1. 2013 IRF-PAI Updates June 19, 2012 Lisa Werner and Melissa Berkoff

2. Changes for 2013 There are 3 significant changes that will take effect on 10/1/12:  New IRF-PAI Quality Indicators  New IRF-PAI Training Manual  CAUTI measures must be reported through NHSN

3. IRF-PAI Changes Quality Indicator changes:  The PUSH tool is being eliminated  3 new items are taking its place  At admission we report: Number of current unhealed pressure ulcers by stage for stages 2, 3, and 4  At discharge we report: Number of current unhealed pressure ulcers by stage for stages 2, 3, and 4 Number of pressure ulcers developed or worsened since admission by noting the number of stage 2, 3, and 4 ulcers Number of healed pressure ulcers since admission by noting the number of stage 2, 3, and 4 ulcers

4. IRF-PAI Changes Other Quality Indicator changes:  The new pressure ulcer Quality Indicators measures will be required. Facilities not collecting and submitting these values to CMS beginning 10/1/2012 face a 2% reduction in reimbursement beginning in FY 2014.  Removed from the quality indicators section are the questions related to respiratory status, pain, and safety.

5. IRF-PAI Changes Quality items that are not changing:  The IRF-PAI retains the items under Medical Needs related to comatose and delirium state on admission, as well as swallowing status and clinical signs of dehydration.  These items (numbers 25 – 28) are on the Medical tab in eRehabData.  They are still voluntary.

6. Preparing for the Changes Steps to take to be ready to report on the new items:  Review the new measures.  Train nursing staff on pressure ulcer staging by tapping into your wound care nurse, or online resources such as http://www.npuap.org/.  Develop a data collection method for admission and discharge.  Watch for clarification notices from CMS on technical questions related to completing the pressure ulcer items by monitoring this website: http://www.cms.gov/Medicare/Quality-Initiatives-Patient- Assessment-Instruments/IRF-Quality-Reporting/index.html.

7. Getting Started When?  The new “Quality” tab on eRehabData will be available soon so you can practice data collection on the new items.  Information entered into the new tab on eRehabData will not be transmitted prior to 10/1/12.  Begin your data collection in advance of the October 1 to ensure that your process runs smoothly and that assessments are completed properly. Review the measures in eRehabData

8. IRF-PAI Training Manual Changes Review of the general changes to the manual:  General observation: Changes in language used were noted; such as, Medicare Part A was replaced with Medicare to represent the broader population served  Acknowledgements were removed  Appendix F: Selected FIM, FRG, and CMG references were removed  Appendix H: General questions about the FIM Instrument were removed  Page ii was added to provide CMS Help Desk and Billing/Payment Questions contact information  75% rule language was modified to reflect 60% rule. The 13 included conditions and conditional questions were listed

9. IRF-PAI Training Manual Changes Changes in Section II IRF-PAI Coding Instructions:  Page II-1: states that the quality indicators section is now required  Page II-10: now states that the IRF-PAI must be completed for both payers 2 and 51  Page II-22: in the section “Specifics for Scoring Function Modifiers and Relationship to FIM Item Scores,” time frames for the assessment period were clarified  Page II-22: in both the bladder and bowel frequency of accidents, the manual states if the helper spills the container, it is not counted as an accident

10. IRF-PAI Training Manual Changes Changes in Section II IRF-PAI Coding Instructions:  Page II-26: a statement was added that says: “If a patient expires while in the rehabilitation facility, record a score of Level 1 for all discharge FIM items.”  Page II-26: simplified the instructions for recording the discharge date. It now states to enter the date the patient is discharged.  Page II-29: mentions that quality indicators are not currently required, but failure to complete such items may result in payment reduction of two percentage points starting in FY 2014.

11. IRF-PAI Training Manual Changes Changes in Section III Functional Independence Measures:  Pages III-37 and III-39: Added the word “(wet)” to the description of the items for tub and shower transfers.  Pages III-38 and III-40: Clarified that if the patient does both a tub and a shower transfer, you should record the lowest score. In the expiring manual the direction was to require the more frequent type of transfer.

12. IRF-PAI Training Manual Changes Appendices  Appendix E: has the new IRF-PAI form  Appendix F: Glossary has new definitions to assist with the pressure ulcer items  Appendix G: Offers links to the CMS Help Desk  Appendix I: Includes the patient privacy and privacy rights act

13. NHSN CAUTI Measures Quality reporting of Catheter Associated UTIs:  National Healthcare Safety Network is gathering information from hospitals on the number of catheter associated UTIs and other measures.  Rehabilitation units and hospitals are required to report CAUTIs beginning 10/1/12.  You must use the NHSN website to report the information.

14. NHSN CAUTI Measures Preparing for the Changes:  Enroll into NHSN at http://www.cdc.gov/nhsn/enroll.html  Select a facility administrator If you are a unit in a hospital, find out who in your hospital is the facility administrator and have them establish your location and users  All facility administrators and users must complete their training before beginning the enrollment period  Access the following resources for help: NHSN Patient Safety Component Manual, January 2012 (http://www.cdc.gov/nhsn/TOC_PSCManual.html)  Chapter 3: Monthly Reporting Plan  Chapter 7: CAUTI Protocol  Chapter 14: Tables of Instructions  Chapter 16: Key Terms  Access sample forms from http://www.cdc.gov/nhsn/forms/Patient- Safety-forms.html  Access training at http://www.cdc.gov/nhsn/training/

15. NHSN CAUTI Measures Preparing for Changes  Determine how you will collect data on CAUTIs  Determine your protocol for patient assessment for signs and symptoms of UTIs on admission

16. Questions? Contact us: (202) 588-1766 Lisa Werner lwerner@eRehabData.com Melissa Berkoff assistance@eRehabData.com