Re: Counting Minutes in PPS

[Guest guest]

This is straight from the horse's mouth (HCFA that is):

Q. Can a patient classify into the RUx or RVx groups based on his 5-day

assessment?

A. Yes, it is possible. The only patients who will classify into either of

these sub-categories are those for whom a week's worth of minutes at the

Ultra-High or Very-High level have been provided and recorded in Section P by

the assessment reference date of the 5 day MDS. As on all 5 day assessments,

Section T must be completed, but the minutes of expected therapy recorded

there will NOT (emphasis added) influence the classification of the patient.

Hope that helps Albert!!

Kathy Shields

Professional Therapy Providers

St. Louis, Missouri

______________________________________________________________________

[Guest guest]

Albert, you have just re-stated the same question I posted about a week ago,

and that several others have posted before us. Nobody seems to post the

" final " answer. The software at my facilities, as best as I can tell, do

not have the capability to run such hypothetical patients under the

different scenarios which you, I, and others describe, so there does not

seem to be a way to test the questions. Yet, the answer seems to me to have

enormous implications about how we manage, care for patients and staff our

facilities.

My question at this point is: does anybody have a direct access to HCFA that

can give us the once-and-for-all solution to this question? Help!!

> Counting Minutes in PPS

>

> I was at a conference about PPS, again, and have heard that if we are

> seeing a patient and believe this patient belongs in the highest RUG

> category, (i.e., the Ultra group), we need to get all of our 720 minutes

> (not just a percentage of the minutes)in within the first 5 days, if that

> is what we are " locking " in as our values in Section P of the MDS.

>

> My belief is that you put in the actual minutes you have treated the

> patient for, but that in Section T, you put in what you project the

> patient's number of minutes to be per week. This reporting, plus an

> accurate reporting of the patient's ADL's drive the RUG category, not the

> fact that you did or did not get the 720 minutes in. I would also argue

> since the 720 minutes is per week and not per when you lock in (5 days),

> that the logic does not work in this case.

>

> Understanding? Rebuttals?

>

> Albert J. Yoshida, MBA, PT

>

>

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>

> ______________________________________________________________________

>

>

[Guest guest]

In a message dated 9/30/98 8:27:26 AM Pacific Daylight Time,

meliason@... writes:

<< If I understand the " 720 minute rule " , you must count the minutes rendered

during *5 consecutive days* during the assessment period. If your reference

date is Day 7, you tally minutes for Days 3-7 (not 1-7). If your reference

date

is Day 6, you count minutes on Days 2-6 (not 1-6). In other words, HCFA

grants

a sliding 5-day window for the initial assessment period.

Is that correct gang? I really hope I'm not making this more murky ...

>>

Let me throw another scenario: what if therapy was not provided on consecutive

days, say you had treatment minutes on day 1, 2, 4, 5, and 6. If your

assessment reference date is Day 6, are you going to count minutes from days

2-6 (in which case you have only 4 treatment days, you therefore miss the

highest 2 RUGs categories) or are you going to count treatment minutes given

on day 1, 2, 4, 5 and 6?

For those of you who are currently on PPS, how are you interpreting this

issue?

Thank you.

Rolando Lazaro, MS, PT, GCS

Stockton, CA

______________________________________________________________________

[Guest guest]

If I understand the " 720 minute rule " , you must count the minutes rendered

during *5 consecutive days* during the assessment period. If your reference

date is Day 7, you tally minutes for Days 3-7 (not 1-7). If your reference

date

is Day 6, you count minutes on Days 2-6 (not 1-6). In other words, HCFA

grants

a sliding 5-day window for the initial assessment period.

Is that correct gang? I really hope I'm not making this more murky ...

Mark

Mark: this is from HCFA's MDS 2.0 Q & A

Q. Can a patient classify into the RUx or RVx groups based on his 5-day

assessment?

A. Yes, it is possible. The only patients who will classify into either of

these sub-categories are those for whom a week's worth of minutes at the

Ultra-High or Very-High level have been provided and recorded in Section P by

the assessment reference date of the 5 day MDS. As on all 5 day assessments,

Section T must be completed, but the minutes of expected therapy recorded

there will NOT (emphasis added) influence the classification of the patient.

