The Extensive Qualifier is Dead! Almost.

The upcoming change from MDS 2.0 to MDS 3.0 is causing much stress and anxiety in the skilled nursing industry.   On October 1, 2010, there will be an entirely new program for MDS coordinators to capture the care that is being provided for their patients.  Therapy managers will also find themselves in uncharted waters in October.

Concurrent Therapy
Concurrent therapy is defined  as the treatment of 2 residents at the same time, when the residents are not performing the same or similar activies, regardless of payer source.  Concurrent minutes will be multiplied by 0.5 in MDS 3.0, so 500 concurrent minutes will be valued at 250 minutes.  How much concurrent therapy has your department been providing historically?  Have you begun to track individual, concurrent and group minutes yet?  You may be surprised to find that over 50% of your MCA minutes are concurrent.  If that's true at your facility, you may find it impossible to deliver the same RUGS distribution with MDS 3.0.  If your team aggressively pursues Rehab Ultra High categories, will you be able to continue to deliver 720 qualifying minutes on the MDS if concurrent minutes get a 0.5 value?

Rehabilitation Plus Extensive Services
Bye Bye Extensive Qualifiers - You can only capture Rehab Plus Extensive RUG with Tracheostomy care, Ventilator or respirator, or Infection Isolation, while a resident in the facility.  In MDS 2.0, you could capture IV medications with a 14 day look back and IV fluids with a 7 day look back to get your Rehab X or L.  There are no more hospital look backs for Extensive Services and IV meds in the facility have been moved to Clinically Complex.

MDS 2.0 provided a significant boost in reimbursement with the Rehab Plus Extensive RUG that allowed a facility to capture RV levels of reimbursement while providing almost no therapy during a 5-day assessment.  RMX and RML RUGS are routinely attained with little more than a therapy evaluation and an IV look back to the hospital MAR.  This would resulted in higher reimbursement than providing 5 days and 500 minutes of therapy.  The cost savings were enormous.

How will your practice patterns change if you cannot project into RM or RH AND cannot capture the X or L with a hospital lookback?

Upcoming Medicare continuing education for therapists.