IMPORTANT REMINDER: November 16 is the deadline for submitting staffing data for the period of July 1 to September 30. Providers that miss this deadline are subject to suppression of your “Overall Staffing Rating” and “Registered Nurse Staffing Rating” for the December 2017 Nursing Home Compare update.Read More
Welcome to the HealthPRO® Heritage Blog
Posted on: November 10, 2017
Posted on: September 26, 2017
RCS-1 Reimbursement Crosswalk Model
HealthPRO®/Heritage has developed a proprietary, sophisticated RCS-1 Reimbursement Crosswalk Model that will help us work strategically with partners to assess aggregate reimbursement risk and understand the interplay between nursing and therapy reimbursement components. The model is dynamic, allowing behavior changes to be modeled so providers can see the impact of specific elements that significantly drive reimbursement under RCS-1 (e.g.: such as diagnostic coding, cognitive assessment, and ADL scoring).
Posted on: August 7, 2017
CMS has released two separate communications related to the Pre-Rule 2019, or ANPRM.
ONE: A “financial analysis” demonstrating the impact of RCS-1 as compared to the RUGs-IV system
While the intention of this recently released file was to support CMS claims for a “budget neutral” impact, significant differences (both positive & negative) can be appreciated. (Note: Analyses are available for those included on or before 2014 Medicare Program and assumes no behavior change on the part of providers.)
HealthPRO®/Heritage is strongly encouraging clients to review this CMS “financial analysis” with your RVP or the Clinical Strategies Division as soon as possible! It is critical to assess the potential impact that RCS-1 may have on your community’s bottom line, and – if necessary – begin thinking about and implementing strategic processes to ensure your future success (should RCS-1 be implemented next year).
Posted on: July 28, 2017
IN THIS ISSUE:
Introduction to RCS-1 • SNFs & HHAs Scorecards: Let’s Get on the Same Page
SNFs & HHAs: What About the PEPPER? • Letters of Non-Compliance with SNF QRP: Threatening Up to 2% FY 2018 Annual Payment Update (APU)
NOTICE: CMS announced on June 25th that Quality Reporting Program (QRP) data for Inpatient Rehabilitation Facilities (IRFs), Long-Term Care Hospitals (LTCHs), and Skilled Nursing Facilities (SNFs) is due August 15, 2017 for the first quarter of 2017.Read More
Posted on: May 16, 2017
Phase Two of The Final Rule goes into effect in seven short months (November 2017), and the post-acute care community must invest time, energy and resources NOW in order to be prepared for the many changes brought on by this recent CMS mandate.Read More
Posted on: May 1, 2017
SPECIAL EDITION ADVISOR: A HealthPRO®/Heritage Position Statement
“The Final Rule: The Next Generation of Quality-Driven Reimbursement”
HealthPRO®/Heritage is Well-Prepared to Assure Our Partners’ Success in a New Reimbursement and Classification Environment
CMS’ proposed next-generation reimbursement system has been revealed, and HealthPRO®/Heritage will set the pace as THE PREMIERE STRATEGIC PARTNER – ready to inform, guide, and help build strategy in response to proposed changes of the Final Rule, including the Resident Classification System, Version I (RCS-I).
Late last week on April 27, CMS outlined the Final Rule and Pre-Final Rule. Among the dramatic, all-encompassing proposed changes is the transition from RUGS-IV to RCS-1 that will take place in October 2018. As thought-leaders, these proposed changes come as no surprise to HealthPRO®/Heritage.
In fact, this shift to a quality-driven reimbursement system is directly aligned with the HealthPRO®/Heritage philosophy. For more than five years – since the onset of the IMPACT Act and the Triple Aim – HealthPRO®/Heritage has embraced clinical strategies, compliance programming, and an operational approach that puts us squarely in line with the expectations proposed in CMS’s Final Rule.
In short, we have already made the necessary changes to ensure YOUR success in the new world of health care reform as it will look in 2018 and beyond. You can trust HealthPRO®/Heritage to help navigate the turbulent road over the next 18 months and beyond.
Details related to proposed regulatory changes, including the inception of RCS-1, will be outlined by HealthPRO®/Heritage subject-matter-experts during an "Open Door” webinar on Wednesday, May 10 at 1:00 PM EDT. Register now!
