Section GG Changes: What Do They Mean for Your Organization?
Are you ready for Section GG collection in your setting? New quality reporting programs are in place for all post-acute settings.
If you practice in a skilled nursing facility (SNF), inpatient rehab facility (IRF), long-term care hospital (LTCH), or home health agency (HHA) and are not reporting on the new measures, you might end up with a reduction in your organization’s payments by up to two percent.
LTCHs were the first to implement these items in April 2016, quickly followed by SNF and IRF that October. HHAs just began collecting Section GG items on January 1, 2019.
What Is Section GG?
Section GG is a set of standardized patient assessment elements that the Improving Post-Acute Care Transformation Act (IMPACT) mandated for collection in all post-acute care settings. The items are meant to measure functional changes in self-care and mobility and will be publicly reported in the near future.
Prior to these changes, settings were collecting their own data with their own definitions and rating scales, which created a challenge in caring for patients when they were transferred from one setting to another. Section GG, which provides a universal language relative to functional ability, is expected to decrease variability, standardize communication and care across settings, and provide the basis for comparing patient types, outcomes, and costs.
Each post-acute setting now incorporates process measures to assess the organization’s collection of these items. The Functional Assessment and Care Plan measure will show the percentage of patients who have had: 1) their admission and discharge functional assessments completed within the first three days of their stay, and 2) a care plan that addresses function.
Four additional outcome measures have also been approved by CMS for the IRF and SNF settings:
- Change in Self-Care Score
- Change in Mobility Score
- Discharge Self-Care Score
- Discharge Mobility Score
It is likely that these four measures will be added to the Home Health program in a future year, which is why it is so important for therapists and nurses to ensure they understand the definitions of each Section GG item as well as the rating system. Failure to accurately score patients could reduce your outcomes and, in the future, your payments.
Below are how the changes affect each post-acute care setting.
Jump directly to your setting:
Home Health Agency
Long-Term Care Hospitals (LTCH)
Inpatient Rehab Facility (IRF)
Skilled Nursing Facility (SNF)
Home Health Agency
To qualify for HH care under the Medicare benefit, the patient must be homebound and require intermittent skilled services delivered by PT, SLP, and/or nursing or have an ongoing need for OT services.
Section GG will be new for HH nursing and therapy staff. However, under the new Patient-Driven Group Model scheduled for implementation January 1, 2020, it will be an important factor in determining the payment amount. This is because the method of payment will remove the number of therapy visits from the calculation and will focus instead on the patient’s clinical presentation and anticipated resource needs during their HH episode of care.
Effective January 1, 2019, new Section GG items will be included in the OASIS data set for all home health agencies. Self-care items include:
- Eating
- Oral hygiene
- Toileting hygiene
- Showering/bathing self
- Upper body dressing
- Lower body dressing
- Putting on/taking off footwear
Mobility items include:
- Rolling left and right
- Sitting to lying
- Lying to sitting on side of the bed
- Sitting to standing
- Chair/bed to chair transferring
- Toilet transferring
- Car transferring
- Walking 10 feet
- Walking 50 feet with two turns
- Walking 150 feet
- Walking 10 feet on uneven surfaces
- Stepping up/down 1 step/4 steps/12 steps
- Picking up an objective
- Wheeling 50 feet with two turns
- Wheeling 150 feet
These items will be collected on all Start-of-Care OASIS, Recertification OASIS, and Discharge OASIS. Only a few items will be collected on the Follow-up OASIS. [Looking for more information on OASIS? MedBridge offers 13 OASIS specific courses.]
Long-Term Care Hospitals (LTCH)
The LTCH item set will not see any changes this year. LTCHs generally collect less self-care and mobility data than other post-acute care settings since patients admitted are often at a lower level of function and rehabilitation may not be the primary reason they are admitted. Self-care items include:
- Eating
- Oral hygiene
- Toileting hygiene
- Washing upper body
Mobility items include:
- Sitting to lying
- Lying to sitting on side of the bed
- Sitting to standing
- Chair/bed to chair transferring
- Toilet transferring
- Walking 10 feet
- Walking 50 feet with two turns
- Walking 150 feet
- Wheeling 50 feet with two turns
- Wheeling 150 feet
Inpatient Rehab Facility (IRF)
Patients can only be admitted to an IRF if they require a minimum three hours a day, five days a week of physical therapy, occupational therapy, or speech therapy and a daily interdisciplinary plan with nursing and physician care. The goal of an IRF stay is to foster the patient’s independence in and management of daily activities, including self-care and mobility, and return them to a safe, active, productive lifestyle if achievable.
The IRF has traditionally used the Functional Independence Measure (FIM™) as its measure of function. FIM™ is also used in calculating the IRF’s payment rate. However, CMS announced in 2018 that they will be using Section GG to measure patient function and calculate the IRF’s payment rate in the future.
In the IRF, items are collected on the Patient Assessment Instrument. Self-care items include:
- Eating
- Oral hygiene
- Toileting hygiene
- Showering/bathing self
- Upper body dressing
- Lower body dressing
- Putting on/taking off footwear
Mobility items include:
- Rolling left and right
- Sitting to lying
- Lying to sitting on side of the bed
- Sitting to standing
- Chair/bed to chair transferring
- Toilet transferring
- Car transferring
- Walking 10 feet
- Walking 50 feet with two turns
- Walking 150 feet
- Walking 10 feet on uneven surfaces
- Stepping up/down 1 step/4 steps/12 steps
- Picking up an objective
- Wheeling 50 feet with two turns
- Wheeling 150 feet
Skilled Nursing Facility (SNF)
To qualify for SNF care under the Medicare benefit, the patient must require daily skilled services delivered by PT, OT, SLP, and/or nursing. While Section GG might currently feel like an “extra” thing to collect, under the new Patient-Driven Payment Model scheduled for implementation October 1, 2019, it will be an important factor in determining the payment amount. That’s because the method of payment will remove therapy minutes from the calculation, instead focusing on the patient’s clinical presentation and anticipated resource needs during a patient’s stay in the SNF.
In the SNF, the items are collected on the Patient Assessment Instrument. Self-care items include:
- Eating
- Oral hygiene
- Toileting hygiene
- Showering/bathing self
- Upper body dressing
- Lower body dressing
- Putting on/taking off footwear
Mobility items include:
- Rolling left and right
- Sitting to lying
- Lying to sitting on side of the bed
- Sitting to standing
- Chair/bed to chair transferring
- Toilet transferring
- Car transferring
- Walking 10 feet
- Walking 50 feet with two turns
- Walking 150 feet
- Walking 10 feet on uneven surfaces
- Stepping up/down 1 step/4 steps/12 steps
- Picking up an objective
- Wheeling 50 feet with two turns
- Wheeling 150 feet.
Stronger Data, Improved Outcomes
Section GG items are intended to measure the effectiveness of rehabilitation care delivered in each setting, as well as the effectiveness of the providers themselves. The tool has significant implications for standardization of care and helps provide stronger data to ultimately improve outcomes.
Want to learn more about Section GG? Watch Ellen Strunk’s MedBridge courses covering Section GG changes and how they affect each setting.
