Indiana hospitals are racking up millions of dollars in penalties for having too many patients return for care within a month of discharge.

Sixty-six Hoosier hospitals—including 17 in central Indiana—will see their Medicare payments docked next year by a total of about $12 million as a result of having patients readmitted within 30 days. That’s up from $9 million in penalties three years ago.

The federal government says readmissions are often unnecessary and cost taxpayers tens of billions of dollars a year for treatments that should have been caught the first time around, or were not followed up adequately.

So for the seventh consecutive year, it is using the pressure of lower reimbursements to get hospitals to improve their numbers.

Hospitals, for their part, say they are working with patients every way they can think of to keep readmissions at a minimum.

Many are sending patients home with a thick, detailed packet of discharge instructions and a month’s worth of medications. Hospitals send nurses and aides to discharged patients’ homes to see how they are doing. In some cases, patients are given vouchers for cabs or van shuttles to get to their primary care physicians for follow-up visits.

Still, the penalties keep climbing.

“It’s getting more difficult,” said Brian Tabor, president of the Indiana Hospital Association. “Hospitals have picked a lot of the low-hanging fruit in terms of strategies. And so the work gets harder and harder.”

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Hospitals are going to be looking to post-acute providers now more than ever to step-up their game. This spring, HTS launched THRIVE a turn-key system to promote successful care transitions following a post-acute stay. Our proprietary clinical programs are just another way that we move our clients forward as leaders of rehabilitation in the markets they serve. Contact us today to learn how partnering with HTS can help improve outcomes and reduce readmissions.

 


October is National Physical Therapy Month!
National Physical Therapy Month is designed to recognize the impact that physical therapists and physical therapist assistants make in restoring and improving motion in people’s lives. Physical therapy may be necessary for those recovering after an illness, a fall, injury, surgery or chronic condition. Physical therapists work hard to help patients retain and regain their quality of life.

 


Speak with your doctor to find out how therapy could benefit you!

HTS is excited to collaborate with our partners for a successful transition to the new Medicare payment model. Our ongoing focus on clinical quality, patient-centered programs, and functional outcomes has prepared our staff in advance to succeed under PDPM. In addition to implementing proprietary clinical program efficacy analysis, HTS has assessed the financial impact of PDPM and is committed to supporting our partners through the challenges of adapting to the new reimbursement model.

HTS will be providing PDPM solutions that include:

  • Staff Education and Training in Critical Areas such as Section GG and ICD.10 Coding
  • PDPM Live Trainings for Partners and Staff in Multiple Locations
  • Internal System Transitions
  • RUGs IV to PDPM Facility-specific Impact Analysis

Our alliance with Proactive Medical Review, the PDPM experts currently providing education on this topic to 25 states, allows us to uniquely provide our partners with additional support for strategic planning, MDS coding efficacy, and nursing best practices.

Patient-Driven Payment Model (PDPM) training dates:

  • Friday, September 21 – Evansville, IN
  • Thursday, October 4 – Fort Wayne, IN
  • Thursday, October 11 – Louisville, KY
  • Tuesday, October 16 – Greenwood, IN
  • Tuesday, October 23 – Kokomo, IN
  • Friday, November 9 – Edmonton, KY
  • Thursday November 15—Phelps, KY

We remain optimistic considering the enormous changes we are facing with this new payment model. As partners in therapy, you can be confident in our resources and unmatched expertise to navigate this change while working together toward a successful transition.

If you have any questions at all about this information, please contact us directly.

National Physical Therapy Month is a celebration held each October by the American Physical Therapy Association (APTA). PT month is designed to recognize the impact that physical therapists and physical therapist assistants make in restoring and improving motion in people’s lives. Physical therapists are movement experts who can help you overcome pain, gain and maintain movement, and preserve your independence, often without the need for surgery or long-term use of prescription drugs. Physical therapy is a cost-effective treatment that allows patients to participate in a recovery plan designed for their specific needs.

