[DYSPHAGIA] RE: MBS Coverage under Med A

[elmwoodie@icnt.net (Jan Corwin)]

I can answer that in the SNF setting, it has to do with PPS (Prospective
Payment System).  Under that system, facilities are paid a per diem rate per
patient based on their RUGS (Resource Utilization Groups) category on the
MDS.  Minutes of rehab. and other measures influence that rate as well as
your geographic region.  For example, urban areas are being paid a higher
rate scale than less densely populated areas.  This per diem rate is
supposed to cover all "routine" costs such as staffing, laundry,
medications, room, board etc.

The cost of the MBS for Med A Patients in an SNF setting is supposed to be
paid by the facility, as it is supposed to come out of the per diem rate.
For some reason, the MBS is considered a routine exam.  However the cost of
the MBS in our area is more than $600 and driven up further by the cost of
transportation to a nearby hospital.  This is several hundred $$ higher that
the facility's reimbursement for the entire per diem rate.  There are some
tests that are "exempt" outside the per diem rate such as CT scans and
MRI's.  I am not sure why the MBS did not fall into this category.

At my facility, as a result, we now have to advocate more with
administration to make a case as to why the MBS is necessary.  Luckily, our
DON and Administrator has told me that if we feel there is a need for
patient safety that the MBS be done, our facility will pay.  I don't
recommend the MBS for everyone.  I try to consider if patient could benefit
as much or more from a FEES which is done by a local ENT who comes to our
facility and bills for the procedure himself.  The facility is not
responsible for that charge.  I also depend more on a careful bedside and
patient observation than I used to when I did acute care where the MBS was
available within 24 hours.  Even if I recommend the MBS, the patient has to
be well enough to tolerate an ambulance ride, transfer to the Haustead
chair, sitting upright for 30-45 minutes and then the return trip.  This
usually takes 3-4 hours door to door.  What we get at best is an MBS on an
exhausted patient.  Many of our patients are too weak or low level to manage
this process.  In these cases, the FEES, which can be done bedside, is
preferable.  The other problem with both exams is that it takes a minimum of
a week to schedule an MBS at our local hospital, longer if any holidays fall
within the period.  Transportation, family permission and family willing to
accompany must also be arranged.  Thus, whether we like it or not, we have
to do more careful bedside observation.  The logistical downside of the
FEES, (bedsides the clinical downside of not being able to directly observe
aspiration during the swallow, the esophageal phase etc.) is that our
wonderful local ENT is amazingly busy and sometimes can't schedule a
facility visit for weeks.

I recommended more MBS's when we had access to Mobilex, but alas they are no
more.  The powers that be make delvering decent care a real mental and
physical workuot for dedicated staff.

Well, I'm going to watch the debates and try to figure out which candidate
will do the least damage to our floundering healthcare system.

Jan Corwin
Berkeley, CA
-----Original Message-----
From: owner-dysphagia@medonline.com
[mailto:owner-dysphagia@medonline.com]On Behalf Of SUZIEEQ@att.net
Sent: Tuesday, October 03, 2000 4:58 PM
To: DYSPHAGIA@medonline.com
Subject:


Hello,
   Can someone enlight me on why MBS studies are not
covered under MCR A ?  Thank you in advance for your
response.             Stacey
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