Burden Calculations LTCH clean 12 19 12

LTCH Quality Reporting Program / Burden Estimate (12.19.12)

1. Estimated Number of Yearly LTCH Discharges and LTCH CARE Data Sets Submissions

Total Number of LTCH in U.S. = 442

Total Number of Discharges from all LTCHs per year:

134,700 - Medicare Beneficiaries

67,350 – Non Medicare Beneficiaries

202,050¹ – Total LTCH D/C’s

Estimated Number of Discharges from each LTCH per year = 457

202,050 D/Cs from all LTCHs / 442 LTCHs in U.S.

Estimated Number of Discharges from each LTCH per month = 38

202,050 D/Cs from all LTCHs / 442 LTCHs in U.S. / 12 months per year = 38

Estimated Number of LCDS’s submitted by all LTCHs per year = 403,988

457 estimated # of D/C’s in each LTCH per year x 442 LTCHs in US = 201,994 D/C’s per all LTCHs per year

201,994 D/C’S per all LTCH per year x 2 LCDS forms per patient = 403,988 LCDS per all LTCHs per year

Estimated Average Number of LCSD’s submitted by each LTCH per year = 914

403,988 LCDS per all LTCHs in U.S. / 442 LTCHs in US = 914 LCDS per each LTCH

Estimated Average Number of LCSD’s submitted by each LTCH per year = 914

(Alternate Method of Calculation)

202,050 D/C’S per all LTCH per year x 2 LCDS forms per patient = 404,100 LCDS per all LTCHs per year

404,100 LCDS per all LTCHs per year / 442 LTCHs in U.S. = 914 LCDS per each LTCH

Estimated Average Number of LCSD’s submitted by each LTCH per month = 76

403,988 LCDS per all LTCHs in U.S. per mo. / 442 LTCHs in US = 914 LCDS per each LTCH per year

914 LCDS per each LTCH per year / 12 months per year = 76 LCDS per each LTCH per month

Estimated Average Number of LCSD’s submitted by All LTCHs per month = 33,666

403,988 LCDS per all LTCHs in U.S. per year / 12 months per year

2. Estimate of Financial (Wage) Burdens for Submission of LTCH CARE Data Set

Time Required to Complete Each LTCH CARE Data Set Assessment = 65 minutes

11 minutes for Admission assessment – nursing/clinical staff time to collect clinical data;

11 minutes for Discharge assessment – nursing/clinical staff time to collect clinical data;

10 minutes administrative data entry time to aggregate and submit data to CMS

32 minutes² – Total time burden to complete LTCH CARE Data Set per patient

Estimated Annual Time Burden per each LTCHs = 480 hrs/each LTCH/year

Estimated Annual Time Burden all LTCHs = 201,552 hrs/all LTCH’s/year

• 32 minutes/form x 76 forms/each LTCH/month = 2,432 minutes/each LTCH/month

• 2,432 minutes / 60 minutes/ hour = 40 hours per LTCH per month

• 40 hours per LTCH per month x 12 months/year = 480 hours per each LTCH/year

• 480 hours/each LTCH/year x 442 LTCHs in U.S. = 212,160 hrs/all LTCH’s/year

3. Cost/Wage Calculation for Completion of the LTCH CARE Data Set:

1. Wages for Clinical Staff Completing the LTCH CARE Data Set

11 minutes for Admission assessment - nursing time to collect clinical data @ $33.23/hour³

11 minutes for Discharge assessment - nursing time to collect clinical data;@ $33.23/hour

• 22 minutes x 914 LCDS forms/ each LTCH / yr = 20,108 minutes nursing time /each LTCH / year

• 20,108 minutes per LTCH per yr / 60 minutes = 335 nursing hours / each LTCH / year

• 335 hours per year x $33.23 per hour = $11,132 nursing wages /per each LTCH / year

• $11,132 x 442 LTCH providers = $4,920,344 nursing wages per all LTCHs / year

2. Wages for Admin Assistant/ Clerical Staff who gather and transmit LTCH CARE Data Set

(NOTE: Administrative data entry time calculated at an hourly wage of $15.59/hour

• 10 minutes x 914 LCDS forms/ LTCH/yr = 9,140 minutes administrative time/LTCH/year

• 9,140 minutes per LTCH per yr / 60 minutes = 152 administrative hours per year

• 152 hours per year x $15.59⁴ per hour = $2,370 admin assistant wages/per LTCH/year

