Time to Think Ahead
Lisa Werner, MBA, MS, SLP Director of Consulting Services, Fleming-AOD, Inc.
If you feel like you have finally caught your breath from the changes to the Case Mix Groups (CMGs) that went into effect on October 1, 2019, make sure you don’t plan to rest for long. I was working with a client last week and we included a planning meeting to review the Final IRF-PAI Version 4.0 that was released in early December. The changes will not impact patient care, but they will require forethought and documentation changes as they call for a significant amount of data collection. To put this into perspective: the length of the document is 30 pages, which is up from 18 pages in the current version. Some of the items that were used only for risk-adjustment have been introduced for discharge assessments as well. Furthermore, many questions are related to the social determinants of health and the Drug Regimen Review. Let’s Take a Closer Look at These Changes The first difference starts on page 3, Section A, where the ethnicity, race and preferred language questions have been added or modified. On the current IRF-PAI, patient race is asked in a different manner. Therefore, you should evaluate whether the expanded questions should be answered by the provider currently assigned to complete the question or if a different provider may have more relevant information. On page 4, a question about transportation has been added. The question aims to determine whether a lack of transportation has interfered with the patient’s ability to manage on a day-today basis. The ethnicity, race and language questions are asked on admission only, but the transportation question is asked at admission and discharge. If these questions are currently built into your EMR and populate eRehabData®, please do not overlook the modification that will be necessary. I see value in including the page 3 and 4 questions on the case manager’s admission and discharge assessment.
On page 5, Section B, there are new questions that address the patient’s hearing, vision and health literacy. These are asked in addition to the expression of ideas and wants and understanding verbal and non-verbal content questions, which continue to be presented in the same form as we currently see them. The discharge IRF-PAI asks the health literacy question again. This is the only Section B question that is repeated. In many inpatient rehabilitation units and hospitals, the expression and understanding questions are completed by the nurses. Since the new questions about vision, hearing and health literacy are loosely related, the nurse should be able to answer them without adding to their workload. Once again, the new questions will need to be added to the EMR using the exact answers as seen on the IRF-PAI in order to upload to eRehabData®.
14 AMRPA Magazine / March 2020
