Article by Cassie Murray, OTR, QCP, IASSC CYB, Chief Operating & Clinical Officer, Healthcare Therapy Services, Inc.

On Friday 4/19, CMS released the pre-publication of the FY 2020 Skilled Nursing Facility Prospective Payment System Proposed Rule. As expected, the Patient-Driven Payment Model is confirmed to go into effect October 1, 2019.
SNF Proposed Payment Updates for FY 2020:

  • Proposed SNF payment update is 2.5% (increase of $887 million from FY2019)
  • The proposed updated Base Rates for the PDPM Components (unadjusted federal per diem rates for urban and rural):

TABLE 3: FY 2020 Unadjusted Federal Rate Per Diem–URBAN

TABLE 4: FY 2020 Unadjusted Federal Rate Per Diem-RURAL

SNF Quality Reporting Program:

  • For FY 2022, CMS proposes the adoption of two process measures:
    • Transfer of Health Information to the Provider-Post-Acute Care.
    • Transfer of Health Information to the Patient-Post-Acute Care.
  • CMS proposes to update specifications for Discharge to the Community SNF QRP Measure to exclude baseline nursing facility residents from the measure.
  • CMS proposes to collect standardized patient assessment data using MDS for all patients regardless of payer source.

PDPM Changes:

  • CMS proposes to change the SNF group therapy definition to match the IRF group therapy definition. This would allow for qualified therapists or assistants to treat two to six patients in a group performing the same or similar activities.
  • CMS proposes that non-substantive updates to ICD-10 codes used in PDPM be made through the PDPM website. Substantive changes would continue to be made through traditional notice and rulemaking processes. Non-substantive updates are to maintain consistency with the most recent ICD-10 code set.
  • CMS proposes updates to the regulation text to coincide with the assessment changes under PDPM:
    • Initial patient assessment regulation would state: “assessment schedule must include performance of an initial patient assessment no later than the 8th day of post-hospital SNF care”.
  • The Optional Interim Payment Assessment would be included in the regulation.

Stakeholder comments will be accepted until June 18, 2019.

Click here to view the CMS Fact Sheet.

Click here to view the FY 2020 Proposed Rule Pre-publication.

If you can look this happy at the end of a 6 hour ICD.10 coding session… then it must have been pretty great! Thank you for everyone who turned out for our Evansville event on April 9th!

“Today’s training was excellent! Our speaker was not only dynamic, but she also helped to simplify everything to focus on what is expected under PDPM. I left feeling a lot better about our coding. “ – Norie B, Director of Nursing

We are committed to supporting our partners by offering exclusive PDPM webinar and live trainings in critical areas to foster success as we “Power through PDPM.”  Please contact us to register. Not a partner? Contact us to learn how we’re providing even more value to our partners

April-May:
Generate Powerful Coding—ICD.10 Live Trainings

June-July:
Supercharge Your MDS: 6-Part Series

by Shelly Maffia, Director of Regulatory Services, Proactive Medical Review

CMS released upcoming improvements to Nursing Home Compare and the Five Star Rating system that will go into effect in April 2019. Key changes that will take place in April include:

Health Inspection Rating:

  • The freeze on the Health Inspection rating will end.
  • Surveys occurring after Nov. 28, 2017 will now be included in the rating.
  • Ratings will again be based on 3 cycles of inspections (3 most recent standard inspections and any complaint inspections occurring within the past 3 years).
  • Cycles will return to pre-“freeze” weightings, with the most recent period (cycle 1) assigned a weighting factor of 1/2, the previous period (cycle 2) with a weighting factor of 1/3, and the third period (cycle 3) having a weighting factor of 1/6 of the health inspection score.
  • Star ratings will not be displayed for Special Focus Facilities.