Count on HealthPRO®/Heritage’s Experience and Proven Success
The proposed changes are expansive in both philosophy and application. The proverbial “Alphabet Soup” will be redefined. HealthPRO®/Heritage will work with our partners to decipher both the minute details as well as the fundamental big picture changes. Some of these elements include:
- Patient-Centered Care
While many other therapy providers have been driven by a minutes/utilization focus, HealthPRO®/Heritage is decidedly patient-focused, encouraging clinicians and managers to drive patient treatment plans based on clinical evaluation and need utilizing standardized, evidence-based testing, prioritizing patient-centric goals, etc.
Important to note: Proposed changes from a minute-based system reflect this fundamental area of concern that has plagued the industry for years. Many studies and reviews concerning the “overutilization of therapy” and “thresholding” of therapy minutes are now in the spotlight. HealthPRO®/Heritage is proud to continue to uphold our position that patient-centered care that aligns with quality functional outcomes will continue to drive our therapy programming.
- Data-Driven Decisions
Since 1997, HealthPRO®/Heritage has focused on collecting outcomes and using these metrics to support clinical decision-making. Our sophisticated, proprietary documentation/outcomes reporting IT system continues to be the industry’s best platform for tracking, reporting, and managing metrics.
Important to note: In 2014 – well before it was mandatory to do so – HealthPRO®/Heritage was the first to integrate CMS’ Care Tool into our proprietary documentation/outcomes tracking IT system, demonstrating our commitment to gathering, managing, and leveraging outcomes data (as defined by CMS).
- Innovative Clinical Programming
Over the past six years, HealthPRO®/Heritage has invested in the development of a full arsenal of proprietary, advanced clinical programs that support:
– Positive functional outcomes;
– Proactive LOS management;
– Safe transitions in care; and
– Rehospitalization mitigation measures
Many other therapy programs may struggle with designing, implementing, and extracting data necessary to be successful in the new proposed world of RCS-1.
Important to note: Reimbursement levels will be set based on clinical and functional parameters and will be tied to a facility’s ability to manage length of stay in the proposed Final Rule. This will require providers to have well-established clinical pathways/programs in place that can demonstrate measurable success.
- A Comprehensive Perspective
HealthPRO®/Heritage understands the larger landscape of comprehensive health care reform. As such, though it may seem these proposed changes will only impact the skilled nursing industry, downstream partners need to understand how the implications of the proposed Final Rule will impact the behaviors of SNF partners so they can prepare to align with the philosophical approach to caring for clinically complex patients, LOS management, rehospitalization rates, etc. that will ultimately impact cross-continuum relationships/networks.
- Strategic, Innovative Partners
HealthPRO®/Heritage forms true partnerships, because we believe that – in order to weather the storms of health care reform and other challenges that come our way – we must, first and foremost, be aligned with our clients’ values. Beyond simply providing therapy services, you can count on HealthPRO®/Heritage for our innovative, proactive approach to health care reform. Our organization offers solutions:
– To understand how the proposed changes will shape the future of healthcare delivery
and value-based reimbursement and to keep YOU in-the-know;
– To support the operational, clinical, compliance, and strategic changes necessary to
prepare for RCS-1;
– To execute on care redesign strategies that will directly align YOUR facility with
expectations outlined in the Final Rule.
Like many industry leaders, HealthPRO®/Heritage has navigated significant changes in healthcare over the past two decades. This upcoming set of challenges will be no different. HealthPRO®/Heritage is perfectly positioned to support our clients in keeping ahead of the curve as the Final Rule takes shape.
Important to note:
As PAC providers begin to digest the proposed changes, CMS is accepting comments on both the Final Rule for FY 2018 and the Pre-Rule for FY 2019 through June 26, 2017. HealthPRO®/Heritage will stay dialed-in as commentary and feedback from thought-leaders are gathered and reviewed. We look forward to what might perhaps be a unified system focused on improved healthcare delivery as a result of several systems and platforms contributing to what might be the future of post-acute care. Stay tuned! Read More
Posted on: March 28, 2017
quan·da·ry (kwon-dree); noun
Posted on: March 23, 2017
On March 20, HHS issued a statement delaying the effective date of the Final Rule as it applies to three new EPMs. The start date has been changed from July 1, 2017 to October 1, 2017 for:
Posted on: February 16, 2017
It’s as easy as 3, 2, 1: 3 Major Tenets + 2 Goals + 1 ProcessRead More