Article by Skilled Nursing News

The federal government on Tuesday finalized a predicted funding increase for nursing homes, while also formalizing changes to several key quality programs — with an eye toward clarifying some parts of the new Medicare payment model for skilled nursing facilities.

Under the terms of the 2020 final rule for Medicare skilled nursing facilities, the Centers for Medicare & Medicaid Services (CMS) will increase payments to nursing homes by $851 million in the coming fiscal year, which begins October 1 of this year.

That figure represents a slight drop-off from the increase of $887 million projected in the proposed version of the rule, which CMS released back in April; the $851 million comes from a 2.8% increase to the Medicare market basket rate in the final rule, as opposed to a 3% rise in the proposal.

The Tuesday announcement also includes several clarifications related to the Patient-Driven Payment Model, also set to take effect October 1. CMS formally changed the definition of “group therapy” to any modality with two to six residents performing the same or similar activities. That change brings group therapy in SNFs more in line with other care settings, such as inpatient rehabilitation facilities, which use the same definition; CMS currently defines group therapy as activities with exactly four residents.

“As PDPM implementation takes place, CMS believes aligning the group therapy definition serves to improve the agency’s consistency in payment policies across PAC settings,” the agency wrote in a fact sheet about the changes.

Click here to continue reading this article.

NASL Newsletter Feature: US Senator Mike Braun Visits HTS Therapy Office
On April 24, 2019, U.S. Senator, Mike Braun visited Healthcare Therapy Services (HTS) and one of HTS’ partner facilities in Indiana. NASL members were able to talk with the Senator about the hospital observation stays issue that was NASL’s top issue during the Winter Conference in February. The Senator spent about an hour visiting with staff, as well as interacting with residents.

Thank you NASL for featuring us in your latest newsletter!

Pictured: Senator Mike Braun; his wife, Maureen; Cassie Murray, HTS COO; and Keith Yoder, CEO with Hickory Creek Healthcare Corporation

Pictured: Healthcare Therapy Services representative Shaleen Bhatnagar, Regional Director; Stephen White, Rehab Manager; Cassie Murray, HTS COO; and Steve Chatham, President

by Stacy Baker, OTR/L, CHC, RAC-CT, Proactive Medical Review

The Quality Improvement Organization (QIO) Program originated with the Peer Review Improvement Act of 1982 and is authorized by Title XI Part B and Title XVIII the Act. The goal of the QIO program is to improve the quality of care for Medicare beneficiaries, including beneficiary complaints, skilled service termination appeals, and Immediate Advocacy to protect the Medicare Trust Fund. The QIO program is to achieve this goal through performance of various case review directives promulgated by CMS in the QIO Contract.

As of June 8th, important updates apply to the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QI) in Indiana and Kentucky. Providers should review documents and publications noted below with references to KEPRO. The following actions should take place:

Indiana:

  • Remove KEPRO (effective June 8, 2019) and replace with Livanta information

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 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.

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

Improve Brain Health & Memory FREE Community Workshops

We’re excited to sponsor FREE Community Workshops focusing on Solutions to Improve Your Mental Fitness & Overall Brain Health. Check out the schedule below to find the workshop in your area. Each workshop will provide you with:

  • Tips To Engage Your Brain For Maximum Mental Fitness
  • Learn What Foods Can Improve Your Memory
  • Benefits of Exercise For Your Brain
  • How Outpatient Therapy Can Help You Regain Your Daily Independence
  • Take Home A Free Brain Health Workout

Light Refreshments will be provided. There is no cost to attend, FREE and open to the public.

 

Workshop Schedule

Crestwood Village East

1123 N Edmondson Ave, Indianapolis, IN 46219, In the Ballroom
Tuesday, March 12th, 2:00 – 3:00 pm
If you have any questions about this workshop, call Madison: 317-351-1786 or Jason: 317-357-1100

Crestwood Village West

230 Welcome Way Blvd, Indianapolis, IN 46214, In the Ballroom
Thursday, March 14th, 2:00 – 3:00 pm
If you have any questions about this workshop, call David 317-273-8800

Crestwood Village South

8809 Madison Ave, Indianapolis, IN 46227, In the Ballroom
Tuesday, March 19th, 2:00 – 3:00 pm
If you have any questions about this workshop, call Jim 317-885-3461

