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2013 IRF-PAI Updates September 4, 2012

2013 IRF-PAI Updates September 4, 2012. Lisa Werner and Melissa Berkoff. Changes for 2013. There are 3 significant changes that will take effect on 10/1/12: New IRF-PAI Quality Indicators New IRF-PAI Training Manual CAUTI measures must be reported through NHSN. IRF-PAI Changes.

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2013 IRF-PAI Updates September 4, 2012

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  1. 2013 IRF-PAI UpdatesSeptember 4, 2012 Lisa Werner and Melissa Berkoff

  2. Changes for 2013 • There are 3 significant changes that will take effect on 10/1/12: • New IRF-PAI Quality Indicators • New IRF-PAI Training Manual • CAUTI measures must be reported through NHSN

  3. IRF-PAI Changes • Quality Indicator changes: • The PUSH tool is being eliminated • 3 new items are taking its place • At admission we report: • Number of current unhealed pressure ulcers by stage for stages 2, 3, and 4 • At discharge we report: • Number of current unhealed pressure ulcers by stage for stages 2, 3, and 4 • Number of pressure ulcers developed or worsened since admission by noting the number of stage 2, 3, and 4 ulcers • Number of healed pressure ulcers since admission by noting the number of stage 2, 3, and 4 ulcers

  4. IRF-PAI Changes • Other Quality Indicator changes: • The new pressure ulcer Quality Indicators measures will be required. Facilities not collecting and submitting these values to CMS beginning 10/1/2012 face a 2% reduction in reimbursement beginning in FY 2014. • Removed from the quality indicators section are the questions related to respiratory status, pain, and safety.

  5. IRF-PAI Changes • Quality items that are not changing: • The IRF-PAI retains the items under Medical Needs related to comatose and delirium state on admission, as well as swallowing status and clinical signs of dehydration. • These items (numbers 25 – 28) are on the Medical tab in eRehabData. • They are still voluntary.

  6. Preparing for the Changes • Steps to take to be ready to report on the new items: • Review the new measures. • Train nursing staff on pressure ulcer staging by tapping into your wound care nurse, or online resources such as http://www.npuap.org/. • Develop a data collection method for admission and discharge. • Watch for clarification notices from CMS on technical questions related to completing the pressure ulcer items by monitoring this website: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/IRF-Quality-Reporting/index.html.

  7. Getting Started • When? • The new “Quality” tab on eRehabData will be available soon so you can practice data collection on the new items. • Information entered into the new tab on eRehabData will not be transmitted prior to 10/1/12. • Begin your data collection in advance of the October 1 to ensure that your process runs smoothly and that assessments are completed properly. • Review the measures in eRehabData

  8. IRF-PAI Training Manual Changes • Review of the general changes to the manual: • General observation: Changes in language used were noted; such as, Medicare Part A was replaced with Medicare to represent the broader population served • Acknowledgements were removed • Appendix F: Selected FIM, FRG, and CMG references were removed • Appendix H: General questions about the FIM Instrument were removed • Page ii was added to provide CMS Help Desk and Billing/Payment Questions contact information • 75% rule language was modified to reflect 60% rule. The 13 included conditions and conditional questions were listed

  9. IRF-PAI Training Manual Changes • Changes in Section II IRF-PAI Coding Instructions: • Page II-1: states that the quality indicators section is now required • Page II-10: now states that the IRF-PAI must be completed for both payers 2 and 51 • Page II-22: in the section “Specifics for Scoring Function Modifiers and Relationship to FIM Item Scores,” time frames for the assessment period were clarified • Page II-22: in both the bladder and bowel frequency of accidents, the manual states if the helper spills the container, it is not counted as an accident

  10. IRF-PAI Training Manual Changes • Changes in Section II IRF-PAI Coding Instructions: • Page II-26: a statement was added that says: • “If a patient expires while in the rehabilitation facility, record a score of Level 1 for all discharge FIM items.” • Page II-26: simplified the instructions for recording the discharge date. It now states to enter the date the patient is discharged. • Page II-29: mentions that quality indicators are not currently required, but failure to complete such items may result in payment reduction of two percentage points starting in FY 2014.

  11. IRF-PAI Training Manual Changes • Changes in Section III Functional Independence Measures: • Pages III-37 and III-39: Added the word “(wet)” to the description of the items for tub and shower transfers. • Pages III-38 and III-40: Clarified that if the patient does both a tub and a shower transfer, you should record the lowest score. In the expiring manual the direction was to require the more frequent type of transfer.

  12. IRF-PAI Training Manual Changes • Appendices • Appendix E: has the new IRF-PAI form • Appendix F: Glossary has new definitions to assist with the pressure ulcer items • Appendix G: Offers links to the CMS Help Desk • Appendix I: Includes the patient privacy and privacy rights act

  13. NHSN CAUTI Measures • Quality reporting of Catheter Associated UTIs: • National Healthcare Safety Network is gathering information from hospitals on the number of catheter associated UTIs and other measures. • Rehabilitation units and hospitals are required to report CAUTIs beginning 10/1/12. • You must use the NHSN website to report the information.

  14. NHSN CAUTI Measures • Preparing for the Changes: • Enroll into NHSN at http://www.cdc.gov/nhsn/enroll.html • Select a facility administrator • If you are a unit in a hospital, find out who in your hospital is the facility administrator and have them establish your location and users • All facility administrators and users must complete their training before beginning the enrollment period • Access the following resources for help: • NHSN Patient Safety Component Manual, January 2012(http://www.cdc.gov/nhsn/TOC_PSCManual.html) • Chapter 3: Monthly Reporting Plan • Chapter 7: CAUTI Protocol • Chapter 14: Tables of Instructions • Chapter 16: Key Terms • Access sample forms from http://www.cdc.gov/nhsn/forms/Patient-Safety-forms.html • Access training at http://www.cdc.gov/nhsn/training/

  15. NHSN CAUTI Measures • Preparing for Changes • Determine how you will collect data on CAUTIs • Determine your protocol for patient assessment for signs and symptoms of UTIs on admission

  16. Questions? Contact us: (202) 588-1766 Lisa Werner lwerner@eRehabData.com Melissa Berkoff assistance@eRehabData.com

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