I am far from the expert here, but my comments on the DAVE/pneumonia issue are:
When PPS started and the MDS was being used in buildings there was almost a mind set of paper compliance, and the care plan was merely a way to save the facilities butt when they had survey. Well now we have moved to the MDS being used for multiple reasons and the rules for one area do not always line up equal to the other rules.
I finally got my hands on the DAVe request for off site review we have recieved at one of our facilities, and can say that there will be absolutley NO PART of the MDS that can stand alone any more without a potential for the reviewer turning the facility in for inaccurate coding. So anyone that was from the "old school of paper compliance only" will be a hinderance for our facilities, be it the DON that pulls the MDSC b/c "it's only paper", to the ADMIN that budgets an MDSC part time b/c the MDSC is always at her desk, to the long time MDSC that NEVER actually leaves her desk and codes based on her memory of what the resident did even a year ago, and just clicks thru the RAPs and Care /Plan without indivualizing.
I have previously worked for a company/coorp that "pushed the envelope and we never made decisions regarding the need for skill or not without calling the main corp office, and speaking with the specialist. This lead to inaccuracies as they wanted to cookie cut all residents with a certain type of diagnosis into a set number of MED A days regardless of what the resident truly needed.
PLEASE UNDERSTAND I AM NOT PICKING ON THE MDSC, (I AM ONE), NOR AM I PICKING ON ANY DISCIPLINE, OR PERSON. I AM JUST SAYING UNTIL ALL MDSC'S AND FACILITIES GET OUT OF THE MIND SET OF PAPER COMPLIANCE AND MOVE FORWARD we will continue to see inaccuracies and see more and more nurses further away from the bed side and auditing and second guessing what we have / had coded.
Subj: DAVE/pneumonia
Date: 2/17/2004 4:56:08 PM Central Standard Time
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I would guess that the utilization of rehab with the dx of pneumonia is being looked at.The assumption was always that a patient would return to baseline once pneumonia was ressolved without the need of skilled rehab.Some patients I believe do need a snf admissiom with dx of pneumonia because they usually have other multiple diagnosis that come into play.But do they need skilled rehab for an extended period of time[I know this is a case by case determination]Remmember a dx of pneumonia is a Complex Rug score but an extended rehab stay is a higher Rug.CMS is always looking at trends.My facility does not keep patients on rehab for long periods of time,we don't have to as we have multiple admissions with few empty beds,but I hear from many other places that alot of the chains 'push the envelope as they say'with keeping patients on skilled 3-4 days after rehab stops for OBSERVATION.Those few days can over time and multiple patients add up to alot of money.I have always practised that we look at each case,no routine days for Observation
.I feel you always have a 30 day window to pick up again and besides most of my short termers don't want to hang around 3-4 days after rehab concludes.As I have said before CAN YOU SUBSTANTIATE YOUR CLAIM ON A MEDICAL REVIEW?If the answer is Yes,then you are making the right decisions.