Woodland Terrace Carmel

689 Pro Med Lane, Carmel, IN 46032, In the Inspiration Room
Wednesday, March 20th, 1:30 – 2:30 pm
If you have any questions about this workshop, call Dennis 317-564-0180

Woodland Terrace, New Palestine

4400 Terrace Drive, New Palestine, IN 46163, In the Fitness Center
Thursday, March 21st, 2:00 – 3:00 pm
If you have any questions about this workshop, call Bryan 317-623-5834

Crestwood Village North

9225 Garrison Dr, Indianapolis, IN 46240, Building #2
Thursday, March 28th, 2:00 – 3:00 pm
If you have any questions about this workshop, call Jill: 317-447-7430 or the office 317-844-9994

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.

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!

HTS Receives INALA Industry Award

HTS is excited and honored to receive the Industry Award from the Indiana Assisted Living Association (INALA).  HTS was nominated by Justus Senior Living which own and operate 6 independent and assisted living communities in the Indianapolis and surrounding area. HTS has partnered with Justus to provide exceptional outpatient therapy.

“HTS continues to be a true partner in our communities. They take a proactive approach and when a resident has a unique diagnosis, they go the extra mile to communicate and educate staff. They are helpful and offer creative solutions, but at the same time are totally appropriate. Our residents trust the therapists and appreciate their courteous approach. The HTS Staff Work well with community teams. At the corporate level we are able to communicate openly and honestly, sharing many of the same values. They truly represent what partnership means.”

Thank you for sharing this thoughtful testimonial. We are extremely happy to work with each of our communities to ensure the residents receive the best care possible. We are honored to receive this award from the INALA Industry Awards. Click here to see all of the 2018 INALA award winners.

About INALA

Indiana Assisted Living Association’s (INALA) mission is to promote the interests of the assisted living industry in Indiana and to enhance the quality of life for the population it serves. The Indiana Assisted Living Association believes assisted living brings a housing option to seniors which offers quality housing and caring assistance in the least prescriptive manner, provided by individuals with the highest professional standards. The Association encourages a residential environment that enhances social interaction and promotes the quality of life. Click here to learn more about INALA.

In this picture: Amanda Green, Executive Director of Marketing/Strategic Development, LaChelle Henkle-Weaver, INALA Board President, Aretoula Nahas, Director of Outpatient Therapy.


 

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

By: Christa Roberts, PT, MPT, RAC-CT and Eleisha Wilkes RN, RAC-CT

The details of proposed rule LSA #18-251 were published on October 4, 2018 by the Indiana Family and Social Services Administration, and introduces plans to revamp the Medicaid program integrity requirements. LSA #18-251 is extensive and impacts the bulk of business facets for Indiana Medicaid providers, including claims filing time limits, medical record retention, provider enrollment, sanctions, audits, and provider appeals.

LSA #18-251 consolidates existing rules, clarifies requirements and adds new program integrity requirements affecting Medicaid providers. Some of the more significant changes are as follows:

  • Currently, providers have up to one year from the date of service to submit an original claim; however, under the proposed rule, providers would have to submit claims for payment within 180 days of the date of service or the claim would be denied (effective January 1, 2019).
  • Providers will be subject to a medical record retention for financial records period of 3 years following submission to Indiana Medicaid (there is currently no record retention policy).
  • The proposed rule consolidates and adds new provider enrollment requirements.
  • Medicaid payment suspension procedures authorized by Federal law are outlined.
  • A new section is added regarding provider exclusions and readmissions (specifically, the rule lists various offenses that could result in an exclusion and sets a duration of up to 3 years for such exclusion).
  • A new section describes prepayment review processes and procedures (previously only available in agency manuals).
  • The proposed rule revises existing Medicaid overpayment provisions to align with changes in Indiana law (adds a 3-year look back period for audits initiated after July 2, 2019, though may be extended to 7 years under certain circumstances).
  • Administrative appeals procedures are consolidated and changed to align with Indiana law.

LSA #18-251 is open for public comment until the public hearing, which is preliminarily scheduled for October 26, 2018. A copy of the proposed rule can be reviewed at: www.in.gov/legislative/iac/20181003-IR-405180251PRA.xml.pdf

 


 

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