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Certainly, the predicted minutes can change after the initial eval.
Part of the confusion may come from the instructions to project to day 15, even
if the resident is discharged. The purpose of those instructions is to
capture the most representative and appropriate payment rate for the days that
the resident was in your facility. You project to day 15 based on the assumption
that if the resident had stayed, therapy would have been delivered as
ordered.
The example you give, however is clearly different. In your case, the
therapists have changed the treatment plan. I don't see how you can predict
days/minutes at 5 days/week, knowing that it wasn't going to be delivered at
that level.
Now, another issue that is raised is, what are you skilling this person for
if therapy is only being delivered 3 days a week? I am assuming there are
skilled nursing needs preventing a higher level of therapy participation.
If you are going to use therapy as the skilling service, then you need to be
sure at least one service is given each day (or 5 days, if you only have 5
days/week therapy) For example, OT M-W-F, PT T-Th-F/S. That way, the
resident is continuing to receive daily skilled service without becoming
overwhelmed or fatigued from therapy.
Hope this helps a little bit.
HS
----- Original Message -----
Sent: Tuesday, January 06, 2004 7:50
PM
Subject: Re: projected minutes
I understand how to calculate it, my question goes back to what
prediction do you use for the minutes after the ARD the ones predicted on
initial eval or the minutes projected when the patient was decreased to
3xwk? Can the predicted minutes change after the initial eval or do you
have to use the initial eval prediction? That is where I am getting
confused.
Lisa
In a message dated 1/6/2004 5:43:09 PM Mountain Standard Time,
[EMAIL PROTECTED] writes:
Lisa,
What I do is to calculate the actual
minutes delivered through the ARD, then project days 9-15, and combine these
for the projected minutes total in section T.
See page 3-216 in the RAI manual: "Count
the days of therapy already delivered from Item P1a,b, and c.
Calculate the expected number of days through day 15, even if the resident
is discharged prior to day 15.... Include the number of minutes
already provided from MDS Items P1ba(B), P1bb (B), and P1bc (B). Calculate
the expected minutes through day 15, even if the resident is discharged
prior to day 15."
I think the intention is clear, to include the
actual minutes up through the ARD, then to calculate the minutes through day
15 and add together.
HS
----- Original Message -----
Sent: Tuesday, January 06, 2004 7:17
PM
Subject: projected minutes
I asked this question last week and have not
seen any repsonses so I will ask the question again. Section T on 5
day Medicare assessment where it asks for the estimated minutes patient to
be seen thru day 15-how is that tabulated? Is it strictly from the
therapist's evaluation or can it be changed? For example Ms
Smith is seen by therapy for eval on day 1 and therapy predicts patient to
be seen 5 days a week/45 min OT and PT. ARD is set for day 7, on day
5 therapy decides Ms Smith cannot tolerated 45 minutes therapy for 2
disciplines and decreased her to 3x week/ 45 minutes each. For the
predicted minutes in section T do you have to use the initial eval
prediction or can you use the projection indicated after therapy
decreased? Is there anywhere it is written? Thanks-this is
very important matter between myself and therapy.
Lisa
Aurora,
CO
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