New Regulation Rings in the New Year - SpecialtyRx
January 8, 2019
New Regulation Rings in the New Year

2019 ushers in big changes for long-term care

Here’s a recap of what’s to come:

Last year, SpecialtyRx discussed a number of regulatory changes coming in 2019. The good news? The Centers for Medicare and Medicaid Services have given us many months to prepare. However, experts say therapy teams should start implementing changes now/yesterday in order to facilitate a seamless transition.

While the Patient Driven Payment Model remains a key topic for discussion, there are lesser-known initiatives that already made their debut. These requirements are sure to affect skilled nursing facilities over the next twelve months.

Let’s rehash some old revisions and explore new ones. As always, CMS says the latest regulation will help improve quality and efficiency of patient care.



Three cheers for LTC

When examined together, the aforementioned measures are designed to help assess patient outcomes and ensure facility compliance (not just for reimbursement purposes). While Medicare remains an important factor, CMS also inspires administrators to continue cultivating stronger care practices.

#1: Critical Element Pathways

Tough placed in effect over a year ago, the updated state survey holds therapists to a higher standard than before. Make sure staff is aware of CEP and fully prepared to answer the following queries. While there are a variety of therapy-specific questions, here’s a sampling from the specialized rehab set:
• What are the current goals and interventions for the resident?
• How was the resident involved in decisions regarding their goals?
• How were you trained on the resident’s therapy or program needs?
• How much assistance does the resident need with their restorative services?
• How do you promote and encourage the resident’s participation?

#2: Value Based Purchasing

October 1, 2018 marks the beginning of fiscal year 2019, making this initiative particularly relevant. VBP rewards operators according to the Skilled Nursing Facility 30-Day All-Cause Readmission Measure, which centers on hospital readmission rates. When SNFs improve patient safety and deliver superior care, they are compensated monetarily. How to get ahead:

• Introduce more effective patient monitoring systems
• Better educate patients about their chronic illnesses
• Improve collaboration with patients’ other care providers

#3: Patient Driven Payment Model

SpecialtyRx partners already know about the upcoming PDPM implementation set for October of 2019. This measure demands coding accuracy when it comes to Medicare reimbursement. The message is clear: don’t wait to make a change. Start emphasizing these new practices with staff as soon as possible (if you haven’t already). Tips:

• Improve accuracy in the patient’s initial LTC Minimum
Data Set (MDS)
• Introduce strategies that promote coding precision
• Steer staff attention toward sections C, K, GG and I