The new Health and Human Services Secretary, Alex Azar, plans to use the Center for Medicare & Medicaid Innovation to nudge along some of the projects that have been in the pipelines for a while now. His focuses to date have included increasing consumer digital access to their healthcare data, including claims; reduced prescription drug costs; and continued focus on quality-based payment models. It appears that many of Azar's focuses are issues that have received bipartisan support, so it is likely we will see some movement.
Is RCS-1 going to become a reality any time in the near future? Only time will tell. At present, the proposed Skilled Nursing Facility (SNF) payment system has not been moved to law making, has not seen revision based on the initial public commenting input, and is not on any schedule. While change is inevitable, it is too soon to invest large amounts of time, money, and resources, but you should continue to consider the impact this change could have on your Medicare reimbursement.
Coming Down the Pike
In Effect and Important
The Five Star health inspection "survey" component freeze is now in effect. Centers for Medicare and Medicaid Services (CMS) shared details about the process that would be used to calculate the surveys, yet the results took many providers by surprise. Those losing a star in their health inspection component will need to focus heavily on impacting the staffing and Quality Measure (QM) components.
The Five Star Technical User's Guide
updates lends guidance, but having an "expert" or two in-house is a must in order to effectively navigate the system and ensure focuses support positive outcomes. The intricacies of the work behind the scenes (the Minimum Data Set (MDS) responses resulting from care and care systems, both individual and systematic) drive your rates.
ACT Senior Living Consulting Services
The ACT Senior Living Consulting team can help you identify, develop, and/or lend support to your QM "experts." We work with you to ensure your experts are equipped with the following tools or knowledge:
- Understanding of QMs and the MDS responses that trigger
- Educated approach to determining whether the responses triggering the QM are accurate
- General understanding of how to effectively apply changes to plans for an individual, as well as a system, that will lead to better outcomes
- Ability to prioritize focus on QMs that require more immediate attention
- Materials that support education for direct care staff to promote not only understanding, but buy-in
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