Re: HCFA's answer: It is my interpretation that therapy must be over " a

week's worth " -- HCFA states a " week " is " 7 consecutive days " . Therefore,

record the number of therapy minutes provided over the past 7 days. And,

actually, HCFA offers a 3-day grace period during the initial 5-day

assessment.

Gee, hope these waters are as blue as the Caribbean pretty soon!!

Kathy Shields

Professional Therapy Providers

St. Louis, Missouri

______________________________________________________________________

[Guest guest]

HI

We've been on PPS for 3 months now and have had the situation stated above

occur. We have interpreted the regs as stating that the therapy had to be

provided over 5 consecutive days, so if day 4 is skipped in the first 5 day

assessment, it will not help to set the reference day on day six to recover

the minutes. You could not use the minutes from day 1, so you would still end

up short. I'm honestly not sure if this ruling came from HCFA or the

intermediary. I'm sure the intermediary's are having just as much fun

interpreting all this as we are!!!

Vicki Tilley PT, GCS

Manager

Pettigrew Rehab

______________________________________________________________________

[Guest guest]

Hello again,

I wish I could just say trust me because I have looked at this question for

a while now and am confident that it is from admit to reference day. It has

been explained in a number of places that the reason we can do day 6, 7 or

8 is because HCFA understands the weekend issue, and that this IS the

reason that grace period was given, why else wouldn't they just make it day

5, if you think about it, ask yourself why was the grace period given.

Actually, this discussion may be somewhat irrelevant, except for RUx and

RVx, since one can " sort " into RHx, RMx and RLx without the listed minutes,

by having enough T minutes.

If day one is a friday and no PT is given over the weekend, the required 5

days of one discipline can still be met by using the next thursday as the

reference day(day 7) or one could stretch it to day 8 the following friday

in case the patient refuses one day, of course there is still the

requirements for minutes and other things like nursing rehab for RLx.

the reference period is over consecutive days, but the therapy doesn't have

to be, it just wouldn't make sense, and i believe this system is pretty

well thought out.

if it had to be consecutive and the patient refused one day, then you would

drop from all categories to the lowest RLx(unless T can make up for it,

which I'm researching), that would be a flawed system, in my opinion.

you can email someone at HCFA named Dana Burley from their MDS pages if you

want it spelled out any clearer, or I will and post the answer.

Cheers,

Yours in SNF PT,

M.

>If I understand the " 720 minute rule " , you must count the minutes rendered

>during *5 consecutive days* during the assessment period. If your reference

>date is Day 7, you tally minutes for Days 3-7 (not 1-7). If your reference

>date

>is Day 6, you count minutes on Days 2-6 (not 1-6). In other words, HCFA

>grants

>a sliding 5-day window for the initial assessment period.

>

>Is that correct gang? I really hope I'm not making this more murky ...

>

>Mark

>

>Mark: this is from HCFA's MDS 2.0 Q & A

>

>Q. Can a patient classify into the RUx or RVx groups based on his 5-day

>assessment?

>

>A. Yes, it is possible. The only patients who will classify into either of

>these sub-categories are those for whom a week's worth of minutes at the

>Ultra-High or Very-High level have been provided and recorded in Section P by

>the assessment reference date of the 5 day MDS. As on all 5 day assessments,

>Section T must be completed, but the minutes of expected therapy recorded

>there will NOT (emphasis added) influence the classification of the patient.

>

>

>Re: HCFA's answer: It is my interpretation that therapy must be over " a

>week's worth " -- HCFA states a " week " is " 7 consecutive days " . Therefore,

>record the number of therapy minutes provided over the past 7 days. And,

>actually, HCFA offers a 3-day grace period during the initial 5-day

>assessment.

>

>Gee, hope these waters are as blue as the Caribbean pretty soon!!

