2013 IRF-PAI Updates June 19, 2012 Lisa Werner and Melissa Berkoff Changes for 2013 There are 3 significant changes that will take effect on 10/1/12: New IRF-PAI Quality Indicators New IRF-PAI Training Manual CAUTI measures must be reported through NHSN IRF-PAI Changes Quality Indicator changes: The PUSH tool is being eliminated 3 new items are taking its place At admission we report: Number of current unhealed pressure ulcers by stage for stages 2, 3, and 4 At discharge we report: Number of current unhealed pressure ulcers by stage for stages 2, 3, and 4 Number of pressure ulcers developed or worsened since admission by noting the number of stage 2, 3, and 4 ulcers Number of healed pressure ulcers since admission by noting the number of stage 2, 3, and 4 ulcers IRF-PAI Changes Other Quality Indicator changes: The new pressure ulcer Quality Indicators measures will be required. Facilities not collecting and submitting these values to CMS beginning 10/1/2012 face a 2% reduction in reimbursement beginning in FY Removed from the quality indicators section are the questions related to respiratory status, pain, and safety. IRF-PAI Changes Quality items that are not changing: The IRF-PAI retains the items under Medical Needs related to comatose and delirium state on admission, as well as swallowing status and clinical signs of dehydration. These items (numbers 25 28) are on the Medical tab in eRehabData. They are still voluntary. Preparing for the Changes Steps to take to be ready to report on the new items: Review the new measures. Train nursing staff on pressure ulcer staging by tapping into your wound care nurse, or online resources such as Develop a data collection method for admission and discharge. Watch for clarification notices from CMS on technical questions related to completing the pressure ulcer items by monitoring this website:Assessment-Instruments/IRF-Quality-Reporting/index.html. Getting Started When? The new Quality tab on eRehabData will be available soon so you can practice data collection on the new items. Information entered into the new tab on eRehabData will not be transmitted prior to 10/1/12. Begin your data collection in advance of the October 1 to ensure that your process runs smoothly and that assessments are completed properly. Review the measures in eRehabData IRF-PAI Training Manual Changes Review of the general changes to the manual: General observation: Changes in language used were noted; such as, Medicare Part A was replaced with Medicare to represent the broader population served Acknowledgements were removed Appendix F: Selected FIM, FRG, and CMG references were removed Appendix H: General questions about the FIM Instrument were removed Page ii was added to provide CMS Help Desk and Billing/Payment Questions contact information 75% rule language was modified to reflect 60% rule. The 13 included conditions and conditional questions were listed IRF-PAI Training Manual Changes Changes in Section II IRF-PAI Coding Instructions: Page II-1: states that the quality indicators section is now required Page II-10: now states that the IRF-PAI must be completed for both payers 2 and 51 Page II-22: in the section Specifics for Scoring Function Modifiers and Relationship to FIM Item Scores, time frames for the assessment period were clarified Page II-22: in both the bladder and bowel frequency of accidents, the manual states if the helper spills the container, it is not counted as an accident IRF-PAI Training Manual Changes Changes in Section II IRF-PAI Coding Instructions: Page II-26: a statement was added that says: If a patient expires while in the rehabilitation facility, record a score of Level 1 for all discharge FIM items. Page II-26: simplified the instructions for recording the discharge date. It now states to enter the date the patient is discharged. Page II-29: mentions that quality indicators are not currently required, but failure to complete such items may result in payment reduction of two percentage points starting in FY 2014. IRF-PAI Training Manual Changes Changes in Section III Functional Independence Measures: Pages III-37 and III-39: Added the word (wet) to the description of the items for tub and shower transfers. Pages III-38 and III-40: Clarified that if the patient does both a tub and a shower transfer, you should record the lowest score. In the expiring manual the direction was to require the more frequent type of transfer. IRF-PAI Training Manual Changes Appendices Appendix E: has the new IRF-PAI form Appendix F: Glossary has new definitions to assist with the pressure ulcer items Appendix G: Offers links to the CMS Help Desk Appendix I: Includes the patient privacy and privacy rights act NHSN CAUTI Measures Quality reporting of Catheter Associated UTIs: National Healthcare Safety Network is gathering information from hospitals on the number of catheter associated UTIs and other measures. Rehabilitation units and hospitals are required to report CAUTIs beginning 10/1/12. You must use the NHSN website to report the information. NHSN CAUTI Measures Preparing for the Changes: Enroll into NHSN at Select a facility administrator If you are a unit in a hospital, find out who in your hospital is the facility administrator and have them establish your location and users All facility administrators and users must complete their training before beginning the enrollment period Access the following resources for help: NHSN Patient Safety Component Manual, January 2012 (http://www.cdc.gov/nhsn/TOC_PSCManual.html) Chapter 3: Monthly Reporting Plan Chapter 7: CAUTI Protocol Chapter 14: Tables of Instructions Chapter 16: Key Terms Access sample forms fromSafety-forms.html Access training at NHSN CAUTI Measures Preparing for Changes Determine how you will collect data on CAUTIs Determine your protocol for patient assessment for signs and symptoms of UTIs on admission Questions? Contact us: (202) Lisa Werner Melissa Berkoff