CMG Trends
Lisa Werner, MBA, MS, SLP Director of Consulting Services, Fleming-AOD, Inc.
Beginning on October 1, 2019, the inpatient rehabilitation facility prospective payment system (IRF PPS) model shifted from FIM™-based case mix groups (CMGs) to functional items found in sections GG and H on the IRF Patient Assessment Instrument (IRF-PAI). Within eRehabData®, we modeled the changes so our subscribers would have an idea of what was coming their way with respect to Medicare reimbursement. Using the information in the April 17, 2019, IRF PPS proposed rule, we presented the 2020 Proposed Grouper Model. The proposed grouper model indicated what your anticipated case mix index (CMI) would be based on the patients admitted in the time period you designated. Providers were able to access data on the difference in average expected reimbursement such that they could assess the likely impact of the transition of the sections GG/H CMGs to their hospitals. Now that we have a full quarter of outcomes data in place, we have the opportunity to reflect on how the transition to the new CMGs has begun to impact the industry. The national CMI has increased as anticipated. At the time of writing, the CMI was 1.4210 for Medicare patients in the fourth quarter of 2019. This was up from the third quarter baseline of 1.3455, which was the last time period for the FIM™based CMGs (with the section GG/H-based CMGs taking effect October 1). This represented $1,542.43 per discharge based on the average Medicare expected reimbursement for the fourth quarter. The fourth quarter section GG/H functional scores were 49.49, while the third quarter section GG/H was 50.69. As I reflect on what has changed in the past quarter, I believe that the most obvious change was the addition of nurses in the assessment process admission scores. Prior to the anticipated CMG changes, the GG scores were largely coming from documentation provided by therapists. Since the nurses are the ones completing the first assessment upon admission, it makes sense to incorporate their observations in the functional scoring. Since we no longer have duplication of functional assessments, it should be expected that nurses capture the admission functional level in the areas that they typically assist with – such as bed mobility, transfers, toileting, eating and oral hygiene. Make sure you are analyzing your data. Based on the difference in the CMI from quarter 3 to quarter 4, the increase in the CMI for Medicare patients was 0.0755. Unless you have experienced significant changes within your organization in the last quarter, the increase in the national CMI should be similar to the CMI change that you experienced.
14 AMRPA Magazine / February 2020
