Dive Brief:
- The Centers for Medicare and Medicaid Services (CMS) shared data Wednesday on services provided by skilled nursing facilities to Medicare beneficiaries.
- The information was compiled from 15,055 skilled nursing facilities, more than 2.5 million stays at the facilities, and nearly $27 billion in Medicare costs in 2013.
- Data were also released on two categories of resource utilization groups (RUGs) for patients being provided high levels of therapy by their skilled nursing facility: Ultra-High (RU), which requires at least 720 minutes of therapy per week, and Very High (RV), which requires at least 500 minutes per week.
Dive Insight:
CMS highlights in its data release that, consistent with previous CMS findings, the information indicates facilities are very often providing their patients with just enough therapy to qualify them for either of these high utilization groups. (An amount within 10 minutes of the minimum threshold.) It notes that by doing so, facilities can recieve Medicare per diem payment amounts up to 25% higher for these patients.
“CMS strives to ensure that patient needs, rather than payment system incentives, are driving the provision of therapy services,” Dr. Shantanu Agrawal, Deputy Administrator for Program Integrity and Director of the Center for Program Integrity, wrote in a prepared statement. “These concerns have prompted us to refer this issue to the Recovery Auditor Contractors (RAC) for further investigation, and our hope is that data transparency will facilitate real changes.”
The states that are shown to have the most Medicare beneficiaries qualifying for these groups--based on therapy amounts within 10 minutes of the minimum threshold--in both the Ultra-High and Very High categories are Texas, Arkansas, Mississippi and Indiana. Three of those states are also in the highest range for average Medicare standardized payments per stay at skilled nursing facilities: Texas, Mississippi, and Indiana.