Part A RUGs – Some Observations

Do you want to see a picture that explains a lot about skilled nursing right now? Take a look at this: (click to enlarge)

This is from the 2016 Medicare Part A data that CMS released a few days ago. There is a lot to unpack in that data set, but just based on this chart alone:

  • 14 of the top 15 RUGs billed Medicare Part A are Rehab.

  • The most used nursing RUG was 13th, ES3.

  • The top 12 RUGs, all Rehab, account for 98.5% of all billed days.

Not shown in the chart, but relevant:

  • Rehab RUGs made up 98.89% of all billed Part A days in 2016.

  • There were only 23 billed RUGs that were not Rehab.

  • Only 8 of those were billed more than 0.1% of the time.

If it weren’t for long-term care residents we’d have a hard time calling these “skilled nursing facilities.”

You can see the impetus for PDPM clearly right here.