Education on PDPM

HTS is actively scheduling PDPM education for hospitals and physicians to keep valued referral sources and community partners informed on the pending change and how it will affect them and their post-acute partners. More specifically, this education will emphasize how important it is to have accurate, thorough, and timely patient information prior to the admission. By utilizing tools such as CliniSign, which captures an electronic signature of the physician and EMR cross-communication, we are on track to engage all parties in the joint goal of successful implementation of PDPM.

“It’s important that we give our hospitals and physicians early education on PDPM so that they understand the significance of this new reimbursement model and how it will impact care delivery. This also keeps them apprised of any significant provider behavior changes that could negatively impact quality of care and potentially increase preventable hospital readmissions.” -Amanda Green, Executive Director of Strategic Development

We would be happy to provide complimentary training. If you would like us to schedule time to meet with your acute care providers and physicians, contact us at info@htstherapy.com.

The way you hold your body is posture and the way you move your body is body mechanics. There are correct ways to hold your body when you stand, walk, sit, lift and even sleep. Proper posture allows us to move in the way we want, causing our bodies the least amount of strain and damage. Adapting proper posture is an essential part to maintaining a healthy skeletal structure as you age.

  • REDUCE PAIN – Poor posture puts extra pressure on your discs and vertebrae and leads to injury and pain.
  • BREATHE EASIER – Good posture allows more space for your lungs to expand.
  • INCREASE ENERGY – When muscles are being used more efficiently it allows your body to use less energy.
  • IMPROVE BALANCE – Posture is part of balance. With age, your body tends to lean forward which makes you unstable and increases your risk for falling.

 

Improve Your Posture with Physical Therapy

A physical therapist can help correct and improve your posture by designing an individualized program of exercises and activities with an emphasis on strength, flexibility, and proper gait. Your balance may be improved with exercises that strengthen the core, back, ankle, knee, and hip muscles along with exercises that improve the function of the balance system. Exercises that are focused on improving posture will stretch tight muscles and keep joints strong. If you have concerns about your posture, call your doctor and ask if physical therapy can help.

 

By: Cassie Murray, OTR, ,QCP, Chief Operating Officer

It is no secret that PDPM will be a significant change for providers. HTS has successfully traversed reimbursement changes alongside our partners in the past and emerged strong. We were prepared to tackle the challenge while maintaining the highest quality of care. PDPM will be no different. HTS has a plan for success. When our partners succeed under the new SNF reimbursement methodology, we succeed. The core elements of the new model press us, as direct caregivers, to essentially return to our “roots” by focusing all care decisions based on patient conditions and needs.

Revenue will no longer be based on managing therapy minutes, but will be directly aligned with patient care delivery. HTS therapists are passionate about individualized clinical profiles and meeting the care needs associated with specific patient characteristics. This change in philosophy will assist in breaking down the unintentional silos built around departments and is an opportunity to promote collaboration with strategic clinical programs and processes. We understand that the PDPM transition is likely to put an extra level of stress on nursing and MDS—who will be under pressure to understand all of the intricacies of PDPM including coding and special rules such as the interrupted stay policy and variable per diem adjustment. The pressure is definitely on as the nursing role in reimbursement rises to the top of the pile. But not to worry, HTS’s partners will have access to exceptional resources and training opportunities as we navigate this change together.

We remain optimistic that quality care, remarkable customer service, and appropriate reimbursement will be achieved under the new model. As partners in therapy, our clients are confident in our resources and unmatched expertise to navigate this change while working together toward a successful transition from RUGs IV to PDPM.

We would be happy to provide complimentary training. If you would like us to schedule time to meet with your acute care providers and physicians, contact us at info@htstherapy.com.

 


 

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

Research shows regular exercise can slow cardiovascular aging.

As you age and become less active, your heart just like any other muscle in your body can weaken. Healthy blood vessels are flexible however with age blood vessels can become less elastic creating more work on the heart to pump.

Many of the effects of aging on the heart and blood vessels can be reduced by regular exercise. Just like other muscles, it’s possible to strengthen your heart too. Regular cardio exercise continues to display powerful benefits on slowing down the hearts aging process. Exercise is beneficial at any age; always consult with your physician before starting a new exercise routine.

Physical Activities for Older Adults

The US Department of Health & Human Services has established key exercise guidelines for older adults. For substantial health benefits, adults are encouraged to do at least 150 minutes of moderate aerobic activity or at least 75 minutes of vigorous aerobic activity a week.