>

>Kathy Shields

>Professional Therapy Providers

>St. Louis, Missouri

>

>______________________________________________________________________

>

>

[Guest guest]

Please allow me to quote HCFA from the MDS 2.0 Q & A section:

" The directions for the completion of section P instruct the assessor to look

back over the " last 7 Calendar days " , counting only post admission days and

minutes of therapy, when counting the days and minutes of rehabilitation therapy

administered. Seven calendar days are, by definition, consecutive days. In the

case of the Medicare 5 day assessment, however, the assessor will choose as the

assessment reference date (MDS item A3a) any day 1-8 of the stay, and will look

back over the prior seven days ( or over the days since admission if the

assessment reference date is earlier than day 7) and count the number of days

upon which more than 15 minutes of therapy were administered, and will count the

number of minutes that were provided to the individual patient during those

days. It is irrelevant if there is a break in therapy for a weekend or holiday

during that time. For example, if day 5 is chosen as the assessment reference

date, the assessor would look back to admission to count the patient's OT, PT

and ST time. If PT was provided for 50 minutes on bothe the second and fifth

days of the stay, that would be recorded as 2 days PT and 100 minutes of PT. "

It seems clear to me that the expectation is to look back over the past seven

calender days to determine minutes and days. In the case of the 5 day

assessment, this could be days 1-5, 1-6, 1-7, or 2-8. Simply count the total

number of minutes and days during the selected period. " It is irrelevant if

there is a break in therapy " . Again, section P is actual hours over the past 7

days or days since admission if the reference date is earlier than day 7. It

does not have to be 5 consecutive days.

T

^^^^^^^^^^^^^^^^

Todd Cepica, P.T.

Assistant Director

Physical Medicine and Rehabilitation

University Medical Center

Lubbock, Tx 79417

Ph: Fax:

ntc@...

______________________________________________________________________

[Guest guest]

While it looks as though your question has been largely answered by

others, perhaps I can help clarify the distinctions between Sections P

and T of the MDS for counting minutes of therapy.

According to the pseudocode for the RUG-III grouper (v5.12) the

following minute-counting rules apply:

UltraHigh: 720 minutes from section P only (2 or more disciplines, 1

discipline 5 or more days, 2nd discipline 3 or more days). This means

that all minutes of therapy must be actually delivered - projected

minutes from Section T do not apply. The best strategy in this case

is to use your grace days to maximize the minutes of therapy actually

delivered (i.e. lock and send on day 7 rather than day 5). Days do not

need to be consecutive, so weekend therapy is necessary only to

achieve the 720 minutes or 5 total days of therapy.

Very High: 500 minutes from Section P only (at least 1 discipline for

5 or more days). This follows the same strategy as Ultra High - you

cannot use Section T projected minutes.

High: At least 325 minutes from Section P (1 discipline for 5 or more

days) OR you can use at least 65 minutes actually delivered from

Section P, combined with at least 520 minutes projected over 8 or more

days (within the first 15 days) from Section T. Lock and send the MDS

as soon as the 65 minutes from Section P have been delivered.

Medium: At least 150 minutes actually delivered over 5 days (any

combination of disciplines) OR you can use at least 240 minutes

expected over 8 or more of the first 15 days from Section T. If you

are projecting 240 minutes, lock and send any time you like.

Low: At least 45 minutes actually delivered (in conjunction with at

least 2 daily restorative nursing sessions for 6-7 days/week) from

Section P OR at least 75 minutes projected over 5 or more of

the first 15 days (from Section T) in conjunction with the restorative

sessions.`

Although these rules are detailed and reflect the computer algorithms

of the RUG-III grouper software rather than simple clinical treatment

logic, I hope this clarifies HCFA regulations.

We have developed a one-page RUG estimator form that clarifies this

and other preadmission/classification issues. I'd be happy to send a

copy to PTManager subscribers. Call me with your real-world address

if you'd like one.

Eiler

Director, SmartRehab

St. Louis, MO

(800)925-7627

______________________________ Reply Separator _________________________________

Subject: Counting Minutes in PPS

Author: <ptmanageregroups> at Internet

Date: 9/29/98 3:37 PM

I was at a conference about PPS, again, and have heard that if we are seeing a p

ient and believe this patient belongs in the highest RUG category, (i.e., the Ul

a group), we need to get all of our 720 minutes (not just a percentage of the mi

tes)in within the first 5 days, if that is what we are " locking " in as our value

in Section P of the MDS.

My belief is that you put in the actual minutes you have treated the patient for

but that in Section T, you put in what you project the patient's number of

minutesto be per week. This reporting, plus an accurate reporting of the

patient's ADL drive the RUG category, not the fact that you did or did not get

the 720 minutes in. I would also argue since the 720 minutes is per week and

not per when you lockin (5 days), that the logic does not work in this case.

Understanding? Rebuttals?

Albert J. Yoshida, MBA, PT

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