Transcript VDC Transformation Step 3

Analytic Resources on DAVE
People:
• Technical Expert Panel
• Analytic Workgroup
• Statistical and infrastructure support within the DAVE team
• Expertise from prior contractors
Data:
• SNF Stay File
• 36 months of all MDS assessments from national
warehouse
• 18 months of national Medicare claims data (parts A & B)
• Other CMS data on providers and chains
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Patterns and Trends in SNF Care
RH is the most common RUG on 5-Day MDS Assessments
50.00%
45.00%
40.00%
35.00%
RU
RV
30.00%
RH
25.00%
RM
SE
20.00%
SS
Other
15.00%
10.00%
5.00%
0.00%
Ja
n99
Ma
r99
Ma
y99
J
ul99
Se
p99
No
v99
Ja
n00
Ma
r00
Ma
y00
J
ul00
Se
p00
No
v00
Ja
n01
Ma
r01
Ma
y01
Understanding how providers respond to payment changes is a goal
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Patterns and Trends in SNF Care
Changes in the Percent of Assessments within Rehab
Categories from 1999 to 2001
60
50
40
30
20
10
0
hospital
freestanding
RU
1999
RV
1999
RH
1999
RM
1999
RU
2001
RV
2001
RH
2001
RM
2001
• The percentage of RH cases has dropped for hospital based units but
increased for freestanding ones.
• The increase in RH in freestanding units is due to a decline in the percent
of cases in RU and RV.
• Outcomes and processes in freestanding and hospital based units are so
different that we are examining them as separate groups.
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Patterns and Trends in SNF Care
Percent of RH Therapy at 5 Day Assessment Based on
Provided rather than Ordered Therapy
0.40
0.35
0.30
0.25
RHA
0.20
RHB
0.15
RHC
0.10
0.05
0.00
1999
qtr 1
1999
qtr 2
1999
qtr 3
1999
qtr 4
2000
qtr 1
2000
qtr 2
2000
qtr 3
2000
qtr 4
2001
qtr 1
2001
qtr 2
Both the GAO and CMS are closely monitoring the use of ordered therapy.
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Patterns and Trends in SNF Care
Average LOS for RH Residents in Freestanding SNF
Units (CY 2000)
Mean LOS of RH Residents
31.8 to
28.2 to
24.9 to
17.9 to
46.9
31.8
28.2
24.9
(11)
(14)
(12)
(14)
Resident population, access to home health, and Medicaid coverage may
account for differences
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Patterns and Trends in SNF Care
Length of Stay Varies Across Site & Ownership Type
(CY2000)
Ownership Type Differences
Facility Type Differences
35
35.0
30
30.0
25
25.0
20
20.0
Free Standing
Hospital Based
15
For Profit
Non Profit
Govn. Owned
15.0
10
10.0
5
5.0
0.0
0
RU
RV
RH
RM
Nonrehab
RU
RV
RH
RM
Nonrehab
Review activity will allow DAVE to determine whether facilities with longer
lengths of stay tend to have more days denied because medical necessity
was lacking.
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Patterns and Trends in SNF Care
State Differences in the Percent of Medicare Residents who
Remain in SNF after Medicare coverage ends (CY 2000)
State Variation in Discharge Status
0.21 to 0.33 (15)
0.12 to 0.21 (18)
0.06 to 0.12 (18)
Differences reflect substantial variation in the percentage of residents
receiving skilled care who already resided in a Nursing Facility
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Preliminary Review Result Findings
Common Discrepancies in Offsite Review:
MDS Item
P8
O1
P7
P1bcB
P1bbB
I1nn
O3
P1bcA
P1bbA
G1hA
O4e
P5
O4c
I1h
P1ad
Item Description
Physician Orders
Number of Medications
Physician Visits
Physical therapy: total # minutes
Occupational therapy: total # minutes
Allergies
Injections (number days)
Physical therapy: # days
Occupational therapy: # days
Eating: Self-Performance
Diuretic
Hospital Stays
Antidepressants
Hypertension
Intake/output
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Preliminary Review Result Findings
Common Discrepancies in Onsite Retrospective
Reviews of Medicaid:
MDS Item
O1
P8
K2b
B4
P7
G1hA
G1bA
G1iA
G1iB
J2a
G1jA
G1fA
G1hB
G1aA
P3a
Item Description
Number of Medications
Physician Orders
Weight (pounds)
Cognitive Skills/Daily Decision Making
Physician Visits
Eating: Self-Performance
Transfer: Self-Performance
Toilet: Self-Performance
Toilet: Support Provided
Pain: Frequency
Personal hygiene: Self-Performance
Locomotion off unit: Self-Performance
Eating: Support Provided
Bed mobility: Self-Performance
Nursing rehab: Range of motion (passive)
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Preliminary Review Result Findings
Common Discrepancies in Onsite Two Staged Reviews
of Medicare:
MDS Item
O1
P8
J2a
A9f
K2b
J5d
P2e
Q2
L1c
J2b
P7
I1nn
J1n
P1ae
J5b
Item Description
Number of Medications
Physician Orders
Pain: Frequency
Patient responsible for self
Weight (pounds)
Stability of conditions: None of Above
Reorientation--e.g., cueing
Overall Change in Care Needs
Some/all natural teeth lost
Pain: Intensity
Physician Visits
Allergies
Unsteady gait
Monitoring acute medical condition
Resident experiencing acute episode/flare-up
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