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Ready for change: How Madonna Rehabilitation Hospitals adapts to new payment models

Madonna Rehabilitation Hospitals and organizations like ours have been preparing for some major Centers for Medicare and Medicaid Services (CMS) payment rules changes.

On Oct. 1, the CMS Patient-Driven Payment Model (PDPM) takes effect for Skilled Nursing Facilities (SNFs) to increasingly link Medicare payments to value rather than volume. Under PDPM, skilled nursing providers will be paid according to a patient’s needs and conditions rather than the volume of service he or she receives.

Also on that date, Inpatient Rehabilitation Facilities (IRFs) must use a different scoring method to assess the abilities and progress of patients, as well as the burden of care required by those patients. Such scores have a direct relationship to Medicare payments, so their accuracy is critical.

Arguably, the most significant of the two payment changes is for IRFs that provide intensive rehabilitation programs, whether they are free-standing hospitals or units within acute care hospitals.

Facilities like ours currently complete an Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI), which includes both Functional Independence Measure (FIM) scores and Section GG scores, which are somewhat duplicative.

FIM scores have been one of the primary methods used to classify patients for payment purposes. GG scores have been used for quality reporting purposes.

Come Oct. 1, FIMs will be dropped from the IRF-PAI, and Section GG scores will be used instead.

It’s a huge shift for the IRF industry because FIM has been the standard for so long. There is going to be a tremendous amount of retraining for much of the industry.

Fortunately for Madonna, we’re ready. That’s due, in part, to the fact that Madonna’s Specialty Hospitals (Long Term Care Hospitals) and Rehabilitation Hospitals (IRFs) in Omaha and Lincoln, Nebraska, as well as our Transitional Care Unit (SNF), have worked hard to accurately assess and report the complexity of the cases we handle by designing rehabilitation-focused documentation.

Madonna selected Allscripts Sunrise™ because of the system’s highly configurable and customizable design. This native flexibility enabled us to create the nation’s first truly transdisciplinary, intuitive, rehabilitation-driven content solution in Sunrise Rehabilitation.

We enhanced the automated scoring algorithm in Sunrise Rehabilitation to account for the upcoming regulatory changes. This algorithm produces accurate scores based solely on documentation completed by the clinicians. All scores produced are therefore fully supported by the documentation and result in the most appropriate payment for the level of care provided to the patient. This eliminates the need to retrain the workforce on new scoring algorithms and allows us to focus our training efforts on how to properly document in the system.

Because Sunrise™ Rehabilitation automates the scoring of patients, our burden in adapting to this and other payment model changes has been greatly reduced. Automating the scoring rules and logic directly into clinician documentation streamlines the assessment process and minimizes staff training time.

Automated scoring increases accuracy, saves time and means Madonna Rehabilitation Hospitals is ready for Oct. 1.

Learn more about Madonna Rehabilitation Hospitals here.

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