Managing the clinically anticipated Medicare Part A length of stay

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Kris Mastrangelo
Kris Mastrangelo

The Medicare adjustments of fiscal year 2012 have left the long-term care profession discussing and debating care strategies to ensure success and mitigate the reductions in reimbursement. A key indicator when analyzing clinical and financial solidity is the facility's clinically anticipated Medicare length of stay.

Careful case management by the interdisciplinary team and a comprehensive approach to care can positively affect not only length of stay but also safe and successful discharges. Generally, when a patient is admitted for short-term rehab his or her underlying medical conditions stabilizes before meeting he or she meet their functional potential. Therefore, it is very likely that the rehabilitation department is the driving force behind the patient's discharge plan.

Medicare supports providing rehabilitation services to help patients achieve their prior level of function. Establishing a patient's prior level of function is part of a comprehensive assessment. This should be thoroughly investigated and considered when discussing the patient's potential discharge. Prior level of function may include:

* Living setting: For example, home, senior apartment, assisted living as well as whether the patient lives alone and/or has assistance and whether the patient is a caregiver.

* Mobility status: To include ambulation, transfers and bed mobility, assistance provided and adaptive devices used in the home and community.

* Activities of daily living: Including basic bathing, dressing, grooming and hygiene tasks, as well as home management responsibilities, including shopping, cooking, cleaning, yard work, home maintenance, pet or child care responsibilities, and any assistance provided.

* Leisure activities: For example, golf, exercise, walking, gardening, sewing, etc.

* Cognitive status: Money management and medication management responsibilities, management of doctor appointments and/or assistance provided.

* Communication status: Communication devices used, telephone use, emergency alert.

* Swallowing abilities, diet and liquid consistencies.

Establishing a thorough prior level of function assists in the establishment of realistic goals and plan of care and supports the need for continued treatment. As the patient progresses through the therapy process, goals should be updated and adjusted to reflect the patient's discharge needs.

It is clinically appropriate to continue the therapy program and further progress the patient to his or her highest functional ability to meet these discharge needs. It is important to update the therapy plan of care to include new goals specific to these higher functioning tasks and ensure that it is documented that these goals directly relate to the patient's prior level of function.

Daily and weekly meetings conducted by the interdisciplinary team should stimulate discussion to reveal the patient's home and community living situation and allow for further customized treatment planning. 


Kris Mastrangelo, OTR, MBA, LNHA, is president and CEO of Harmony Healthcare International, a consultancy that provides onsite auditing of MDS and associated medical records.

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