Quality Measure Rating:

  • Separate Quality Measure ratings created for short-and long-stay measures.
  • Each facility will continue to have an overall QM rating, which will be used to calculate the overall nursing home star rating.
  • Overall QM rating will be equally based on the short-stay and long-stay quality ratings.
  • Increased thresholds for ratings, based on the rate of improvement on QM scores since the last revision in February 2015.
  • Every six months, QM thresholds will be increased by 50% of the average rate of improvement in QM scores to incentivize continuous quality improvement.
    • Individual QMs will be weighted and scored differently.
      High and medium weighting levels established.
    • Total number of points available for QMs with high weighting will be 150 points and medium weighing will be 100 points each.
    • Points for QMs weighted “high” will be awarded by thresholds established at each decile, whereas points for QMs weighted “medium” will be awarded by thresholds established at each quintile.
  • Adding the long-stay hospitalization measure and a measure of long-stay emergency department transfers to the QM rating.
  • Short-stay pressure ulcers and successful discharge to community measures are being replaced by the similar measures from the SNF Quality Reporting Program (QRP).
  • Removing long-stay physical restraint measure from QM rating’s calculation, but will continue to report the measure on Nursing Home Compare.

Staffing Rating:

  • Adjusted thresholds for staffing ratings to increase the weight registered nurse staffing has on the staffing rating.
  • Four days (instead of seven days) without RN onsite will trigger automatic downgrade to one-star Staffing Rating.

About Proactive Medical Review
HTS partners with Proactive Medical Review, a third party company who specializes in ensuring compliance with regulatory standards and promoting measurable care excellence. The team includes SNF experienced nurse, MDS, Health Facility Administrator, therapist and reimbursement specialists with experience serving in multi-site contract therapy operations, as corporate directors of quality, clinical program specialists, and Compliance Officers. Proactive is uniquely positioned to assist in managing the many changes and challenges facing providers partnered with HTS. Learn more about our commitment to compliance here.

  1. Master PDPM Methodology

    Master PDPM methodology and include all staff in job relevant PDPM subject matter trainings. Since we started PDPM training in September 2018, we have seen a trend of key departments who are being left out of the mix. This includes the Admissions teams, floor nurses, social services, medical directors, nurse practitioners, business office and medical records. Needless to say, PDPM will take the village.

    Trainings should Include an intermediate level of PDPM understanding.
    •  ICD-10 Coding
    •  GG Coding
    •  Quick Tip: Coding of the functional status in GG should be based on usual performance and should be determined by IDT collaboration.

     

  2. Ensure Documentation Confidence

    •  Ensure that your nurses are comfortable with the transition from section G to section GG for functional measure coding.
    •  
    Ensure that the nurses are comfortable with documenting their skill. Since nursing has its own component, they have to be able to “own” their nursing skill and document to justify their services.
    •  Ensure confidence in capturing all active diagnosis. This means that you will need to (or already have) rewritten your admissions procedures and utilize preadmission forms to capture NTA items. Our PDPM analysis across the board shows a great opportunity to improve coding to accurately reflect the conditions of our patients.

     

  3. Set-up for MDS Success

    Set MDS up for success. Evaluate the work flow for MDS and gain an accurate picture of job responsibilities. While there are fewer required MDS assessments under PDPM, the time not spent in assessments can be used to ensure accurate and timely coding under PDPM. Business office managers can begin conversations with managed care providers to ascertain any expected changes in reimbursement.

     

  4. Adapt & Modify Processes

    Adapt and modify your current processes to align with PDPM specific conditions and coding. In our pilot sites, HTS and our partners are adding PDPM processes to current operations to prepare and identify best practice prior to October 1st. This can be achieved alongside our current RUG system to give your team more confidence and reduce the “flipping of the PDPM switch” on midnight of September 30th.

    Examples include:
    Changes to your weekly Medicare meeting forms
    •  Changes to your admission processes Begin a 5-day assessment meeting for all Med A patients with each department contributing their PDPM-related information
    •  Establish the IDT approach to selecting the primary diagnosis prior to the skilled stay.
    •  Use the CMS Clinical Category Mapping “Return to Provider Codes” which will be rejected beginning October 1st

     

  5. Restorative Nursing

    Restorative nursing for your skilled patients may be a positive adjunct to therapy services under PDPM.

    Under PDPM, providing two restorative programs for the nursing groups Reduced Physical Function and Behavioral or Cognitive Symptoms will result in an increased nursing CMI.

