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2 Reasons You Should be More Concerned about Casemix than RCS-1 if You're In Tennessee

2 Reasons You Should be More Concerned about Casemix than RCS-1 if You're In Tennessee

Tennessee is in a unique position right now. Everyone is trying to figure out how RCS-1 will change Medicare Part A. However at the same time Tennessee is also preparing to transition to case-mix for Medicaid.

RCS-1 can tend to look more important because a lot more people are talking about it but here are two reasons why you should focus more of your energy on understanding casemix.

  1. Case-mix will likely have a larger impact on your reimbursement than RCS-1. Which do you have more of: Medicare Part A or Medicaid residents? For a facility with 10 Med A residents and 60 Medicaid residents, a $1 change in daily reimbursement is 6 times more impactful for Medicaid than Medicare Part A. Small changes to Medicaid can make a big difference and the majority of the changes you can make simply involve better documentation of work you already do.
  2. You have far more control over your case-mix than your Med A with RCS-1. With RCS-1 you will have 4 RUGs per patient with RCS-1. (Check out our RCS calculator for more information.)  Two of those RUGs, PT/OT and Speech, are largely out of your control. Those two RUG make up around half of the  overall payment for RCS.

Between your facility payer mix and the nature of RCS-1, you can see that a good understanding of case-mix is going to be important. There is good news however:

  • The 48 grouper is an excellent choice. With the 48 grouper you'll use the same ADL scoring system that you use for Part A. (Until RCS-1 at least.) Also, the therapy RUGs make sense. Imagine using a Medicaid grouper with an UH RUG. Don't laugh, some states do. I've worked with a wide variety of Medicaid groupers. Based on my experience I would pick the 48 grouper above the others. (with a few minor tweaks)
  • You aren't the first state to transition to case-mix or start using the 48 grouper. In fact you are in good company. The 48 grouper is quickly overtaking the 34 grouper as the most used. That means there are good resources out there to help you educate yourself. (Try our our MDS Calculator for example.) 

While we don't know rates yet and won't for a while, Broad River can analyze your Medicaid population and give you a "first look" at how things might shake out. We can also assist you in setting up programs that make sure your documentation is absolutely air-tight while at the same time delivering the highest quality care AND make sure you get fully reimbursed for your work. We have many years of case-mix experience. Put our experience to work for you. Call us today and let's talk it over! 1-800-596-7234

Q1 2018 North Carolina Medicaid

Q1 2018 North Carolina Medicaid

“You can’t manage what you can’t measure”

The latest data from the state of North Carolina has been published. We spend considerable time carefully studying the data here at Broad River. It’s like a second report card that we get every quarter. (Obviously the most important report card comes from the customer.)

This data tells us how our customers compare to the rest of the state. It also tells us whether we’ve been successful in helping our customers reach their performance goals. We take it very seriously. 

Here are a few of the things we study:

1. - PPD by facility

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Contrary to what a lot of people believe, North Carolina Medicaid reimburses well IF you follow the rules and document the work you do. (More on this later) Accurate documentation means increased reimbursement. The first thing we look at is how our customer PPD compares to the state. We look at this number for each facility as well as overall. As you can see, for this quarter, Broad River customers averaged $188.48 dollars per patient day versus the state average of $178.96. That's $9.52 more each day on average. 

2. CMI versus PPD by Facility

PPD can be deceptive on some occasions so it’s important to look at the case mix index for each facility and compare it to the PPD. We expect our customers to be among the highest performers in the state. Any outliers get special attention. We want to understand the reasons behind the data. Many times we get good insights on ways to improve

You can see in this image we have facility with relatively high case-mix but lower than average PPD. This is a good opportunity to deep dive into the data and figure out why. There is also a building with lower than average CMI. That's a new customer so we'll be following up next quarter on that one.

3. ADL Scoring by Facility

We’ve never seen a facility that captures EVERY bit of the care they deliver to the resident. The higher the percentage of care you document, the higher your case mix. ADL scores are a great indicator of how well you are documenting. Broad River is always looking for innovative ways to help our customers do a better job capturing the critical work that staff in the building do. We do onsite training. We offer remote training. We have our employees document nursing ADLs when appropriate. We don’t just talk about helping you with ADLs, we actually try hard to fulfill that promise. 

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Broad River customers average more than a point higher than the rest of the state. This can be significant in terms of reimbursement.

4. Percent of Medicaid residents in rehab

This one sounds obvious but we’re always surprised how many companies don’t pay attention to it. A low percentage of Medicaid residents in rehab can indicate a staffing problem or other performance issue.

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Broad River averages a higher percentage of Medicaid patients on rehab and a lower percentage of residents in reduced physical function. 

These are just a few of the things we look at each quarter with regards to Medicaid. We strongly believe that to be successful, our customers have to be successful. That means working together as a team to make sure our residents get the highest quality care possible. It also means understanding how reimbursement works. It's not just about therapy.