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Elevating Patients Care & Maximizing Facility Reimbursement

The Opportunity:  Medicaid is a major source of funding for many nursing homes. CMI analysis is crucial for understanding how the acuity and needs of a beneficiary affects reimbursement. A higher CMI directly correlates with increased Medicaid payments which covers the cost of patient care.

Changes on the Horizon: States have an additional two years after October 1, 2023, to implement PDPM methodology. This implies that Medicaid will no longer recognize RUG-III or RUG-IV for federal assessments after PDPM adoption.

Here is what we know so far:

  • Effective July 1, 2024, Kentucky will implement PDPM methodology for Medicaid.
    • Rates effective 1/1/2024 are calculated using RUGs. Rates effective 4/1/2024 will be frozen at the prior quarter’s rates (those effective 1/1/2024). Beginning 7/1/2024, rates will be calculated using PDPM. Rebasing provider rates is also being considered. Additional calculation details to be released.
  • Ohio will continue to determine direct care rates using RUG-IV for this biennium.
    • Effective 10/1/2023, RUGs case mix scores could only be calculated from the Optional State Assessments (OSA). After 10/1/2023, providers were allowed to freeze their case mix for the biennium, thereby eliminated the need for OSAs.
    • No additional information is available for Indiana or Michigan at this time.

Current Methodology:  By benchmarking facility data compared to state and national averages and breaking down report components, we as a team can better assess how we measure up in terms of resident acuity and case-mix. This information guides quality improvement initiatives in a targeted manner.

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Kentucky Issues New Incident Forms

Long-Term Care Facility Self-Reported Incidents

The Centers for Medicare and Medicaid Services requires long-term care facilities to self-report incidents occurring in their facilities to the Office of Inspector General. For your convenience, fillable forms are available to promote continuity and consistency.

Two new Facility-Reported Incident forms have been released and are now posted HERE.

Please use the new forms effective immediately. Remember, if there is insufficient space to complete an answer, additional pages may be attached.

Questions may be directed to your respective OIG Division of Health Care Branch Office.

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ATTENTION: We need your help to support this bill!

Legislation has been introduced to postpone the 15% reimbursement cuts to PTA and OTA treatments. Please help us to support this bill.

Dear Partners and Friends,

Please take a few minutes to read the below message from NASL regarding the new legislation that has been introduced in the US House. We need everyone to support this bill in order to postpone the 15% reduction in reimbursement for Med B services provided by PTAs and OTAs. This cut is set to happen on 1/1/2022. If this legislation is passed, it will delay this cut until 1/1/2023. Additionally, this bill allows for rural and underserved areas to be exempt from these cuts once they are implemented.

As skilled nursing operators and professionals, I urge each of you to take a few minutes to read the letter, make any additional edits/comments, and submit it to your personal representative. Spending a few minutes of your time could result in a very positive impact for our patients, as well as our industry. Your action is extremely time-sensitive because if this bill does not have enough support, it will not move on.

From NASL: Click here to access the letter and the ability to submit directly to your representative.

The time for advocacy on this issue is now as there is not much time left on the legislative calendar for Congress to act before this policy is implemented on January 1, 2022. NASL has prepared a letter for you to email to your respective House members urging them to cosponsor the Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act of 2021 (H.R.5536) and asking them to add the bipartisan legislation to any legislative packages moving before the end of the year.

Use the link above or visit https://app.govpredict.com/gr/m5bwzm-u to access and send this email in under two minutes.

Thank you for your time and effort to support this bill!

Sincerely,

Cassie Murray, President

 

Cassie Murray, OTR, MBA, QCP

President of HTS

Healthcare Therapy Services, Inc.

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Top 5 Therapy Clinical Outcome Focus Areas Part 5 of 5: Part B Programming

HTS has identified the top 5 therapy clinical outcome focus areas for 2021 based on our experiences from 2020 which allow us to uniquely identify opportunities for clinical growth.

