[Dysphagia] Medicare holidays

[Jmwslp at aol.com (Jmwslp@aol.com)]

I know I'm jumping into this discussion late but I couldn't pass  on this 
conversation.  In reading several emails on this topic, please  let me try to 
clarify a few items about Medicare guidelines, holiday  coverage and Medicare 
Provider requirements for skilled  rehabilitation:
 
----A "Medicare week" begins with the date of admission and runs for seven  
days.  Medicare documentation requirements are built around the Medicare  week 
premise and (for example) skilled rehabilitation requires, at least, one  
progress note every seven days.
----If a patient is ordered skilled rehabilitation for 5 times a week,  the 
patient is to have treatment five out of every seven days, regardless of  
holidays or PPS MDS assessment periods.  The reasoning  Medicare Medical Reviewers 
provide for this is that a patient who  can do without treatment "every once 
in awhile" can (most likely) do without so  much treatment all of the time.  As 
for missed sessions outside assessment  periods, the question of clinical 
reasoning for the frequency during the  assessment period must be raised.
 
-----When planning holiday coverage, it's important to understand (and  
effectively use) the underlying premise of OBRA for Medicare coverage.  In  that 
the optimal quality of life is paramount (per OBRA), treating a  patient who 
emotionally and socially wishes to enjoy (and could benefit  from) a holiday with 
friends and family may not be in the patient's  best interest.  We are 
treating the whole patient with the goal of making  them well and/or providing them 
with the best quality of life.  Even  Medicare allows for a patient to enjoy a 
holiday, if/when that pleasure is truly  in the interest of the patient's 
overall well-being. Even the totally  dependent frequently exhibit behavioral 
changes when enjoying an  event, gift or activity.  
 
-----When a change in treatment pattern is considered best for the patient,  
recording how the decision was made is an essential piece of the medical 
record  as well as the documentation for the clinical  reasoning behind the 
modified treatment plan.
 
Hope this helps!
                          Joanne