Introduction:
LTCHs which have been excluded from the inpatient prospective payment system under section 1886(d)((1)(B)(iv) of the Social Security Act, are certified under Medicare as short-term acute-care hospitals and, for the purpose of Medicare payments in general, are defined as having an average inpatient length of stay of greater than 25 days. The formula for an unadjusted LTCH PPS prospective payment is:
Federal Prospective Payment = MS-LTC-DRG Relative Weight * Standard Federal Rate
(The standard federal rate used for this assignment will be $40,397.96)
Use the excel sheet attached (CMS 1588 F- Table 11) to answer the following questions
(Note: you are able to “sort” the data in the various columns to assist you in completing the assignment)
- What are the top ten MS- LTC- DRGs based on # of cases?
The following is the list of top ten MS- LTC- DRGs based on the number of cases.
- Are these the types of cases you would expect to see in a LTC Acute Hospital? Explain Why or Why Not.
Long term acute care hospitals are hospitals that among other things specialize in the care of patients who have severe medical conditions, at times more than one condition. Such conditions require that the patient be provided care on a continuing basis. Nonetheless, the patients do not require extensive diagnostic procedures or intensive care units. Typically, the patients in these facilities have been discharged from intensive care units and are in need of care, a degree more than is offered at skilled nursing facilities, rehabilitation centers or at home. These are the patients that I would expect to find at a long term acute care hospital. Firstly, these patients need to be hospitalized for a little over twenty five days. Additionally, these patients have the characteristics of patients who would be confined in long term acute care hospitals. These characteristics include weaning or prolonged use of a ventilator, transfusions and multiple intravenous medications, continuing dialysis for patients with chronic renal failure, care for burns or care for complex wounds and intensive respiratory care.
- For the top 10 MS LTC DRGs listed in question 1, complete the table below:
The table below shows the weight, standard federal rate and payment rate to the list of top ten MS- LTC- DRGs based on the number of cases.
- Using the excel sheet (CMS 1588 F Table 11) identify the 5 MS LTC DRGs with the highest relative weight.
The table below shows a list of the 5 MS LTC DRGs with the highest relative weight.
- Using the excel sheet (CMS 1588 F Table 11) identify the 5 MS LTC DRGs with the longest average length of stay.
The table below shows a list of the 5 MS LTC DRGs with the longest average length of stay.