 

This month’s clinical outcome focus area is:

Part B Programming

One of the many challenges faced during the Public Health Emergency in 2020 included keeping up with the federal, state, and facility specific protocols and strategies to mitigate the risk of exposure to COVID-19. However, with vaccinations and new processes in place based on evolving regulation, utilizing Part B Programming has become less restricted and more able to be optimized. HTS has prioritized 5 ways to maintain quality part B programming in your facility.

1) Take a Deep-dive into Your CASPER
Quality Measures (QMs) are a rich source of information that are recommended to be monitored on a routine basis to assist with quality improvement. QMs directly impact survey results, can influence referral sources and partnerships, and could even be a factor for pay-for-performance which may be where the future is headed. QMs are based on indicators of the outcome of resident care based on resident specific information from MDS assessment information as well as a few claim-based measures.

QM reports are available through the CASPER report system. The CASPER Report MDS 3.0 Resident Level Quality Measure Report identifies all residents, active and discharged, who were included in the QM calculations. The report indicates which, if any, QMs were triggered for each resident. This serves as an important tool that facilitates detailed record review of residents. The information may be used in QAPI activities, survey process, and to potentially identify rehab need.

2) Utilize a Systematic Approach for Therapy Referrals
We have seen the most success when there are streamlined processes for referring to therapy when changes in function are identified prior to the completion of the MDS. Ideally, the quarterly schedule is distributed to the IDT so that there is adequate time for thorough screening, a physician order, and completion of therapy evaluation(s) before the onset of the assessment period.

  • For example, the MDS coordinator would distribute the quarterly assessment schedule at least two weeks in advance of the assessment period.
  • Then, therapy performs the direct screen as well as collaborates with the IDT to identify any areas of change or skilled need.
  • For patients identified as appropriate for therapy services, the physician’s order is obtained and therapy is scheduled to successfully be captured on the MDS as clinically indicated.

3) Look for Change in Function Through MDS Review
The MDS has several sections that are helpful when identifying potential rehab need. Comparing the last two most recent assessments for change in function is an additional screening strategy that can be used in conjunction with the preferred streamlined referral process. The information can also be used as supportive documentation which can then lead to a request for a physician’s order for a therapy eval and treat as indicated.

  • Sections of the MDS that can be used as supportive documentation for rehab orders (if change is observed) include Sections B, C, GG, H, I, and K.
  • SLP focus example: there are a few sections that can help a SLP identify rehab need. Section K codes for swallowing and nutrition and also weight loss of 5% or more in the last month or 10% or more in the last 6 months.
  • Section K0510C is of particular importance for SLPs. In this section, it is made known if the patient has had a change in texture of foods or liquids. If there has been a recent downgrade, this is something to consider when selecting patients for screening purposes.
  • Some MDS software even have reports that can show any diet downgrades that have occurred in a specified timeframe. This orders report that is filtered by diet changes at the resident level serves as another great screening tool.

4) Implement HTS Proprietary Clinical Programming and Pathways
HTS clinical programs are created and introduced in pace with the expanding needs and legislative changes of our industry. Guiding principles for program creation are contingent upon an IDT approach, person-centered care delivery, quantitative research, and quality measure improvement.

Examples of HTS Clinical Programs & Pathways are available below:

The 3 Most Recently Developed HTS Clinical Programs

COVID-19 Recovery

Most recently, HTS has created a Post COVID-19 Rehabilitation Program. This program was developed by HTS clinical staff in response to a large need of individuals who have recovered from COVID-19 and are experiencing lingering health issues. Ideally, outpatients and long-term residents who have recovered from COVID-19 would benefit from this type of therapeutic intervention.

Fall Prevention

STEADY: Comprehensive Therapy Approach to Fall Prevention was designed to provide the best tools and evidenced-based practices to reduce resident falls and improve safe movement.

  • Therapy-driven program utilized by PT, OT, and ST
  • Reviews 12 areas that lead to falls
  • Use of evidence-based assessments and interventions
  • Patient and caregiver education is a vital component
Quality Measures

Star Quality Improvement Program

Therapy expertise and intervention is a key factor in improving quality. Therapy can have a direct impact on quality and outcomes. The HTS Star Quality Improvement Program focuses on utilizing rehab services to assist in improving specific quality measures. Currently, facility ratings are based on the performance of specific quality measures that are listed on the CMS Care Compare website, previously known as Nursing Home Compare.