AEROBIC ACTIVITIES:

  • Walking or hiking
  • Dancing
  • Swimming
  • Water aerobics
  • Bicycle riding
  • Aerobic exercise classes

MUSCLE-STRENGTHENING ACTIVITIES:

  • Weight machines
  • Hand-held weights
  • Digging in the garden
  • Carrying groceries
  • Some forms of tai chi
  • Some yoga postures

Also, the American Heart Association recommends walking at least 150 minutes a week or 10,000 steps a day. Studies show for every hour of brisk walking, life expectancy for some people may increase by two hours.

 

Therapy Can Help with Cardiac Conditions

If you have a cardiac/cardiopulmonary condition, talk to your doctor about your treatment plan and ask if Physical or Occupational therapy can help. Therapy interventions include help with energy conservation techniques, activity tolerance training, sternal precautions after surgery, adaptive equipment training, stress management strategies, breathing techniques, home exercise programs, and patient education on diet and heart disease. The goal of therapy is to help you control your symptoms and resume an active and productive life within the limits of your condition.


Resources: Dept. of Health & Human Services, American Heart Association

The HTS proprietary “RISE: Falls Prevention & Alarm Reduction Program” is designed to provide the best tools and evidenced-based practices to reduce resident falls and improve safe movement. Implementing a robust fall prevention plan can help residents maintain healthy lifestyles and improve quality of life.

Falls Prevention

Falls are the leading cause of fatal and nonfatal injuries in adults 65 and older. Your facility’s falls with major injury and other quality measures are being tracked and reported upon.

The HTS “RISE: Falls Prevention Program” aims to create a facility-wide proactive culture that anticipates and addresses patient needs, identifies patients at high fall risk and applies root cause analysis to determine causes of falls and future prevention methods.

Alarm Reduction

Alarms provide a false sense of security and may actually be a contributing factor to falls. The HTS “RISE: Falls Prevention and Alarm Reduction Program” focuses on educating the IDT on consequences of alarm use, strategies to create a proactive culture that anticipates and addresses patient needs, and a process to apply root cause analysis to fall prevention ultimately eliminating the use of alarms.

HTS RISE is now available for all partnering communities. Our proprietary clinical programs are just another way that we move our clients forward as leaders of rehabilitation in the markets they serve.

PDPM replaces the RUG-IV system beginning 10/1/19. The methodology for determining payment shifts from resource usage (or amount of services provided) to patient characteristics. Currently, under RUG-IV, there are 3 components: Nursing, Therapy, and Non-Case Mix. PDPM is meant to be “Budget-Neutral” and breaks the per diem payment into 6 components: Nursing, Non-Therapy Ancillary, PT, OT, SLP, and Non-Case Mix. Each of the 6 components creates a per diem amount. The sum of all 6 components establishes the total per diem rate of reimbursement.

Calculation of Per Diem Rate

PT and OT are calculated by first determining the clinical category (based on the primary ICD-10 code entered on the MDS). Next, the functional score is determined based on Section GG coding on the 5-day assessment (functional areas used for scoring include: eating, oral hygiene, toilet hygiene, bed mobility items, transfer items, and walking items). These criteria result in a PT and an OT case-mix group which then correlates to a PT and an OT case-mix index. The CMI is then multiplied by the urban or rural federal rate per diem to establish the reimbursement rate for PT and OT. Additionally, a variable per diem adjustment is applied to both PT and OT after day 20. Beginning with day 21, a 2% reduction is applied every 7 days. Up to 25% of the total therapy provided is permitted to be in group or concurrent (25% per discipline).

SLP is calculated by first determining if the clinical category is acute neurologic or non-neurologic based on the ICD-10 diagnoses coded on the MDS. Other factors include whether there is a presence of cognitive impairment, any SLP co-morbidities, swallowing disorder, or an altered diet. These criteria result in a SLP case-mix group which correlates with a SLP case-mix index. The CMI is then multiplied by the urban or rural federal rate per diem to establish the reimbursement rate for SLP. There is no variable per diem adjustment applied to SLP. Up to 25% of therapy is permitted to be group or concurrent.

Nursing is calculated very similarly as to how it is calculated now under RUG-IV. Under PDPM, the 43 Nursing RUGs are collapsed into 25 classifications. Several Nursing RUGs are combined into 1 PDPM Nursing case-mix group. Additionally, the function score for nursing will use Section GG (instead of Section G). In contrast to the RUG-IV ADL scoring, the PDPM function score assigns higher points to higher levels of Independence. Additionally, an 18% increase in the nursing per diem will be applied for patients with HIV/AIDS as coded on the SNF claim. No variable per diem adjustment is applied to Nursing.

Non-Therapy Ancillary (NTA) is calculated by assigning points to specific patient conditions and services based on MDS coding and from data on the claim. The total number of points obtained results in a NTA case-mix group which correlates to a NTA case-mix index. The CMI is then multiplied by the urban or rural federal per diem rate to establish the reimbursement for NTA. A variable per diem adjustment of X 3 is applied to days 1-3, and beginning on day 4, the rate returns to the base NTA CMI with no further adjustment.

