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Medical Rehab

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As noted in the Rebaseline Timeline posted in the June 2016 National Healthcare Safety Network (NHSN) Newsletter, the Centers for Disease Control and Prevention (CDC) submitted standardized infection ratios (SIRs) to the Centers for Medicare and Medicaid Services (CMS), using the new 2015 baseline starting with 2016 Quarter 1 data. The inpatient rehabilitation facility (IRF) quality reporting program (QRP) preview reports that CMS provided on September 1, 2016, contained calendar year (CY) 2015 healthcare-associated infection (HAI) SIRs in accordance with the new NHSN baselines, based on nationally collected data from 2015. However, providers were unable to use NHSN to verify the accuracy of the HAI data contained within their preview reports for the Compare sites during the 30-day preview period established for this purpose.

As a result, CMS will begin publically displaying the NHSN data on the Compare sites for IRFs in the next quarterly refresh in spring 2017 instead of in fall 2016. Providers will have the chance to appropriately review their HAI data and inquire about data they believe to be incorrect. IRFs will receive preview reports in December 2016 for the data that will be displayed in spring 2017.

This change will affect the posting of quality performance data on the quality measure: NHSN Catheter-Associated Urinary Tract Infection (CAUTI) Outcome Measure.

When the IRF Compare website is launched in fall 2016, the following quality metrics will be displayed:

IRFs —

  • Percent of residents or patients with pressure ulcers that are new or worsened (short stay); and
  • All-cause unplanned readmission measure for 30 days post-discharge from inpatient rehabilitation facilities.

To assist IRFs in understanding the use of the rebaselined data, and how to monitor their data using the new baseline, a document has been posted in the downloads section of the IRF Quality Public Reporting web page.

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In July 2016, the Centers for Medicare and Medicaid Services (CMS) proposed new bundled payment models to shift Medicare payments from rewarding quantity to rewarding quality by creating strong incentives for hospitals and clinicians to deliver better care to patients at a lower cost. These proposed new bundled payment models focus on heart attacks, heart bypass surgery, and hip fracture surgery, and would reward hospitals that work together with physicians and other providers to avoid complications, prevent hospital readmissions, and speed recovery. This proposal follows the implementation of the Comprehensive Care for Joint Replacement (CCJR) Model that began earlier this year which introduced bundled payments for certain hip and knee replacements.

CMS just released the second annual evaluation report for Models 2–4 of the Bundled Payments for Care Improvement (BPCI) Initiative, which include both retrospective and prospective bundled payments that may or may not include the acute inpatient hospital stay for a given episode of care. This report describes the characteristics of the participants and includes quantitative results from the first year of the initiative. Key highlights include:

  • 11 out of the 15 clinical episode groups analyzed showed potential savings to Medicare. Future evaluation reports will have more data to analyze individual clinical episodes within these and additional groups;
  • Orthopedic surgery under Model 2 hospitals showed statistically significant savings of $864 per episode while showing improved quality as indicated by beneficiary surveys. Beneficiaries who received their care at participating hospitals indicated that they had greater improvement after 90 days post-discharge in two mobility measures than beneficiaries treated at comparison hospitals; and
  • Cardiovascular surgery episodes under Model 2 hospitals did not show any savings yet but quality of care was preserved. Over the next year, we will have significantly more data available, enabling CMS to better estimate effects on costs and quality.

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The Centers for Medicare and Medicaid Services (CMS) published a final rule in the September 16, 2016 Federal Register that establishes national emergency preparedness requirements for Medicare and Medicaid participating providers and suppliers to plan adequately for both natural and man-made disasters, and coordinate with federal, state, tribal, regional, and local emergency preparedness systems. It will also assist providers and suppliers to adequately prepare to meet the needs of patients, residents, clients, and participants during disasters and emergency situations. The effective date of the regulations are effective on November 15, 2016.

