Well Prepared With Proof

א' תמוז התשס"ח
Faunus 3

Well, I soon have an out of state interview for an MDS (Minimum Data Set) Coordinator position. I've also assembled the evidence to support my excellent job performance, which includes a graphical analysis of the facility's CMI (case mix index - an index of financial signifiance in Indiana) "before" and "after" I was employed as its MDS Coordinator.

The graph demonstrates quite clearly my "turnaround accomplishment", taking the facility's CMI from a significant negative trend (with a slope of -0.024 CMI points per quarter) to a significant positive trend (with a slope of +0.031 CMI points per quarter). The slopes may "look" like small numbers in this prose post, but when the CMI range is 1.06 (the state average) - 1.20, the slopes (rates of change) are quite impressive.

What is equally impressive is how the turnaround accomplishment translates into dollars.

For example, generally for every 0.01 point of CMI change, there is a corresponding change of $0.65 per resident per patient day. For example, with an average daily Medicaid census for the month of June at 65, and with 30 days in June, using the month of June for a comparative approximating calculation, we have:

The dollar amount associated with the increasing the Medicaid reimbursement rate:

30 X 65 X (0.65 X 3.1 positive points of CMI change) = $3,929.25 more dollars per month or $11,787.75 more dollars per quarter

Over the course of 1 year, my positive trend translates to $47,151.00 more revenue!

The dollar amount associated with the decreasing Medicaid reimbursement rate by which the facility was losing money prior to my employment:

30 X 65 X (0.65 X -2.4 negative points of CMI change) = $3,042.00 fewer dollars per month or $9,126.00 fewer dollars per quarter

Over the course of 1 year, the negative trend prior to my employment translates to a loss of $36,504.00.

These are conservative approximations. There are other ways to calculate the approximations which produce similar results.

I've also assembled proof of our 100% EDS (electronic data systems) audit, validating the RUG (resource utilization group) scores which provide the clinical data to support the financially driven CMI. For example of clinical data which support RUG-based reimbursement, if I had claimed an IV (intravenous medication) as a clinical intervention for which the facility could be reimbursed, I had a copy of the medication administration record to prove that the resident was indeed administered the IV.

In addition to the reimbursement turnaround and 100% EDS audit accomplishments, I also have had, to date, no delinquent assessments. I also have proof of that.

As this post suggests, I like to be sure that the data upon which reimbursements are based can be easily proven true and valid. One primary reason I am leaving my current position is not because I am being paid the salary of a nurse with 5 years experience (when I am a nurse with over 20 years experience), but because our corporate QA nurse no longer allows me and has directed me not to attach reimbursement proof to the MDS assessment. This makes me very nervous. My signature goes on the MDS assessments which are transmitted to the state and federal government for reimbursement purposes, not hers. She has no investment in proving the validity our reimbursement data, I do. Thus, I am seeking other employment.