Providers are now tasked with the responsibility of mitigating the risk of virus exposure in their facilities which, unfortunately, sometimes requires preventing some staff from entering the building. At times the staff being turned away has included therapists. Lack of detailed guidance early on during the PHE created an environment in which key long term care decision-makers such as administrators were left to interpret regulations as best as possible until further clarification was received. However, thanks to the numerous studies recently published in 2020 and clarification from the CDC, it has become clear that providing early and consistent rehabilitation care throughout the SNF stay is important for successful outcomes.

Long-term negative physical, cognitive, and psychosocial effects for those not receiving the caliber of care required to meet their individualized needs are now evident. Furthermore, on March 19, 2020, a Memorandum from the Department of Homeland Security stated that therapy practitioners are critical health care workers and need to be a part of the treating team.  Simply put, if a patient requires skilled level of care, that service must be provided. If services required to rehabilitate the patient back to a prior level of function are not being delivered, this puts the facility at risk for substandard quality of care.

The CDC has also now provided guidance. When asked “should any diagnostic or therapeutic intervention be withheld due to concern about transmission of COVID-19?” The CDC answered by stating patients should continue to have the opportunity to get any interventions they would normally receive as a standard of care. The Journal of Physical Therapy Science recently published research study findings to further support this claim. The purpose of the study was to recommend methods of respiratory rehabilitation and psychotherapy for patients in different stages of the coronavirus.

“Physical therapy of COVID-19 patients will not only reduce the mortality rate of patients, hospital admission time, and medical expenses, but also save medical resources, reduce personal and national economic losses, and the probability of adverse social stability events such as medical collapse. Therefore, physical therapy should be introduced into the mainstream treatment of COVID-19 patients as early as possible.”

Although this example depicts the critical nature of service delivery from a physical therapist…occupational therapists and speech-language pathologists also play a pivotal role in patient rehabilitation. With respiratory distress comes a myriad of potential complications including insufficient breath support for communication and/or swallowing as well as the inability to complete one’s daily tasks due to insufficient pulmonary capacity required to complete the activity. The bottom line remains that therapists are highly skilled healthcare professionals that play a significant role in the rehabilitation of patients.

In order to further support HTS therapists, resources, and tools were created to not only educate on infection control but also to facilitate best practices in these unprecedented times. Check out the list below for just a few examples of recently created materials:

  • Breathe: A Pulmonary Intervention Program
  • Therapist Treatment Hierarchy Delivery Chart
  • Dining Assistant Emergency Program Toolkit
  • HTS Annual Training: COVID-19 Supplement
  • Teletechnology Quick Reference Tools
  • Virtual Home Assessment Tool
  • Waiver Related Claim Guidance

Written by: Sheena Mattingly, M.S., CCC-SLP, RAC-CT, HTS Director of Clinical Outcomes

 

Sources:

Presenting:  Staying Healthy During COVID

During this presentation, we discuss the impact COVID has had on our daily lives and overall wellness. A closer look at our emotional, social and physical wellness is discussed with strategies and tips to stay in good physical and mental shape.

Toolkit Includes:

  • VIDEO – Staying Healthy During COVID Presentation Recording
  • MARKETING FLYER – Use this flyer to advertise the presentation video airing on your community TV channel or a specialviewing in the lounge area.
  • HANDOUT – Tips to Stay in Good Physical & Mental Shape

HTS Partners can conveniently access this toolkit along with many other wellness resources under the Wellness Dashboard on HTS PartnerHQ web portal.

Meet Denise Johnson, PT

Denise brings with her several years of field experience and a somewhat new accolade: Teletechnology Delivery Service Mode Expert. It all started back in September with a SNF COVID-19 outbreak. Implementation of telehealth as a service delivery mode became imperative after the outbreak and Denise led the charge! Denise, like many other HTS therapists, provides therapy at a few buildings. As we know all too well, due to the PHE, many facilities have implemented policies prohibiting therapists to work at mulsites in order to mitigate exposure of contagion. These types of (necessary) policies and the need for therapeutic services in a building with a COVID-19 outbreak furthermore illustrated the need for Telehealth.

So, how did Telehealth implementation begin? After the administrator of the building was made aware and approved Telehealth as a service delivery mode, the therapy team went to work on logistics. Per Denise, this is the biggest challenge with Telehealth Services. Consent forms must be received prior to treatment. Brian Kemp, PTA at Southfield Village suggests use of a binder so that all of the consent forms can be tracked and kept in one place. Once the consent form is signed and received, the person at the other end of the camera with the patient must then play their part in order to effectively provide a Telehealth session. Most often this person is a PTA/COTA. However, depending on your facility’s staffing and policy, other facility staff members are also able to fill-in. “Things like getting the camera angle right and assuring the patient is able to hear you is imperative and contributes to the effectiveness of your skilled therapeutic session” says Denise. As a seasoned PT working with Telehealth, Denise’s main concern with the newly available platform being used (Zoom) is those patients suffering from dementia. Patients with poor or limited participation poses its own set of challenges. However, for the most part, telehealth has worked and bottom line, although most therapists prefer visits to be face-to-face and hand- on, Telehealth provides an acceptable alternative to provide coverage to a population who needs it.