• $2,370 x 442 LTCHs = $1,047,540 per all LTCH providers/year

4. Combined Calculations:

$11,132 Nursing wages/per LTCH /year (LTCH CARE Data Set)

$ 2,370 Admin assistant wages/per LTCH /year (LTCH CARE Data Set)

$13,502 Total Annualized Cost to Each LTCH Provider

$ 4,920,344 Nursing wages/per ALL LTCHs /year (LTCH CARE Data Set)

$ 1,047,540 Admin assistant wages/per ALL LTCHs /year (LTCH CARE Data Set)

$5,967,884 Total Annualized Cost For All LTCH Providers

5. Additional Calculations:

Total Yearly Cost To All LTCH Providers for Reporting Data using the LCDS = $5,967,884

• $13,502 x 442 LTCHs in U.S. = $5,967,884

Total Yearly Cost To Each LTCH Provider for Reporting Quality Data = $13,502

• $5,967,884 yearly cost for all LTCHS / 442 LTCHs in U.S. = $13,502

Estimated Average Monthly Cost To Each LTCH Provider for Reporting Quality Data = $1,125

• $5,967,884 Total yearly cost for all LTCHS/ 442 LTCHs in U.S./ 12 months per year = $1,125

Estimated Average Cost per each LCDS Submission = $14.77

• $5,967,884 yearly cost of LCDS submissions for ALL LTCHs / 403,998 LCDS submissions per all LTCHs/year = $14.77; OR

• $13,502 yearly cost of LCDS submissions per each LTCH / 914 LCDS submissions per LTCHs/year = $14.77

Itemized Time and Wage/Cost Burden Estimate for the LTCH CARE Data Set Assessments:

• The LTCH CARE Date Set consists of 4 different assessment forms.

• All of these forms consist of some data items (questions) that are required, and some that are voluntary (LTCH may chose not to answer these items without affecting quality reporting compliance)

• An LTCH is required to perform and submit an admission assessment within 3 days after the patient is admitted.

• An LTCH must also perform a discharge assessment on each patient,( but only one of the three discharge assessment forms is used)

• There are 3 different types of Discharge Assessment forms:

  • Planned Discharge Assessment

  • Unplanned Discharge Assessment

  • Expired (Death) Assessment

• The type of discharge assessment form used is based on the circumstances of the discharge.

Admission Assessment

Number of Required Questions: 25 @0.3 minutes each = 7.5 minutes

Number of Voluntary Questions: 11 @0.3 minutes each = 3.3 minutes

Total Number of Questions: 36 @0.3 minutes each =10.8 minutes

Planned Discharge Assessment

Number of Required Questions: 25 @0.3 minutes each = 7.5 minutes

Number of Voluntary Questions: 11 @0.3 minutes each = 3.3 minutes

Total Number of Questions: 36 @0.3 minutes each =10.8 minutes

Unplanned Discharge Assessment

Number of Required Questions: 25 @0.3 minutes each = 7.5 minutes

Number of Voluntary Questions: 11 @0.3 minutes each = 3.3 minutes

Total Number of Questions: 36 @0.3 minutes each = 10.8 minutes

Expired Assessment

Number of Required Questions: 13 @ 0.3 minutes each = 3.9 minutes

Number of Voluntary Questions: 4 @0.3 minutes each = 1.2 minutes

Total Number of Questions: 17 @0.3 minutes each = 5.1 minutes

LTCH Quality Reporting Program

Time and Wage Burden Estimate – Clinical Wages

Assessment Type	Number of Required Items	Number of Voluntary Items	Total Number Of Items	Time Required To Complete Required Items	Time Required To Complete Voluntary Items	Clinical Staff Wages for Required Items	Clinical Staff Wages for Voluntary Items	Total Clinical Staff Wages for Admission Assessment
Admission Assessment	25	11	36	7.5 min. 0.3 min per item x 25 items	3.3 min. 0.3min per item x 11 items	$ 4.15 7.5 min. x $33.23/hr.	$1.83 3.3 min. x $33.23/hr	$ 4.16 + $ 1.83 $ 5.99
Planned Discharge Assessment	25	11	36	7.5 min. 0.3 min per item x 25 items	3.3 min. 0.3 min per item x 11 items	$4.15 7.5 min. x $33.23/hr.	$1.83 3.3 min. x $33.23/hr	$ 4.16 + $ 1.83 $ 5.99
Unplanned Discharge Assessment	25	11	36	7.5 min. 0.3 min per item x 25 items	3.3 min. 0.3 min per item x 11 items	$4.15 7.5 min. x $33.23/hr.	$1.83 3.3 min. x $33.23/hr	$ 4.16 + $ 1.83 $ 5.99
Expired Discharge Assessment	13	4	17	3.9 min. 0.3 min per item x 13 items	1.2 min. 0.3 min per item x 4 items	$2.16 3.9 min. x $33.23/hr.	$0.66 1.2 min. x $33.23/hr	$ 2.16 + $ 0.66 $2.82

