’s look at the re-hospitalization number. For your re-hospitalization component, you could be getting 10, 20, 30, 40 or 50 points and that is the same for all five of the new measures, including re-hospitalization measure, the emergency room use, the successful discharge to the community, the improvement in function for the short stay and the decline in function for the long stay. Pull your most recent five-star report and you’ll be able to see (the third column from the left on those reports) that data and would be able to make a determination as to which area you wanted to make improvements in your quality before it starts to negatively affect your organization.
It was a rough way to start the fiscal year for a 99-bed nursing home operator in Oakland, California: a payback to their assigned Recovery Auditor of over $186,000 in Medicare payments they had earned three years ago for the provision of care to eligible patients. Why? The provider failed to properly review what services were being billed and failed to comply with certain details of billing Medicare for services. As a result, the planned remodel of their dining room and rehabilitation gym—both of which would have markedly improved patients’ quality of life—would have to wait several months for a round of capital funding.
Experts say care for dementia patients may get a boost now that the condition is being added to The Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation Medicare Advantage Value-Based Insurance Design (MA-VBID) model. “I definitely see it as a positive,” says Renee Kinder, MS, CCC-SLP, RAC-CT, director of clinical education for Encore Rehabilitation Services in Louisville, Kentucky.
In preparing for the holiday festivities, it is essential that friends and family understand that while there are loved ones are in a nursing home, they can still partake in the holiday parties and goodie exchanges without putting their Medicare coverage at risk. According to Medicare law, nursing home residents may leave their facility for family events without losing their Medicare coverage for instances including: