In a final rule from the US Centers for Medicare and Medicaid (CMS), inpatient rehabilitation facilities (IRFs) will see a 2.5% payment increase in the 2020 fiscal year (FY), which begins October 1, 2019—an approximate boost of $210 million. But they’ll also need to prepare for some expanded reporting measures in the years to come—including a requirement to report data on social determinants of health.
Reporting requirements won’t change much in FY 2020. However, beginning with the FY 2022 IRF Quality Reporting Program (QRP), IRFs will be required to provide certain standardized patient assessment data (SPADE) to CMS. The additional SPADE requirements are aimed at bringing IRFs up to speed with provisions of the 2014 IMPACT Act, a law that mandated more uniformity in reporting across postacute care (PAC) settings. In a fact sheet on the final rule, CMS writes that the addition of these SPADES “will improve coordination of care and enable communication.”
Specifically, CMS will adopt the SPADES on pain interference on sleep, therapy, and day-to-day activities, provisions being added in light of the opioid crisis. CMS is considering adding future SPADEs including dementia, bladder and bowel continence, care preferences, advance care directives and goals of care, caregiver status, veteran status, health disparities and risk factors, and sexual orientation. Also on CMS’ radar: assessments related to opioid use, and frequency, exchange of electronic health data, and interoperability.
The final 2019 rules for skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs) are substantially similar to what the Centers for Medicare and Medicaid (CMS) proposed in the spring, but that’s not to say physical therapists (PTs) should assume it’s a “same rule, different year” situation.
In fact, the situation is far from a “same as usual” scenario—at least for PTs in SNF settings, who will be facing a dramatic change in how payment is determined.
The new rules, set to go into effect in October of this year, include increases in payment of 2.4% for SNFS and 0.9% for IRFs, but the heart of the changes have less to do with payment increases and more to do with how payment will be determined and what needs to be reported. For PTs in IRFs, the reporting process could become a bit less burdensome, while PTs in SNFS will need to get up to speed with an entirely new payment system that does away with the Resource Utilization Groups Version IV (RUG-IV) process.
The final 2018 rules for inpatient rehabilitation facilities (IRFs) and skilled nursing facilities (SNFs) released by the US Centers for Medicare and Medicaid Services (CMS) don’t vary much from the proposed versions issued this spring, following through with proposals for an overall 1% payment increase, changes to reporting requirements, and updates to the list of ICD-10-CM codes the agency uses to evaluate facility compliance with the so-called “60% rule.” That rule states that 60% of an IRF’s patients must require treatment for 1 or more specified conditions.
As in the proposed rules, payment increases amounting to $80 million for IRFs and $390 million for SNFs are included, as are increased quality-reporting requirements—and consequences for noncompliance. More detail on the proposed rules appears in a PT in Motion News storypublished in May. CMS has published fact sheets on both the SNF and IRF final rules.
For patients who are very elderly, receiving postacute stroke care in inpatient rehabilitation facilities (IRFs) often results in increased functional ability, with 54% of patients achieving discharge to the community. But, say researchers who studied IRF data from 2002 to 2007, there are “worrisome trends” that point to the notion that the average length of stay (LOS) wasn’t enough to produce a clinically significant increase in function.
The study, e-published ahead of print in Physical Therapy (PTJ), APTA’s scientific journal, examined functional outcomes and length of stay in inpatient rehabilitation facilities for patients with stroke at age 85 or older. Most studies haven’t broken out the data for this age group, which is “most at risk for disability,” authors note.
Authors focused on IRFs because stroke outcomes have been “consistently associated with more functional improvements and more discharges to home” for patients in IRFs than for those in skilled nursing facilities. IRFs are required to provide at least 3 hours of therapy per day.