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Common Citations During Infection Focused Surveys

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.

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Avoid the Survey Tag (F-866) with Five Simple Steps

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.

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Knee Pain

The knee joint is the largest and most complex joint in the body.  Enduring a significant amount of stress, the knee acts as a support system for our body when sitting, walking, running, and climbing.  The number of moving parts in the knee that makes it so useful also causes it to be vulnerable to injury.

Knee pain is a common complaint that affects people of all ages.  Simple wear and tear and years of walking can cause the knee joint to weaken and become susceptible to inflammation.  While we can’t go back and reverse the damage, there are lifestyle changes you can do now to lessen the stress.

 

Maintain a healthy weight.  Remember that every extra pound adds more strain on your joints and increases your risk of injury and osteoarthritis. 

Keep moving.  Exercise is a great way to alleviate knee pain. Low impact exercises such as walking, yoga, and swimming can help your knees without further damaging the joint.

Increase your strength.  Strength training to build up the muscles in the hip and around the knee joint can help provide support to your knee.

 

How Can Therapy Help?

A Physical Therapist can help you to reduce pain while increasing strength and flexibility to help your body feel and move better.  You will learn what exercises can help your knees without further damaging your joints.

An Occupational Therapist can help you to reduce strain on your joints during daily activities.  You will learn methods to relieve discomfort and improve performance through various physical techniques and activity modifications.

If pain is limiting your ability to perform normal daily activities or participate in activities you enjoy, ask your doctor if Physical or Occupational Therapy is right for you.

 

 

Sources:

https://www.mayoclinic.org/diseases-conditions/knee-pain/diagnosis-treatment/drc-20350855https://www.mayoclinic.org/diseases-conditions/knee-pain

https://www.health.harvard.edu/pain/unlocking-solutions-to-chronic-knee-pain

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Enforcement Cases Held during the Prioritization Period and Revised Survey Prioritization

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

On 08/17/2020 CMS announced that they are revising guidance on the expansion of survey activities to authorize onsite revisits and other surveys, and guidance was provided to State Survey Agencies (SA) on resolving previously “on hold” enforcement cases. A temporary expansion to the desk review policy was also announced.

Background & Recent Updates

On June 1, 2020 CMS issued survey reprioritization guidance to transition States to more routine oversight and survey activities once a State has entered Phase 3 of the Nursing Home Reopening Guidance. At that time, states were authorized to expand beyond conducting only IJ, Focused Infection Control, and Initial Certification survey, and were permitted to resume the following types of surveys, at the state’s discretion:

  • Complaint investigations that are triaged as Non-Immediate Jeopardy-High;
  • Revisit surveys of any facility with removed Immediate Jeopardy (but still out of compliance);
  • Special Focus Facility and Special Focus Facility Candidate recertification surveys; and
  • Nursing home and Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) recertification surveys in facilities where it has been over 15 months since the last standard survey.

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.

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Stories from the Field

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!”

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Stories from the Field

Featuring Marita Huey, PTA

At age 43, Marita Huey decided to go back to school to pursue a career in which she could serve people within the healthcare space. This journey led her to becoming a PTA. Marita has now been with HTS for seven years!

One of Marita’s newest therapy tricks is the use of The Point of Care (POC) functionality provided by Optima. Marita first was drawn to documentation on POC due to its portability. After a couple uses of the system, she began to understand the user-friendly features which made her more efficient. One of Marita’s pain points, however, is that the goal build function does take longer than what she is used to when documenting on COM (the web-based documentation platform utilized via laptop and desktop). She now typically uses narrative vs the build function which is a blessing in disguise since created goals are now more individualized to meet resident needs.

Another time saving feature Marita described as user-friendly is the ability to bring up all past notes when completing a progress report so the skilled interventions data is able to be easily reviewed. Marita has some advice for new POC users, “Get a peer to help you navigate the Chromebook if you are not techy. Also, it’s a good move to keep a copy of the training manual with you the first one or two times you use POC.”

All in all, Marita is glad to have the use of POC as a documentation option. In a building with a total of nine therapists, there is a possibility to have a device with you to document at all times which in her opinion is a “game-changer.”

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!”