When specifically asked about the benefit of Telehealth as a service delivery mode, Denise emphasized and thanked the PTAs and COTAs she has worked with. For example, a therapist providing Telehealth is unable to look to quantify edema in the legs, accurately observe when a patient goes sit-to-stand, or if there is a retro bias when the patient is standing. The therapist on the other side of the Zoom video call may be missing firsthand on these clinical components and are heavily reliant on the person on the other camera who is with the patient to pick-up on these types of observations. What’s the silver lining? Well, according to Denise, the nice thing is that the therapy assistants she has worked with are even more in-tune with the global picture of what is trying to be achieved during evaluations and supervisory visits. This results in more accurate documentation and effective treatment sessions.

 


Past Stories From the Field can be found on the HTS Portal. Have a great “Hoping & Coping Story from the Field ” you would like to share with fellow HTS therapists?

Email Sheena Mattingly, Director of Clinical Outcomes at sheena@htstherapy.com for your chance to be featured in a “Story from the Field!”

Featuring HTS Healthcare Hero, Kristen Stedman

Meet Kristen Stedman, a 9-year HTS veteran and a PTA at Ketcham Memorial Center.

Kristen’s healthcare hero status was further solidified by Ketcham’s Administrator, Kathy Wittmer who stated, “We wouldn’t have been able to make it through navigating the PHE without the infection control nurse and Kristen.”

Kristen displayed her commitment to the residents during the PHE in many different capacities. For example, she showed up at Ketcham everyday – regardless if she had therapy patients on her schedule or not. Specifically, Kristen was involved in helping transition patients to ambulances, checking temperatures, and answering call lights to help prioritize patient needs.

Kristen stated the most challenging part of the PHE is knowing residents who became sick and some who even passed away. Oden, Indiana (where Ketcham is located) is a small town. “Since the community is so small, we are like family,” said Kristen. As like many facilities across the nation, Ketcham’s staff pivoted to meet the needs of residents. They adapted and they did so as often as necessary. The therapy team at Ketcham was praised for many reasons with the primary being their ability to change in order to navigate these new COVID-ridden waters.

Now that the initial shock and “pivot” is over, Kristen described some other COVID-related challenges. Restorative is now working in the therapy gym side by “distanced” side. This has required some shift in scheduling. The activities department is now requiring split groups. This also presents a call to action for better communication and organization when scheduling patients attending therapy sessions. All in all, everyone at Ketcham has worked together nicely. As Kristen put it, “For other facilities that are going through this now, it is most important to stick together (with the IDT). Everyone has to work together and you have to be there for each other.”

Thank you Kristen and Ketcham Memorial Center for sharing your Story from the Field!


Past Stories From the Field can be found on the HTS Portal. Have a great “Hoping & Coping Story from the Field ” you would like to share with fellow HTS therapists?

Email Sheena Mattingly, Director of Clinical Outcomes at sheena@htstherapy.com for your chance to be featured in a “Story from the Field!”

Blog by:  Shelly Maffia, MSN, MBA, RN, LNHA, QCP, CHC, Director of Regulatory Services, Proactive Medical Review

Now that routine surveys are beginning to take place in most states, it is important that vigilant infection prevention and control practices do not take a backseat to other survey-ready quality assurance activities. Notably, HHS announced a $2.0 billion payment incentive program (VBP) with $500 million per month for four months Sept. -December 2020 paid based on SNF performance in managing the rate of COVID-19 infections each month and the COVID-19 mortality rate for the month as compared to other facilities with similar community infection rates. Details are forthcoming on the specific formula to be used for distribution of funds, but it is anticipated that a facility may be excluded from receiving a portion of these funds if performing significantly worse than peers on these measures.

Click here to continue reading this blog.

 

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.

By: Sheena Mattingly, Director of Clinical Outcomes

On August 26, 2020 CMS released a memo detailing COVID-19 testing requirements. In order for nursing homes to participate in Medicare and Medicaid, staff and residents need to adhere to new testing requirements. A revised survey tool for surveyors to assess nursing home compliance in this matter is also available.

See below for a list of steps that need to be taken to remain in compliance.

1. Remember, only antigen tests and PCR tests are permitted to be used to meet the testing requirement – antibody tests are not acceptable forms of testing.

2. Testing is based on three different triggers:

Symptomatic Individual Identified

  • Staff with signs/symptoms must be tested
  • Residents with signs/symptoms must be tested

Outbreak

  • Test all staff with previous negative results until no new cases identified
  • Test all residents that previously tested negative until no new cases identified

Routine Testing

  • Test staff according to County Positivity Rate in the past week
  • Resident testing not recommended unless resident leaves the facility routinely

3. Routine testing must be completed of staff according to the table below and is based on the facility’s county positivity rate in the prior week. These county-level positive rates are available here (last modified Sept. 8, 2020). The below table identifies minimum testing frequency related to the county positivity rate within the past week.