Modules include:

  • ADL
  • Mobility
  • Pressure Ulcer Prevention
  • Physical/Medication Restraint
  • Pain Treatment
  • Falls
  • Weight Loss
  • Discharge to Community

Therapy driven IDT programming, pathways, and education facilitate quality HTS Part B Programming

HTS therapists are equipped with clinical programs, pathways, and therapy specific education modules to address functional declines in your building. HTS e-Academy has two on-demand webinars available to HTS therapists to facilitate robust Part B Programming. These webinars are entitled “Quality Part B Programming for SNFs” which includes strategies for physical and occupational therapists and “Quality SLP Part B Programming.” Both webinars include a step-by-step guide to process improvement for your part B caseload as well as all the resources needed to accomplish successful program implementation.

5) Review Benchmarking and Trends with Quality Part B Reporting

HTS Therapy Rehab Managers and Regional Directors use Business Intelligence (BI) which is powered through Net Health Therapy (formally known as Optima). BI reports are pulled on a weekly basis to identify areas of opportunity. Action plans are developed and implemented with the IDT as warranted. Key performance indicators specific to Part B patients include but are not limited to:

  • PT/OT/ST B units per visit
  • Percent of long-term residents receiving therapy services
  • GG outcomes
  • Average length of stay by payor
  • Average length of stay by diagnostic category

These 5 solutions to maintain quality part B programming allow HTS therapists to continue to provide function focused, patient-centered care based on medical necessity. The high caliber of clinically driven HTS therapists paired with HTS Part B Programming and report interpretation uniquely positions us to care for your residents.

Need a Powerful Therapy Partner? Contact Amanda Green, Executive Director of Strategic Development amanda@htstherapy.com for information about our contract therapy partnerships.

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Top 5 Therapy Clinical Outcome Focus Areas – Part 4 of 5: Section GG Outcomes

HTS has identified the top 5 therapy clinical outcome focus areas for 2021 based on our experiences from 2020 which makes us better equipped to overcome COVID-19 related obstacles. Furthermore, after attending a 15-hour training and certification process, HTS management staff have all become “PDPM Masters.” These additional “feathers in our cap” allow us to uniquely champion process improvement initiatives alongside your interdisciplinary team. As HTS continues to identify opportunities for clinical growth, a key process improvement area will be discussed each month.

 

This month’s clinical outcome focus area is:

Section GG Outcomes

Analysis of outcomes comes in many different forms. For CMS, outcome data is derived from coding in Section GG of the MDS. As we begin to see more medical review of PDPM claims, we have seen first-hand that section GG and documentation of collaboration of the patient’s usual functional performance is the golden ticket to defend our claims. As information and regulatory standards continue to evolve, HTS has concentrated therapist efforts and education to assure training and documentation standards of care align with Section GG regulations and standards.

Improving communication and processes between departments produces the best Section GG accuracy. The top three ways to improve Section GG Coding include:

1) Therapy use of the HTS Business Intelligence functionality via Net Health’s (formerly known as Optima) operating system provides a detailed analysis of the Section GG Daily Dashboard. This information is then used at the site level to identify facility-specific process improvement initiatives. The dashboard also allows the user to drill to the patient level, identify trends and/or outliers, and action plan as clinically indicated.

2) Facility staff rounding for OBRA ARD communication between the MDS and therapy department will be fine-tuned to assure best GG coding practices across all payors. To meet the state requirements for GG collection for OBRA assessments, processes to collect this information should be effectively communicated. We recommend that all IDT work together when possible, to code usual GG performance. When the therapy assessments align with the ARD, therapists can then contribute GG information for Med B, MGD B, Medicaid, and Private Pay so that collaborative coding is achieved.

