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Case-Mix In Tennessee
Tennessee has announced its intention of moving towards the 48 RUG grouper for Medicaid in skilled nursing facilities. This post is intended to be a reference about the 48 grouper you'll be using in Tennessee.
You are in good company
The 48 grouper is used by quite a few states. Its use is also growing. You can see how many states are using the 48 grouper in green. (Gray states either aren't case mix or I'm not familiar with it.)
You are using a standard weight set
|HE2||1.88||Special Care High|
|LE2||1.61||Special Care Low|
|PE2||1.25||Reduced Physical Function|
"CMS Set F01" to be specific. That's good news because so far that means every state that has switched to the 48 grouper has chosen the same weight set. That makes it much easier to find resources and compare performance across states. (It also makes it a lot easier for analysis.)
I'm showing the weights to the right. Note that they are more simple than many weight sets in use with other groupers. Weights often have 4 significant digits.
You can borrow information from other states
Since you are using the same weight sets as other states you can take advantage of the material published by other 48 grouper states. Obviously you want to be careful here, but feel free to see if other states have created a grouper walkthrough or decision tree that you find easier to use. Here's a nice one the state of Wisconsin made. Thanks Wisconsin! Here's another one from Mississippi courtesy of Meyers and Stauffer. It's much longer but maybe it's more appropriate for you. Here's one from Indiana. This is one you should use more caution with since Indiana time-weights.
You can ask for help
While case-mix might be new to Tennessee, it's been around a long time in other states. Seek out counsel from experienced people. There are plenty of people out there that like to help. Feel free to contact me.
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.
- 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.
- 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