Non-Case Mix remains as currently calculated under RUG-IV.
The per diem amount for each component is summed for the total per diem rate.

Additional Elements to PDPM

MDS Assessments: PDPM requires only 5-Day and Discharge Assessments. The 5-Day Assessment drives reimbursement for the duration of the stay. SOT’s, COTS, and EOTS are eliminated. The new Discharge Assessment adds multiple therapy details as a means for CMS to monitor provider behavior changes (specifically reduction of therapy services) and to oversee the amount of group and/or concurrent therapy provided. CMS indicates that provider behavior changes and exceeding the 25% limit for group/concurrent may result in reviews, denial of coverage, and/or policy changes. An Interim Payment Assessment (IPA) is added as an optional assessment that providers may elect to perform if a patient’s condition changes to the extent that reimbursement would be modified.

Interrupted Stay: The interrupted stay rule applies when a patient discharges from the SNF, but returns to the same SNF within 3 days. When this occurs, the stay resumes using the original 5-Day assessment results. No new MDS is completed. The variable per diem adjustments do NOT re-set. If a patient returns after 3 days, a new MDS is completed and a new stay is initiated. If a patient admits to a different SNF, a new MDS is completed and a new stay is initiated. The discharge destination is not a factor for applying the interrupted stay rule.

General Projections of Impact

While PDPM is intended to be budget-neutral, providers may experience varying levels of reimbursement impact. Based on CMS provided data using FY 2017 claims, broad generalization may be applied with the following characteristics most likely to generate increased reimbursement levels: shorter length of stays, smaller facilities, non-profit organizations, rural facilities, higher nursing needs (Extensive Services), prevalence of conditions requiring expensive medications, and moderate-to-lower levels of therapy intensity. Specifically, providers with a large volume of Ultra High level of therapy will likely see a decrease in reimbursement under PDPM. Providers who have historically provided moderate therapy intensity while achieving excellent outcomes will be the winners under PDPM.

Provider Impact and Operational Success

Timely and accurate processes are critical to successful operation under PDPM. The 5-Day assessment determines the case-mix classifications (or reimbursement) for the entire stay. Providers need to provide extensive training for accurate ICD-10 coding as the clinical category is a primary factor for CMI for Nursing, PT, OT, SLP, and NTA.

Additionally, Section GG coding directly impacts the functional score element for the PT, OT and Nursing Case-Mix Groups. Comprehensive training and auditing to ensure accurate coding for these items will aid in capturing the precise functional statuses for calculation of the CMIs. With this fundamental change in methodology, SNFs need to collaborate closely with their software provider to confirm functionality and utilize all available tools. Additionally, partnering with your therapy provider to implement processes and practices for best outcomes will secure your position in the market.

The SNF VBP and QRP mandates continue under PDPM. Clinical programs that cater to the needs of the residents you serve will result in reduced hospital re-admissions, improved quality measures, and higher star ratings. Through detailed analysis of the provider-specific impact files published by CMS using FY 2017 claims, SNFs can identify areas for improvement, implement enhanced programs and processes to promote success under PDPM.

 

More people in America suffer from pain than diabetes, cancer and heart disease combined. When pain lasts for a long time (3 to 6 months or more), it is called chronic pain. The CDC recently released a report estimating that 50 million Americans, more than 20 percent of the adult population, have chronic pain.

Managing & Treating Your Pain

Chronic pain can have real effects on your day-to-day life and your overall health. Treating chronic pain can be difficult because it varies from person to person as well as many different causes and possible treatments. Developing the right treatment plan for your diagnosis is often the work of a multidisciplinary team of medical professionals. When consulting with your doctor, he may refer you to visit a physical and occupational therapist.

Physical Therapy (PT)
Physical therapy practitioners can assess your chronic pain, and based on your goals, will establish a therapy treatment plan fit for you. Treatment may include both passive and active treatments. Passive treatments help you to relax, while active treatments are therapeutic exercises that strengthen your body and help you deal with your pain.

Occupational Therapy (OT)
Occupational therapy practitioners understand that pain it subjective and complex. OT’s work individually with you to evaluate the pain’s impact on your desired activities and quality of life. They teach you skills and strategies to manage and cope with your pain.

Pain Reducing Technology
Therapists may use non-invasive technology such as Electrical Stimulation (e-stim) which blocks the pain signal to the affected area while reducing inflammation. Also, Ultrasound and a combination of heat and cooling therapies may be used to reduce pain.

If you or a loved one suffer with chronic pain, it is important to pay attention to your body. Be proactive to keep your pain under control. Consult with your doctor and ask if physical and occupational therapy can help you!