3) Review of RAI item set definitions to master the intent of each GG item being coded. HTS encourages all section GG contributors to familiarize themselves with the item set definitions so that coding is as accurate as possible. This review is important because it helps secure proper reimbursement for the care being provided by your team.

  • For example, per the RAI, the admission assessment for wheelchair items should be coded only for residents who used a wheelchair prior to admission. If the patient did not use a wheelchair at prior level of function and declined in the hospital which then required the use of a wheelchair in the SNF, section GG0110 (prior device use) would be coded as “no.” This is coded as such since GG0110 is indicative of use prior to the current illness, exacerbation, or injury. Then, if during the SNF stay the resident is not learning how to self-mobilize using a wheelchair, the 5-day assessment for wheelchair use would also be coded as “no.” This then elicits a skip pattern on the MDS, no goal would be applied, and the answer would remain “no” on the discharge assessment.
As we continue to learn more about medical review focus areas, denials based on lack of supportive GG documentation continues to be an area for improvement. Good communication and processes are imperative to support your coding decisions.

Need a Powerful Therapy Partner? Contact Amanda Green, Executive Director of Strategic Development amanda@htstherapy.com for information about our contract therapy partnerships.

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National Skilled Nursing Care Week

In recognition of this week, we would like to take this opportunity to commend our partners and healthcare heroes for your unwavering commitment to improving the lives of those you serve.

To celebrate this week, HTS has created a fun activity for residents and staff.

HTS will present cash prizes of $200, $100 and $75 to the top three communities that show the best participation! Be sure to take photos and let us know how your community shined this week.

Sunshine Award

Get your residents and staff involved in this fun coloring activity to share sunshine and appreciation. Tell someone they brighten your day by presenting them a Sunshine Award.

Display your Sunshine Awards on resident doors, decorate the halls, promote/share on Facebook, and find other creative ways to get your community involved!

Choose from multiple awards to download, print, and distribute for residents and staff to color and share their appreciation. Click here to download yours today!

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CMS Posts COVID-19 Data

CMS posted initial data analytics on COVID-19. Data was collected from nursing home reports to the CDC’s National Healthcare Safety Network. Data will be updated on a weekly basis moving forward.

COVID-19 Focused Survey Items for Nursing Homes to be Completed by July 31, 2020

Indiana COVID-19 Updates and Resources

Kentucky COVID-19 Updates and Resources

What can providers do?

For questions or additional information, contact your Regional Director or Cassie Murray.

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National Skilled Nursing Care Week

HTS Celebrates National Skilled Nursing Week

In recognition of National Skilled Nursing Week, Healthcare Therapy Services, Inc. celebrated with their partners by honoring our aging in addition to the health care heroes for their unwavering commitment to improving the lives of those served. National Skilled Nursing Care Week was established by the American Health Care Association (AHCA) in 1967. National Skilled Nursing Week ran from May 10-16, 2020. Inspired by this years’ theme “Sharing Our Wisdom”, HTS created an art activity for residents and staff to participate. “It’s more important than ever to celebrate our skilled nursing communities. This year’s celebration looks a little different than in year’s past since we have social distancing and other restrictions in place. We wanted to do something that everyone could participate in. Reading the heartfelt words of wisdom from our residents has been one of the most rewarding parts of all of this. We are just thrilled with the participation that we received!” -Holly Skidmore, Director of Marketing

Congratulations to our winners!

Congratulations to the following winners of the National Skilled Nursing Week “Sharing Our Wisdom” contest. We had great participation from our homes and many residents shared their wonderful words of wisdom. Thank you to all who participated!

1st Place Winner: Heritage Pointe of Huntington, Huntington, IN
2nd Place Winner: The Cedars of Lebanon, Lebanon, KY
3rd Place Winner: Golden Years Homestead, Fort Wayne, IN

Click here to view the video showcasing photos for the contest.

Some inspiring words of wisdom from the residents of our partner communities:

Barb F: “Be Happy. Smile more and worry less.”

Mary M: “Do your very best in everything you do.”

Clara F: “Enjoy the little things in life. Don’t take anything for granted.”

Jonetta W: “Do unto others as you would have them do unto you.”

