McKnight’s Articles

The cheese has moved…will Sniff find it?

In 1988 Spencer Johnson, M.D., published an allegorical tale (or was it tail?) about how four characters respond to change. One of the characters (a mouse) was called Sniff. Well, Sniff, start sniffing!

Currently, Medicare pays for services provided by skilled nursing facilities (SNFs) under the Medicare Part A SNF PPS benefit on a per diem using the RUG-IV grouper.

The most significant driver of this reimbursement model is the amount of therapy (days and minutes) provided to a Medicare patient, regardless of their specific needs or outcomes achieved. Through the years, many impressive governmental and independent advisory groups — whose acronyms rival a can of alphabet soup — have voiced concerns about inappropriate incentives in the current reimbursement system.

Caregivers also shared some of these same concerns. Therapists have also complained about a system that “de-incentivizes” an individualized approach to therapy treatment. Nurses felt their patients’ care was usurped by a system that didn’t look at their overarching needs.

Enter RCS-1.

Continue reading Steven Littlehale’s guest column on