VDC Transformation Step 3

1
Analytic Resources on DAVE

• People
• Technical Expert Panel
• Analytic Workgroup
• Statistical and infrastructure support within
  the DAVE team
• Expertise from prior contractors
• Data
• SNF Stay File
• 36 months of all MDS assessments from national
  warehouse
• 18 months of national Medicare claims data
  (parts A B)
• Other CMS data on providers and chains

2
Patterns and Trends in SNF Care
RH is the most common RUG on 5-Day MDS Assessments
Understanding how providers respond to payment
changes is a goal
3
Patterns and Trends in SNF Care
Changes in the Percent of Assessments within
Rehab Categories from 1999 to 2001

• The percentage of RH cases has dropped for
  hospital based units but increased for
  freestanding ones.
• The increase in RH in freestanding units is due
  to a decline in the percent of cases in RU and
  RV.
• Outcomes and processes in freestanding and
  hospital based units are so different that we are
  examining them as separate groups.

4
Patterns and Trends in SNF Care
Percent of RH Therapy at 5 Day Assessment Based
on Provided rather than Ordered Therapy
Both the GAO and CMS are closely monitoring the
use of ordered therapy.
5
Patterns and Trends in SNF Care
Average LOS for RH Residents in Freestanding SNF
Units (CY 2000)
Resident population, access to home health, and
Medicaid coverage may account for differences
6
Length of Stay Varies Across Site Ownership
Type (CY2000)
Patterns and Trends in SNF Care
Ownership Type Differences
Facility Type Differences
Review activity will allow DAVE to determine
whether facilities with longer lengths of stay
tend to have more days denied because medical
necessity was lacking.
7
Patterns and Trends in SNF Care
State Differences in the Percent of Medicare
Residents who Remain in SNF after Medicare
coverage ends (CY 2000)
Differences reflect substantial variation in the
percentage of residents receiving skilled care
who already resided in a Nursing Facility
8
Preliminary Review Result Findings
Common Discrepancies in Offsite Review
9
Preliminary Review Result Findings
Common Discrepancies in Onsite Retrospective
Reviews of Medicaid
10
Preliminary Review Result Findings
Common Discrepancies in Onsite Two Staged Reviews
of Medicare