     

  6. Talk with Your Docs 

    You have from now until October 1st to work with your hospitals and physicians to ensure efficient data collection for the 5-day MDS and optimal information for coding accuracy. This may include a review of how you obtain your data, what EHR is being used and if they are willing to build reports or have the ability to add reports to their standard transfer paperwork. It may be necessary to call a meeting about PDPM to your referral networks and educate doctors and hospitals on the importance of sending this key information. This includes: providing timely discharge summaries, operative reporting, ICD-10 codes, accurate active diagnosis and any specialty information.

     

  7. Know Your Software

    Whether you are using PCC, Matrix, Vision, etc. it is important to know what new functionalities will be available under PDPM.
    •  Know what current PDPM tools and reports are available for you to take utilize now.
    •  Get involved in any PDPM workgroups offered by the software provider to offer feedback and suggestions.
    •  Take advantage of any trainings, modules or alerts of new functions.

Did you know that every one pound of body weight, it adds three pounds of force to the knees? The knee is the largest joint in the body and gives you flexibility and stability for standing, walking, crouching, running, jumping and turning. With so many moving parts in the knee, it is vulnerable to injury.

Give your knees a break with these measures:

  • Strengthen Your Leg Muscles. Strong quadriceps and hamstring muscles will protect your knees from injury.
  • Stretch Before and After Any Workout. Stretch your quadriceps and hamstring muscles before and after exercising to reduce pressure on your knees.
  • Maintain a Healthy Weight. Every step you take places about three times your body weight on your knees.
  • Wear Shoes with Proper Arch Support. Stay away from flip-flops and other shoes that provide poor arch support and put unnecessary stress on the knee joint.

If pain is limiting your lifestyle or activities in any way, you should consult with your doctor. Also, ask your doctor about receiving physical therapy. Therapy can instruct you on exercises that improve your knee stability and health without increasing the risk for injury and further damage.

In the meantime, you may want to R.I.C.E. it. “RICE” is an acronym used by medical professionals meaning: rest, ice, compress and elevate. Rest the joint from strenuous movement, ice the area of discomfort, compress with an elastic bandage to reduce inflammation, and finally elevate both to unload pressure and again reduce inflammation.

by Skilled Nursing News
Starting October 1, skilled nursing facility operators will have no choice but to become proficient with a specific type of medical coding that previously had no bearing on reimbursements — and leading industry voices say there are multiple paths to getting there.

ICD-10 codes, specific diagnosis identifications long used by hospitals, will play a key role in the new Patient-Driven Payment Model (PDPM), and facilities only have a few more months to get staffers up to speed.

Click here to continue reading this article.

Exclusive PDPM Training For HTS Partners

Generate Powerful ICD.10 Coding
We are committed to supporting our partners by offering exclusive PDPM webinar and live trainings in critical areas to foster success as we “Power through PDPM.”

These sessions will review ICD-10-CM coding conventions and official guidelines for coding/reporting to gain knowledge on appropriately assigning ICD-10 codes, a focus on the diagnosis codes that impact reimbursement under the Patient Driven Payment Model (PDPM). Please contact us to register. Not a partner? Contact us to learn how we’re providing even more value to our partners.

Tuesday, April 9 – Evansville
Wednesday, April 10 – Louisville
Wednesday, May 29 – Fort Wayne
Thursday, May 30 – Indianapolis

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

Site-Specific PDPM Impact

Individual PDPM Meetings with all partner sites: All HTS partner sites received education on PDPM along with their specific PDPM Impact Analysis.

Deep Dive into Data

HTS operations is diving deep into site-specific data in order to establish additional best practices and clinical pathways based on diagnosis category and functional level. HTS is conducting extensive data analysis by site to analyze the following key items: history, patient population, conditions, principle diagnosis, diagnostic category, functional level, the amount of time spent in therapy as well as their functional outcomes. This data gives sound strategic direction to process improvements and clinical positioning to foster success under PDPM.

Therapy GG Coding Analysis

All HTS therapists are certified in the CMS Care Tool, which is the standardized outcome for mobility and self-care. However, we are auditing our therapists’ GG coding to ensure continued confidence that our therapists are accurate and skilled in GG coding.

