PDPM – Nursing Categories


CMS has released a provider specific impact analysis for PDPM using 2017 data. There’s a lot to analyze and that takes time. However, one interesting question we can answer with the data is something along the lines of “What would happen if all the therapy minutes disappeared?” 

(Note: Since CMS still refers to the nursing classification as a “RUG”, I will too. When I refer to “category”, I mean Extensive Services, Rehab, Clinically Complex, etc.)

This data set lends itself to that kind of analysis because CMS calculated the nursing RUG as if PDPM had been in place for FY 2017. From there, we just find the most frequent category and RUG by state. Then we map it:

Click to enlarge – you know you want to.

The pattern is interesting. The blue states have a majority of nursing RUGs in the Clinically Complex category. The orange states have a majority of nursing RUGs in the Reduced Physical Function category. There’s a nice east/west thing going on. 

The Importance of Documentation

Why does it look like this? There are a number of possible reasons but let’s talk about one that is critical to your success: documentation. Under our current PPS system, there really isn’t much harm in slacking on that documentation from a reimbursement perspective. (Obviously it’s a terrible idea clinically speaking.)

Under PDPM, a bright light will shine on your nursing documentation. Every Part A patient will have a nursing RUG regardless of whether any therapy is being done or not. The time to clean up that documentation is right now. Contact Broad River Rehab if you want some ideas about how to do that.