Georgette P: “Love your family, everybody, and the Lord. Haste makes waste. Love your neighbor as yourself. I love everyone.”

Cathy S: “Strength doesn’t come from what you can do. It comes from overcoming the things you once thought you couldn’t.”

Cleola: “Take care of people and God will take care of you!”

Herb: “Never stop learning.”

Lewis: “Accept Christ as your Savior and you will live life in security. Watch your money. Never go for revenge.”

Ron: “Enjoy your life when you are young!”

Helen: “Be nice to people.”

Deloris: “Make life fun, never stop playing!”

Fay: “Always start your prayer with “Thank you Lord, for all you’ve done for me” before you ask for anything.”

 

#NSNCW

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COVID-19 Clinical Tips for Respiratory Assessment

Blog by Sherry Roberts, RN, Clinical Consultant, Proactive Medical Review

COVID-19 is an acute, sometimes severe, respiratory illness caused by a novel coronavirus SARS-CoV2. Person-to-person spread occurs through contact with infected secretions, mainly via contact with large respiratory droplets, but can also occur via contact with a surface contaminated by respiratory droplets. Nursing facilities face higher risk of transmission due to high population density creating difficulty in maintaining avoidance precautions. Significantly, residents of nursing homes are at high risk for more severe disease because of age and underlying medical disorders.

Clinical Presentation

People with COVID-19 may have few to no symptoms, although some become severely ill and die. Symptoms can include fever, cough, and shortness of breath. The exact incubation time is not certain with estimates ranging from 1 to 14 days. The risk of serious disease and death in COVID-19 cases increases with age. COVID-19 can cause Pneumonia and ARDS (Acute Respiratory Distress Syndrome), Severe Acute Respiratory Syndrome (SARS), Acute Respiratory Failure and several other conditions.

Respiratory Assessment

If COVID-19 disease is suspected as part of the screening process, a  thorough respiratory assessment is essential, including careful auscultation to identify residents with a risk of significant lower respiratory illness.

Click here to continue reading this blog.

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Hospitals hit with fines over patient readmissions

Indiana hospitals are racking up millions of dollars in penalties for having too many patients return for care within a month of discharge.

Sixty-six Hoosier hospitals—including 17 in central Indiana—will see their Medicare payments docked next year by a total of about $12 million as a result of having patients readmitted within 30 days. That’s up from $9 million in penalties three years ago.

The federal government says readmissions are often unnecessary and cost taxpayers tens of billions of dollars a year for treatments that should have been caught the first time around, or were not followed up adequately.

So for the seventh consecutive year, it is using the pressure of lower reimbursements to get hospitals to improve their numbers.

Hospitals, for their part, say they are working with patients every way they can think of to keep readmissions at a minimum.

Many are sending patients home with a thick, detailed packet of discharge instructions and a month’s worth of medications. Hospitals send nurses and aides to discharged patients’ homes to see how they are doing. In some cases, patients are given vouchers for cabs or van shuttles to get to their primary care physicians for follow-up visits.

Still, the penalties keep climbing.

“It’s getting more difficult,” said Brian Tabor, president of the Indiana Hospital Association. “Hospitals have picked a lot of the low-hanging fruit in terms of strategies. And so the work gets harder and harder.”

Click here to continue reading this article.

Hospitals are going to be looking to post-acute providers now more than ever to step-up their game. This spring, HTS launched THRIVE a turn-key system to promote successful care transitions following a post-acute stay. Our proprietary clinical programs are just another way that we move our clients forward as leaders of rehabilitation in the markets they serve. Contact us today to learn how partnering with HTS can help improve outcomes and reduce readmissions.

 

October is National Physical Therapy Month!
National Physical Therapy Month is designed to recognize the impact that physical therapists and physical therapist assistants make in restoring and improving motion in people’s lives. Physical therapy may be necessary for those recovering after an illness, a fall, injury, surgery or chronic condition. Physical therapists work hard to help patients retain and regain their quality of life.

 

Speak with your doctor to find out how therapy could benefit you!

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