Archive for December, 2012

December 19, 2012

M1000 answer depends on type of observation

Dear Lisa: We are receiving many referral from hospitals that the patient was listed as “observation only.”  How do we mark M1000?

Lisa says: Your answer depends on whether the observation was inpatient or outpatient observation. If the patient was inpatient observation then the patient was discharged from a facility. If the patient was billed as outpatient, then it does not count as an inpatient facility discharge. 

December 4, 2012

CMS will not pick standardized risk of falls tool

CMS addresses valid risk of falls tools and M1910 …

Question: We see that a validation study has been published for the Missouri Alliance for Home Care’s Fall Risk Assessment Tool (MAHC-10). Does this mean that we can now use that tool as the single standardized, validated, multifactor tool to meet the “Yes” response for M1910? And if so, should the threshold of “4” or “6” be used to indicate fall risk?

Answer from CMS: Per existing guidance, if you want to report M1910 as “Yes” (that Fall Risk Assessment was conducted), you must use a multifactor standardized tool that has been scientifically tested and validated, and the tool must be appropriately administered based on established instructions. CMS does not approve or disapprove individual tools.

It is the agency’s responsibility to determine if the tool you are using includes these elements. If an agency has evidence (from published literature, the tool developer, or another authoritative source) that the tool they are using assesses multiple factors that contribute to the risk of falling, has been scientifically tested and validated on a population with characteristics similar to that of the patient being assessed, and shown to be effective in identifying people at risk for falls, and includes a standardized response scale, then the agency can consider the tool to meet the requirements for the OASIS-C best practice assessment.

In determining if a patient is at risk for falls, the standardized tool should have a standardized response scale, and/or established and validated threshold at which fall risk exists. A tool may have multiple thresholds identifying various levels of risk (i.e, “no risk”, “low risk”, “high risk”). Select Response 1 if the standardized response scale rates the patient as no-risk, low-risk, or minimal risk. Select Response 2 if the standardized response scale rates the patient as anything above low/minimal risk. If the tool does not provide various levels, but simply has a single threshold separating those “at risk” from those “not at risk”, then patients scoring “at risk” should be reported as Response 2.

See more CMS Q&As.

December 2, 2012

HHQI releases best practices on patient self-management

Selman-Holman Associates is a coordinator with this, and it is exciting! HHQI now has released its Best Practice Intervention Package on patient self-management.

Are you familiar with your community’s efforts to improve the 30-day readmission rates of patients to your local facilities? Most communities around the country are addressing this issue in one form or another. Have you been contacted by someone in your community to discuss this issue? If not, you may want to ask yourself, ‘why not?’

As we all know, home health plays a central role in helping patients regain their health and remain in their homes. If you are not currently ‘at the table’ for your community discussions, now is the time to contact other providers –other home health agencies as well as hospitals, nursing homes, SNFs and physician offices – and begin the discussion as to what you can do as a community to improve the quality of care you provide to your citizens as they move from one care setting to another.

The Home Health Quality Improvement (HHQI) national campaign recently released the focused Best Practice Intervention Package (BPIP) on the topic of Patient Self-Management. This BPIP is much smaller than the previous packages updating the content published in 2011.

If you haven’t downloaded it yet, please do so and share with your community partners. To download this, please go to the HHQI website and either register or login.

The BPIPs are found under the “Education” tab on the blue tool bar.

December 1, 2012

If wound margins meet on pressure ulcers, do you have 1 ulcer or 2?

A clarification from CMS regarding M1308:

Question: Upon admission, our patient had 2 distinct pressure ulcers in close proximity. Over the course of the episode the ulcers deteriorate and no longer have any separating tissue. Do we now call this 1 pressure ulcer at the worst stage?
Answer from CMS: If the patient had one pressure ulcer and then later developed another pressure ulcer, and eventually the wound margins met, it would be counted as two ulcers, as long as it remains possible to differentiate one ulcer from another based on wound margins. Depending on the timing and progression, it may be difficult for the clinician to know that a current ulcer was once two ulcers, and/or where one ulcer ends and another begins for assessment/reporting purposes. It would be up the assessing clinician to determine the number of pressure ulcers in situations where multiple ulcers
may have merged together.

More CMS Q&As.