The Future of Medicare Home Health and Rehab Services

1. The Future of Medicare Home Health and Rehab Services Arnie Cisneros, P.T.

2. Arnie Cisneros P.T. 28 years geriatric Physical Therapist SNF, Home Health rehab provider President, Home Health Strategic Mgmt. Author-Advance/PT �Home Health Forum� Home Health consultant/speaker Home Health rehab contractor

3. The Future of Home Health Where Are We Going?

4. Where Are We Going? OASIS - C Pay for Performance (P4P) MedPac modifications Recovery Audit Contractors (RAC) Co-payments Progressive reforms Post-Acute Bundling

5. Med Pac Home Health Mandate �Medicare Home Health payments should be adequate for efficient providers�

6. Recovery Audit Contractor (RAC) Where Are We Going?

7. RAC Mandate/ Goals Identify improper payments Overpayments-claims that do not meet coding or medical necessity policies Underpayments-when reimbursed complicated procedures are preformed Retroactive to 3 years

8. HISTORY OF PPS-SNF/LTC Prior Reasonable - Cost Basis Decreased Hospital L.O.S. Skilled Nursing Facility - SNF PPS Implemented 1998 Resource Utilization Group � RUGs Increased patient acuity post-DC

9. RUG REHAB CATEGORIES Ultra High 720 mins/wk Very High 500 mins/wk High 325 mins/wk Medium 150 mins/wk Low 45 mins/wk

10. SNF REHAB COMPONENTS Administration Admission Rehab Staff Social Services Nursing Floor staff

11. ADMINISTRATION - Role of rehab in SNF - Programming support - Marketing

12. ADMISSIONS Marketing - hospital - community - payors Bed definition Management Role in skilled rehab progression

13. SOCIAL SERVICES Rehab team member Communication liaison between families � SNF rehab Weekly rehab meeting Assertive discharge management

14. Nursing Support for SNF rehab Aware of PPS � RUG mechanism Accountable to rehab programming

15. Direct Floor Staff Support for rehab program Awareness of: -Rehab patients -Level of function -Progress in skill level

16. WEEKLY REHAB MEETINGS separate from Medicare meeting

17. Rehab report SOC DC date Level of function - Transfers Gait ADLs Other � speech, pain, etc. Comments section

18. Rehab Departmental Meeting All rehab staff weekly Total patient review RUG level review -with assessment focus

19. 2009 Guide to SNF Programming Rehab - Rapid eval & treatment Skilled, daily documentation Treatment vs. function level Therapeutic exercise Gait Modalities Weekly notes � 10 days

20. REHAB Transfers Gait Modalities Groups or Concurrent Therapy Occupational Therapy Speech Therapy Nursing Support

21. DISCHARGE CHOREOGRAPHY Family issues DME Home Health Alternative placements Part B Homecare

22. SUCCESSFUL ASSISTED LIVING REHAB PROGRAMS

23. Continuum of Care Realities Role of Home Health Future Home Health Reforms Pro-active Rehab Management Restorative Care Opportunities Assisted Living

24. Hospital Lengths of Stay SNF reimbursement (20 days) Readmission Concerns Part B Programming Assisted Living

25. Part A Home Health Home Health Reforms-P4P/RAC Future Home Health Reforms Post-Acute Bundling Decreased Reimbursement Pro-active Rehab Management Assisted Living

26. Restorative Nursing Program Managed by Rehab Professional (PT/OT) Unlicensed Rehab Technician Private Reimbursement Maintenance Opportunities Identifies Functional Declines Identifies Fall Risks Identifies Skilled Care Needs Assisted Living

27. Home Health Strategic Management1-877-449-HHSMwww.homehealthstrategicmanagement.com