Goals of physical therapy include:

  • Restore physical function
  • Improve the ability to ambulate
  • Strengthen the body affected by injury/illness
  • Reduce pain and inflammation
  • Education and prevention

We offer comprehensive rehabilitation services including physical, occupational and speech therapy. Our therapists are experts in treating conditions affecting adults ages 50+. Therapy is a cost-effective treatment that allows patients to participate in a recovery plan designed for their specific needs to regain function and independence for a better quality of life.

For more information, contact www.htstherapy.com.

 


October is National Physical Therapy Month!
National Physical Therapy Month is designed to recognize the impact that physical therapists and physical therapist assistants make in restoring and improving motion in people’s lives. Physical therapy may be necessary for those recovering after an illness, a fall, injury, surgery or chronic condition. Physical therapists work hard to help patients retain and regain their quality of life.

 


Speak with your doctor to find out how therapy could benefit you!

 

Resource: APTA, www.apta.org

The Q4FY15 release of the Skilled Nursing Facility (SNF) Program for Evaluating Payment Patterns Electronic Report (PEPPER) with statistics through September 2015 is now available for download through the PEPPER Resources Portal. To obtain your SNF’s PEPPER, the Chief Executive Officer, President, Administrator or Compliance Officer of your organization should:

  1. Review the Secure PEPPER Access Guide.
  2. Review the instructions and obtain the information required to authenticate access. Note: A new validation code will be required. A patient control number or medical record number from a claim for a traditional Medicare FFS beneficiary with a “from” or “through” date in September 1-30, 2015 will be required.
  3. Visit the PEPPER Resources Portal.
  4. Complete all the fields.
  5. Download your PEPPER.

The SNF PEPPER will be available to download for approximately two years.

Revised in this release: The “Therapy RUGs” target area has been discontinued.

 


About SNF PEPPER

PEPPER is an educational tool that summarizes provider-specific data statistics for Medicare services that may be at risk for improper payments. Providers can use the data to support internal auditing and monitoring activities. PEPPER is distributed by TMF® Health Quality Institute under contract with the Centers for Medicare & Medicaid Services.

The U.S. Food and Drug Administration (FDA) released Consumer Guidance regarding portable bed rails safety and tips for caretakers on December 19, 2013. The recommendations were released because of the continuing injuries and deaths related to entrapment and falls associated with bed rail products. Overall, there is no standard definition for bed rails but they are typically divided into three distinct types: adult portable bed rails, child portable bed rails, and hospital bed rails. Adult portable bed rails are different from hospital beds, which feature a unified system of mattress, frame, and rails. Read more

The PEPPER report compares your skilled nursing facilities to peers nationally on key measures identified by the OIG as potentially high risk areas for improper Medicare payments. PEPPER data will be shared with both the Medicare Administrator Contractor (MAC) and the Recovery Audit Contractor (RAC.) Read more

Section 603(c) of the American Taxpayer Relief Act of 2012 (ATRA) changed the payment liability for denials resulting from the outpatient therapy caps from beneficiaries to providers effective January 1, 2013. Medicare systems were not updated in time to accurately represent this change on provider remittance advices (RAs). Medicare contractors may have already processed therapy cap denials for services provided in 2013. These denials incorrectly report on RAs beneficiary liability (Group Code “PR”) when liability legally rests with the provider (Group Code “CO”). Read more

Monday, April 29, 2013

AHCA/NCAL has made the issue of Observation Stays one of its top advocacy and outreach priorities. Our efforts include supporting the Improving Access to Medicare Coverage Act of 2013, which ensures observation stays count toward the Medicare-required three-day hospital stay, and connecting with key members of Congress to support this legislation. To boost our efforts, we need your help in collecting stories and/or names of those beneficiaries who have been impacted financially and emotionally by this observation stays issue. Read more

Nursing home operators can now download a brief clarifying which tasks physicians may delegate to other practitioners caring for Medicare beneficiaries in skilled nursing facilities, the Centers for Medicare & Medicaid Services announced in a document released Wednesday. Read more

The Centers for Medicare & Medicaid Services has proposed changing the way hospital readmission penalties are calculated as part of its 2014 Medicare rate update. Potential readmissions penalties for long-term care providers — such as those recently floated by the White House — would likely be based on the established CMS formula for hospitals. Read more