The following are cost estimates for several combinations of the LTCH CARE Data Set Admission and Discharge forms:

Planned Discharge / Required and Voluntary Data Given By Provider

Admission Assessment – Nursing Wages (Required) 7.5 minutes @33.23 per hour = $ 4.16

Admission Assessment – Nursing Wages (Voluntary) 3.3 minutes @33.23 per hour = $ 1.83

Admission Assessment – (Admin Assistant) 10.0 minutes @15.59 per hour = $ 2.60

Planned Discharge Assessment (Required) 7.5 minutes @33.23 per hour = $ 4.16

Planned Discharge Assessment (Voluntary) 3.3 minutes @33.23 per hour = $ 1.83

21.6 minutes @33.23 per hour = $11.98

10.0 minutes @15.59 per hour = $ 2.60

31.6 minutes = $14.58

Unplanned Discharge / Required and Voluntary Data Given By Provider

Admission Assessment – Nursing Wages (Required) 7.5 minutes @33.23 per hour = $ 4.16

Admission Assessment – Nursing Wages (Voluntary) 3.3 minutes @33.23 per hour = $ 1.83

Admission Assessment – (Admin Assistant) 10.0 minutes @15.59 per hour = $ 2.60

Unplanned Discharge Assessment (Required) 7.5 minutes @33.23 per hour = $ 4.16

Unplanned Discharge Assessment (Voluntary) 3.3 minutes @33.23 per hour = $ 1.83

21.6 minutes @33.23 per hour = $11.98

10.0 minutes @15.59 per hour = $ 2.60

31.6 minutes = $14.58

Planned or Unplanned Discharge / Required Only Data Given By Provider

Admission Assessment – Nursing Wages (Required Data Only) 7.5 minutes @33.23 per hour = $ 4.16

Admission Assessment – (Admin Assistant) 10.0 minutes @15.59 per hour = $ 2.60

Planned Discharge Assessment (Required Data Only) 7.5 minutes @33.23 per hour = $ 4.16

15 minutes @33.23 per hour = $ 8.32

10 minutes @15.59 per hour = $ 2.60

25 minutes = $10.92

Expired Discharge / Required and Voluntary Data Given By Provider

Admission Assessment – Nursing Wages (Required) 7.5 minutes @33.23 per hour = $ 4.16

Admission Assessment – Nursing Wages (Voluntary) 3.3 minutes @33.23 per hour = $ 1.83

Admission Assessment – (Admin Assistant) 10.0 minutes @15.59 per hour = $ 2.60

Expired Discharge Assessment - (Required) 3.9 minutes @33.23 per hour = $ 2.16

Expired Discharge Assessment -(Voluntary) 1.2 minutes @33.23 per hour = $ 0.66

15.9 minutes @33.23 per hour = $ 8.81

10.0 minutes @15.59 per hour = $ 2.60

25.9 minutes =$11.41

Expired Discharge / Required Only Data Given By Provider

Admission Assessment – Nursing Wages (Required) 7.5 minutes @33.23 per hour = $ 4.16

Admission Assessment – (Admin Assistant) 10.0 minutes @15.59 per hour = $ 2.60

Expired Discharge Assessment - (Required) 3.9 minutes @33.23 per hour = $ 2.16_

11.4 minutes @33.23 per hour = $ 6.32

3.9 minutes @15.59 per hour = $ 2.60

15.3 minutes = $8.92

1 MedPAC Report To Congress, March 2012, page 261 (http://www.medpac.gov/documents/Mar12_EntireReport.pdfhttp://www.medpac.gov/documents/Mar12_EntireReport.pdf)

2 This time estimate includes the time required to complete both the required and voluntary questions on the LTCH CARE Data Set.

3 The mean hourly wage of $33.23 for a Registered Nurse was obtained from the U.S. Bureau of Labor Statistics. See http://www.bls.gov/oes/current/oes291111.htm)

4 The mean hourly wage of $15.59 per hour for a Medical Secretary was obtained from the U.S. Bureau of Labor Statistics. See http://www.bls.gov/oes/current/oes436013.htm