Ask the payment expert: implementing restorative nursing in your facility

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Ask the payment expert
Ask the payment expert
I'm having a hard time convincing my administrator that restorative nursing needs to be implemented in our facility. What do you suggest?

I have five key reasons why an RAI-compliant Restorative Nursing program is very important to your facility. First, the expectation of regulations is that a resident entering your facility either maintains or improves their function in ADLs. Survey outcomes can be positively affected by a restorative nursing program.

Second, the Medicare program reimburses for Restorative Nursing as part of Rehab Low and in the lower 18 RUG categories. Third, states with case mix Medicaid programs reimburse for Restorative Nursing as part of the Rehab RUG alternative criteria and also in the lower 18 RUG categories.

Fourth, the Five Star program uses two ADL Quality Measures as 40% of the QM Star Rating. A Restorative Nursing program can positively affect these results. Fifth, ADL Quality Measures are also used for both long-stay and short-stay residents in the demonstration program for the Nursing Home Value-Based Purchasing also known as Pay for Performance.  

You can't afford not to have an RAI-compliant Restorative Nursing program.  

Where can we find specific information on the demonstration project for the Nursing Home Value-Based Purchasing Program?

Look at This site will give all the specifics of the structure of the project, including how staffing, avoidable hospitalization, resident outcomes (measured by Quality Measures) and survey outcomes will be calculated. The demonstration runs through June 2012.

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