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Robena Web Edited

RCPA is pleased to announce the hiring of Robena Spangler as the new director for its Children’s Division. Robena has worked for NHS Human Services for many years in several key positions, including operations resource specialist, regional director – children’s services, director of out of home services and gender responsive services, and children and youth program specialist. In addition to her bachelor’s degree in sociology/human services, she holds an MS degree in leadership and professional advancement from Duquesne University.

Robena will begin in this position on September 26 – just in time for the RCPA Annual Conference. As many of you know, Connell O’Brien serves as the current children’s services director and will be retiring. Connell will remain with RCPA to assist in the transition and to continue with select initiatives. Please join us in welcoming Robena to RCPA!

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The RCPA Board of Directors is pleased to announce the appointment of Steven Alwine, CEO of HealthSouth Rehabilitation Hospital of York, as its newest member. Steve has worked at HealthSouth for almost 25 years. He was promoted in 2002 to chief financial officer at HealthSouth Nittany Valley and returned to York in 2011 as chief executive officer. He currently fills a vacancy for an unexpired term ending June 30, 2017, as an RCPA director-at-large.

In addition, the board also selected Charles Barber, CEO of Erie County Care Management, Inc., to complete the unexpired term ending June 30, 2017, as board treasurer. Charlie has already been serving on the RCPA Board of Directors, but was recently voted to fill the vacant officer position of treasurer.

Join us in congratulating these individuals in their appointments. For a complete listing of the RCPA board members, please visit our website.

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The Centers for Medicare and Medicaid Services (CMS) has announced that the inpatient rehabilitation facility (IRF) quality reporting program (QRP) provider preview reports are currently available until September 30, 2016. Members are encouraged to preview the performance date on each quality measure prior to public display on the IRF Compare website. While corrections to the underlying data will not be permitted during this timeframe, members can request a CMS review during the 30-day preview period if you feel the data is inaccurate. Additional information, including instructions on how to access preview reports, is available from the IRF Quality Public Reporting web page.

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The Department of Human Services (DHS) has published a notice that includes proposed changes to the Medical Assistance Fee Schedule for the Aging, COMMCARE, Independence, and OBRA Waivers in the Pennsylvania Bulletin.

The Office of Long-Term Living (OLTL) is proposing to add the following employment services to three of its waivers listed below:

  • COMMCARE waiver – Benefits Counseling, Career Assessment, Employment Skills Development, Job Coaching Intensive, and Follow-along and Job Finding.
  • Independence waiver – Benefits Counseling, Career Assessment, Employment Skills Development, Job Coaching Intensive, and Follow-along and Job Finding.
  • OBRA waiver – Benefits Counseling, Career Assessment, Employment Skills Development, Job Coaching Intensive, and Follow-along and Job Finding.

DHS has developed Medical Assistance (MA) fee schedule rates for the additional services added to these waivers. The proposed MA Fee schedule rates are available for review.

Comments regarding the notice and the proposed MA fee schedule rates will be accepted until Monday, October 3, 2016, and should be sent to: Department of Human Services, Office of Long-Term Living, Bureau of Policy and Regulatory Management, Attn: HCBS Rates, PO Box 8025, Harrisburg, PA 17105-8025. Comments can also be sent via email.

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The Departments of Human Services (DHS) and Aging just announced their selection of three managed care organizations (MCOs) for Community HealthChoices (CHC). CHC will coordinate physical health and long-term services and supports (LTSS) to individuals who are dually eligible for Medicare and Medicaid, older Pennsylvanians, and individuals with disabilities.

Through a review of a request for proposals, the following MCOs have been selected to proceed with negotiations to deliver services statewide in Pennsylvania beginning in 2017:

  • AmeriHealth Caritas
  • Pennsylvania Health and Wellness (Centene)
  • UPMC for You

CHC will roll out in three phases. Persons eligible for CHC are individuals aged 21 or older who have both Medicare and Medicaid, or who receive long-term services and supports through Medicaid because they need help with everyday activities of daily living.

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