PPS FOR THE NURSING HOME MEDICAL STAFF

NYAHSA Conference Presentation March 29, 1999

Robert S. Stall, M.D. 14 Heritage Rd W Williamsville NY 14221

Phone 716 636-7531 FAX 716 636-7532 E-mail mailto:drstall@acsu.buffalo.edu



Handout-Table of Contents

Four PPS items physicians must know...* 1 RUG III Descriptors-Summary Table** 10
What Attending Physicians Need to Know...** 2 ADL Index** 11
MDS 2.0 RUGS Categories** 3-6 MDS 2.0** 12-21
SNF Consolidated Billing** 7-9 PPS and Other Recent Federal Regulatory...*** 22-25


Expectations-What To Ask of the Medical Staff

  1. Understanding of the new system
  2. Patience and cooperation with the new system
  3. Involvement in the new system


Relevance-What To Offer the Medical Staff

  1. Facility Medicare provider number
  2. The name of the MDS coordinator and other key staff
  3. List of PPS covered residents
  4. Relevance of the new system
    1. Regulatory/Fraud & abuse implications
    2. Addresses common goal of appropriate, cost-effective care
  5. Quantitative feedback (e.g. medication use, lab use compared to others)
  6. Medication formulary (with pharmacy consultant and vendor feedback)
  7. Good admission information (discharge summary, labs, etc.)
  8. Structured progress note--NHProgressNoteForm.doc (Microsoft Word for Windows 95 7.0 format)
  9. Ways to make their life easier
    1. Dictation services
    2. Coordination of phone calls to physician


Engagement-How to Talk to the Medical Staff

  1. Person-to-person
  2. Collegial rather than confrontational
  3. Convenient time & place
  4. Pleasant setting and good food
  5. Administration presence
  6. Interdisciplinary team presence
  7. Governing board/owner presence
  8. Medical Staff meeting (video, handout, discussion)


Education-Topics to Cover With the Medical Staff

  1. PPS importance to facility
  2. Concept of consolidated billing & PPS overview
  3. Which residents will be affected
  4. "Medical necessity" as the main criteria for all orders
  5. Importance of preventing complications
  6. Documentation must correlate with other staff documentation
  7. Audits will occur
  8. RUGS-sensitive MDS items
    1. ADL index
    2. Diagnoses (esp. dehydration, diabetes, hemiplegia, pneumonia, terminal illness)
    3. Cognition
    4. Behavior
    5. Depression
    6. Fever defined as 2.4 degrees above baseline


References

  1. *PPS Alert for Long-Term Care, October 1998.
  2. **AMDA PPS Program

http://www.amda.com/pps/index.html

  1. ***Annals of Long-Term Care, December 1998.
  2. AGS Geriatrics At Your Fingertips 1998/1999 Edition (pocket guide to geriatric medicine)

http://www.americangeriatrics.org/gayf.html

  1. Dr. Stall's Home Page-Dedicated to Geriatrics and Hospice Care

http://wings.buffalo.edu/~drstall/