References: American Occupational Therapy Association

Article By:  PT in Motion, www.apta.org

Patients with low back pain (LBP) who see a single physical therapist (PT) throughout their episode of care may be less likely to receive surgery and may have lower downstream health care costs, researchers suggest in a study published in the December issue of PTJ (Physical Therapy). “Limiting the number of physical therapy providers during an episode of care might permit cost savings,” authors write. “Health care systems could find this opportunity appealing, as physical therapy provider continuity is a modifiable clinical practice pattern.”

Authors examined data from nearly 2,000 patients in Utah’s statewide All Payer Claims Database (APCD) to look for associations between continuity of care for LBP patients and utilization of related services such as advanced imaging, emergency department visits, epidural steroid injections, and lumbar spine surgery in the year after the first primary care visit for LBP. APTA members John Magel, PT, PhD; Anne Thackeray, PT; and Julie Fritz, PT, PhD, FAPTA, were among the authors of the study.

Patients were between the ages of 18 to 64 who saw a PT within 30 days of a primary care visit for LBP. Researchers excluded patients with certain nonmusculoskeletal conditions; neurological conditions, such as spinal cord injury, that could affect patient management; and “red flag” conditions such as bone deficit or cauda equina syndrome.

Researchers found that greater provider continuity significantly decreased the likelihood of receiving subsequent lumbar spine surgery, noting that “disparate management strategies across a variety of providers might inhibit or prolong the recovery in a patient with a worsening condition and contribute to the patient eventually receiving lumbar surgical intervention.” They also note that a strong therapeutic alliance is associated with improved outcomes.

Contrary to authors’ expectations, high provider continuity was not associated with decreased use of advanced imaging, steroid injections, or emergency department visits. “The timing of physical therapy for LBP might have a greater impact on these outcomes than does provider continuity,” they suggest. Researchers did find a link between use of these services and the presence of comorbidities, previous lumbar surgery, and use of prescription opioids or oral steroids.

The average cost of care in the year following the initial primary care visit was $1,826 per patient. Costs were slightly less, at $1,737, for the 90% of patients with high provider continuity but rose to $2,577 for patients with a lower level of provider continuity.

While the study’s findings do not identify any cause-and-effect relationships, “it seems reasonable that physical therapists should consider approaches to managing patients with LBP that limit provider discontinuity,” authors write.

Click here to continue reading this article.

 


 

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

Thrive Successful Care Transitions

We provide a step-by-step implementation guide for successful addition to your care transitions strategy.

HTS is excited to introduce Thrive, a successful care transitions program designed for skilled care providers. Thrive was developed by a collaboration of HTS therapists, partner communities, nurse practitioners and physicians to create a robust, turn-key system to implement successful transitions of care. This program is perfect for post-discharge from skilled nursing back into the community, or to an senior living campus.

Core Objectives:

  • Follow Patient For Up To 90 Days Post-discharge
  • Utilize a Turn-key System For All Members of the Care Team
  • Provide Risk Stratification for Potentially Preventable SNF 30-day Readmissions
  • Reduce Hospital Readmissions with a Collective & Thorough Approach

Thrive is evidence-based and focused on empowering and equipping each member of the care team with the necessary tools to promote the best outcomes for each patient.

Elements of the Thrive Program:

  • Pre-discharge Patient Consultation Tool
  • Rehabilitation Successful Care Transitions Planner
  • Community Resources & Support Guide
  • Discharge IDT Family/Stakeholder Meeting Guide
  • Post-Discharge Communication Guide
  • Quarterly Analysis
  • Thrive Patient Outcomes Tracker

HTS will be rolling out Thrive to all partnering communities. Our proprietary clinical programs are just another way that we move our clients forward as leaders of rehabilitation in the markets they serve.

 


 

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

By: Cassie Murray, Chief Operating Officer I Chief Clinical Officer

The CMS Fact Sheet for the CY2019 Physician Fee Schedule Final Rule was released Thursday, November 1, 2018.

Note that CMS finalized the discontinuation of the Functional Status Reporting (G-Codes) for outpatient therapy services effective January 1, 2019.

Additionally, the payment reduction to 85% for outpatient therapy provided by PTAs and OTAs will go into effect January 1, 2022. CMS clarifies that the new modifiers for therapy provided by PTAs (CQ) and OTAs (CO) will be used alongside the current PT and OT modifiers (GP, GO, and GN). CMS explained that the new modifiers (and payment reduction) will apply when more than 10 percent of the service is furnished by the PTA or OTA. These new modifiers will be required on claims beginning January 1, 2020. The payment reduction will begin January 1, 2022.

For calendar year 2019, the KX modifier must be applied when therapy services reach $2,040.

Click here to read the CMS Fact Sheet.

 


 

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