RUG distribution FY2012: Are you an outlier?

The full year (FY12)  RUG distribution has been posted by CMS on the SNF PPS website (http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Spotlight.html), called "SNF Monitoring."  It is helpful to keep up with these stats, because this is one way CMS decides who is an outlier for Medical Review.  If your Rehab Ultra numbers are much greater than this, you can expect medical review.  Crucial numbers are:  RU:  48.6%   COT: 11%.

Here are some of the stats from this report:

Table 2: SNF Case-Mix Distribution for Therapy RUG-IV Groups, by Minor RUG-IV Therapy

Categories

	FY 2011	FY 2012
Ultra-High Rehabilitation (≥ 720 minutes of therapy per week)	44.8%	48.6%
Very-High Rehabilitation (500 – 719 minutes of therapy per week)	26.9%	25.6%
High Rehabilitation (325 – 499 minutes of therapy per week)	10.8%	10.1%
Medium Rehabilitation (150 – 324 minutes of therapy per week)	7.6%	6.2%
Low Rehabilitation (45 – 149 minutes of therapy per week)	0.1%	0.1%

Table 4: Distribution of MDS assessment types

	FY 2011	FY 2012
Scheduled PPS assessment	95%	84%
Start-of-Therapy (SOT) assessment	2%	2%
End-of-Therapy (EOT) assessment (w/o Resumption)	3%	3%
Combined SOT/EOT	0%	0%
End-of-Therapy assessment (w/ Resumption) (EOT-R)	N/A	0%
Combined SOT/EOT-R	N/A	0%
Change-of-Therapy (COT) assessment	N/A	11%