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The Proof is in the GG

By: Sheena Mattingly, Director of Clinical Outcomes

In case you are in need of a recap, let’s start from the beginning. PDPM came into our lives on October 1, 2019. IDT processes and collaborative effort toward patient-centered care became even more imperative. Therapy remained a necessity in the recovery process under the methodology. The Centers for Medicare & Medicaid Services made it clear as mud that they will be looking at provision of services and outcomes. Presumably, medical review will surround any substantial changes in these areas. Let us also not forget that outcomes are publicly reported and impact quality measures, QRP, VBP, five-star, and so much more. Now that you are all caught up, let’s get to the good stuff!

HTS has shown improved Section GG outcomes when FY2019 is compared to the first six months post PDPM implementation.

So, what does this mean? If outcomes are equal to or above historic values, there is less risk for medical review and it means patient care and delivery is not compromised under PDPM. Also, improved outcomes provide further evidence of the great care HTS therapists deliver…even during a Public Health Emergency!

The proof is in the GG but in case you want more, check out the list below to see just a few more accomplishments from the past couple months:

  • Outpatient clinics are back up and running at almost full capacity!
  • Therapists are now equipped to use two new delivery service modes: telecommunication technology and telehealth.
  • Procedures such as cleaning, disinfecting, and sanitizing have been successfully implemented company-wide in order to mitigate risk of exposure to COVID-19.
  • Therapists have utilized a new Treatment Hierarchy Guide provided by HTS to help prioritize the treatment visits and provide services in a sequential manner according to priority level to further mitigate risk of exposure.
  • The Breathe Program introduced in April has improved pulmonary intervention for patients.
  • Therapists have demonstrated commitment to best practice by accommodating new regulation and compliance standards due to the public health emergency with quick turnaround time! This has allowed HTS to continue to provide services to patients in need during uncertain times.

The Bottom Line… HTS therapists have been rocking it out even harder than ever before and for that we thank you!

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Keep Moving for Better Health

As we get older, society tells us to take it easy and rest. However, research shows that this whole “sitting around all day” can actually do us more harm than good. According to the CDC, statistics show that 75% of older adults are sedentary.

Having an inactive lifestyle can be very harmful to your health. Sitting for long hours a day can decrease your bone density and heighten your risk for a heart attack or stroke. Physical activity is an important part of healthy aging.

Ask yourself these questions…
• Do You Ever Feel Tired?
• Do You Have Unexplained Aches and Pains?
• Are You Afraid That You Might Fall or Injure Yourself?

If you answered “yes”, you may want to consider adding a little exercise to your life. This doesn’t mean you need to go out and join a gym, many things can count as exercise like walking, gardening, cleaning, swimming, and dancing. At all ages, some physical activity is better than doing none.

Therapy Can Help Adults Stay Active & Independent

Physical therapists can teach you how to exercise appropriately for joint mobility, muscle strength and fitness. Occupational therapists help older adults to safely do the things they want to do, stay active and live well despite limitations. Talk to your doctor today about the benefits of physical and occupational therapy!

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Q4FY19 PEPPER Now Available for Download

SNF PEPPER summarizes data statistics which are obtained from paid SNF Medicare UB-04 Claims for SNF episodes of care that end in the most recent three federal fiscal years (the federal fiscal year spans October 1-September 30). The current version of PEPPER now available reviews episodes of care through quarter 4 of FY2019 including statistics for 2017, 2018, and 2019. SNFs are compared to other SNFS in three comparison groups: nation, MAC, and state. These comparisons enable a SNF to determine if their results differ from other SNFs and whether it is an outlier and/or at risk for improper payments.

Target Area Updates

The following RUGs focused target areas will be phased out for FY2020 as a result of PDPM: Therapy RUGS with High ADL, Nontherapy RUGs with High ADL, Change of Therapy Assessment, & Ultrahigh Therapy RUGS. These target areas are included in the current FY2019 report along with the target areas: 20-day episodes of care, 90+ day episodes of care, and a new target area: 3-5 day readmissions which reviews readmissions to the SNF following a 3-5 calendar day gap. Please note this target area will not reflect claims until FY2020 and is intended to give providers information on readmission practices before and after PDPM implementation in order to assess the level to which facilities “may attempt to circumvent interrupted stay rules.”

Please click here for a table of target area definitions and suggestions.

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New SNF QRP COVID-19 Tip Sheet Now Available!

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.

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