*Source: https://www.cms.gov/files/document/qso-20-38-nh.pdf

4. There is a 48-hour time requirement for results of COVID-19 testing. If for any reason, this is unable to be met, the facility should have documentation of efforts to obtain results as quickly as possible. Also, document the lab the facility is using and any contact the facility has had with local and state health departments. Criteria for the inability to meet testing result time requirements may include supply shortages, limited access, or labs failing to process tests within 48 hrs.

5. The newest F-Tag (F-866) is related to noncompliance with new testing requirements. However, if the facility has documentation supporting their attempts to adhere to new testing parameters such as timely contacting state officials and inquiries with labs that can provide results within 48 hours, then surveyors should not tag the facility. Instead, they are to inform state and/or local health departments of the facility’s lack of resources.

Hoping & Coping:  Smiling Faces

This story from the field focuses on the new “HTS Hoping & Coping Series”. This series emphasizes all the wonderful HTS therapists and the extraordinary lengths taken to assure quality services and patient well-being are maintained during the PHE.

Meet Alexis Jackson, OT and Rehab Manager at Good Sam Home in Evansville, Indiana. Alexis found herself reimagining the work environment during the PHE after watching the May “HTS Lunchtime Learning: COVID-19 & The New Normal”. That very afternoon, Alexis knew The Smiling Faces Initiative described on the webinar was one that would improve morale at Good Sam Home. Smiling face nametags encourage facility staff members to post pictures of themselves on their nametags so that patients are able to more easily identify them and, of course, see their smiling faces! This initiative eliminates a created barrier, real or perceived, between staff and patients. “I feel strongly that our patients deserve to see who we are in order to make a connection that is needed to deliver quality therapy” said Alexis Jackson, OT.

Alexis and the Good Sam Home therapists were the drivers of The Smiling Faces Initiative. Their mission was to bring out smiles from underneath masked faces. First, Alexis trolled Facebook and found pictures of each therapist. Then, after the pictures were included on their nametags, the therapy team began wearing them on a daily basis. “Once we therapists starting wearing smiling face nametags, the initiative just took off!” said Alexis. Soon the facility’s DON, Admission’s Coordinator, Nursing, and Staff Development Coordinator were all wearing a smiling face nametag. We can all use a few more smiles and thanks to the Good Sam Home therapy team, patients are now getting them!

From left to right: Alexis Jackson, OTR/L, Sherri Moore, PTA, Becky Williamson, COTA/L, Rachel Runyon Lortie, OTR/L.


Past Stories From the Field can be found on the HTS Portal. Have a great “Hoping & Coping Story from the Field ” you would like to share with fellow HTS therapists?

Email Sheena Mattingly, Director of Clinical Outcomes at sheena@htstherapy.com for your chance to be featured in a “Story from the Field!”

On July 24, 2020 CMS released a SNF QRP COVID-19 Tip Sheet. Here’s what you need to know:

  • Starting on July 1, 2020, SNFs are expected to resume timely quality data collection and submission of measure and patient assessment data for the MDS/RAI.
  • Specific quarters requiring reporting of data for the QRP program for CYs 2019 and 2020 are listed below:October 1, 2019–
    • December 31, 2019 (Q4 2019)
    • January 1, 2020–March 31, 2020 (Q1 2020)
    • April 1, 2020–June 30, 2020 (Q2 2020)
  • The MDS should be submitted for all new admission records and discharge records that occur on or after July 1, 2020.
  • Timely submission and acceptance requirements of MDS data to meet the 80-percent threshold are unchanged. SNFs are required to submit at least 80 percent of the necessary data to calculate the SNF QRP quality measures.
  • Before QM data is publicly reported on Nursing Home Compare, SNFs have the opportunity to review and correct and/or preview their data. A quarterly Provider Preview Report can be accessed via the Certification and Survey Provider Enhanced Reports (CASPER) application which is accessible from a SNF’s “Welcome to the CMS QIES Systems for Providers” page. Full instructions are available here.

 

Did You Know?

As part of the HTS Partner Plus Program you get access to multiple MDS specialists and nursing consultants to assure your coding is accurate which not only impacts PDPM reimbursement but also QRP? Contact HTS Director of Clinical Outcomes today for more details at sheena@htstherapy.com.

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.

Blog by Cassie Murray, OTR, MBA, QCP, Chief Operating & Clinical Officer

During the May 12th CMS Office Hours broadcast, CMS provided guidance for SNF therapists to include the time spent donning and doffing PPE in the MDS Section O minutes. Therapists should begin including this time in the total treatment time for each session. This topic is covered in the recorded podcast between time markers 3:02 and 3:54. The link below is to the recording and written transcript.

Tuesday, May 12, 2020, CMS Office Hours (ZIP)

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