Current MDS Data Analysis

HTS is partnering with clients to upload actual 2018 MDS data and provide patient-specific analysis to identify opportunities, trends, education, and auditing needs to ensure accuracy incoding and optimize system processes. This information is valuable as we craft a PDPM strategic plan for each community we serve.

Powerful Partnerships

We have collaborated with the nursing and MDS experts from Proactive Medical Review to provide comprehensive training and resources for nursing and other nontherapy departments within the IDT. Together we are offering our Power Through PDPM exclusive training series of monthly trainings to focus on each key component of PDPM preparedness.

The Bungee Mobility Trainer by Neurogym Tech. available through Medline

“Therapists like this piece of equipment because it allows our rehab guests to work on static and dynamic balance while eliminating the fear of falling. I witnessed a new CABG patient with sternal precautions dancing with one of our therapists using this device. Pretty amazing stuff!

Also, I like the design and smaller footprint of this piece as before our only options for partial weightbearing were to purchase ceiling tracks and harnesses, or large, expensive equipment that fits over treadmills and takes up too much space in the rehab gym. We have heard nothing but good reviews from our therapists on this piece of equipment. It’s becoming the next “must have” in addition to the Biodex Balance Trainer and the ACP Omnicycle which are always popular.”

–  Amanda Green, Executive Director Marketing & Strategic Development

Check it out now!

Diabetes is a chronic disease that affects how your body turns food into energy. There is not any one specific cause of diabetes however there are many factors which contribute to a higher risk of getting the disease including but not limited to genetics, obesity, physical inactivity, high blood pressure and cardiovascular disease.

Type 1 Diabetes – Caused by genetics and unknown factors
There is no cure, however it can be managed to prevent further diabetes-related complications.

Type 2 Diabetes – Caused by genetics and lifestyle factors
Can be prevented or delayed with healthy lifestyle changes.

Prediabetes affects more than 84 million adults in America
Losing weight and staying active can greatly reduce your risk for developing type 2 diabetes.

Healthy Lifestyle Choices

Diet – A healthy diet is one that is rich in nutrients and low in calories. Eat foods high in fiber such as fresh fruit, vegetables, whole grains and nuts.
Hydration – Be sure to drink plenty of water and avoid sugary drinks and caffeine.
Exercise – It’s very important to exercise for 45 minutes or more at least 3-4 times per week. Walking, riding a bicycle, running, and swimming are a few examples.

Therapy’s Role in Managing Diabetes

Occupational Therapy can help improve the individual’s physical, cognitive, psychosocial, and sensory aspects; which are important in all aspects of everyday living activities.
Physical Therapy can assess to determine a set exercise routine that would be safe and beneficial. Also, diabetic neuropathy can be treated with massage, balance and gait training, and conditioning.
Speech Therapy can assist with difficulty swallowing or talking, due to complications of diabetes.

 


Source: Centers for Disease Control and Prevention

Last September through December, HTS provided introductory trainings via a series of PDPM 2-hour live trainings for partner communities and staff. The training covered PDPM fundamentals and methodology accompanied with an action plan for success. A facility specific PDPM impact analysis was completed as a baseline resource for operational readiness.

“I was privileged to be invited to a recent PDPM training in Edmonton conducted by HTS. The information that was provided at the training was focused and well presented. Although, I know there will be changes as the final rule develops in mid-2019, I felt that HTS had done an excellent job summarizing the proposed rule on PDPM and did a great job with the presentation.” – Terry Skaggs, CFO Wells Health System, Owensboro, KY

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.

We are committed to supporting our partners by offering exclusive PDPM webinar and live trainings in critical areas to foster success as we “Power through PDPM.”

January:
PDPM Impact & Facility Action Plan

February:
Effective Systems & Section GG Coding

March:
Light up Your Admissions Process: Systems for Successful PDPM Transition

April-May:
Generate Powerful Coding—ICD.10 Live Trainings

June-July:
Supercharge Your MDS: 6-Part Series