Final Rule Released: What You Need to Know to Win the Race to October 1st

The Centers for Medicare and Medicaid Services issued the FY 2020 Skilled Nursing Facility Prospective Payment System Final Rule which will take effect on October 1, 2019.  This rule finalizes payment policies for Medicare Part A in SNFs and updates the SNF Quality Reporting and Value-Based Purchasing Programs. Below are the highlights:

  • SNF market basket percentage is 2.4% or $851 million for FY 2020 (decreased from the proposed update of 2.5%).
  • The unadjusted urban and rural federal per diem rates will decrease slightly compared to the proposed rule rates.
  • Come October 1, 2019, group therapy will be defined as, “a qualified rehabilitation therapist or therapy assistant treating two to six patients at the same time who are preforming the same or similar activities.”
  • The sub-regulatory process for updating the ICD-10 codes used to classify patients under PDPM has been finalized for FY 2020.
  • Two new quality measures for the SNF QRP related to transfer of health information have been adopted.
  • Baseline nursing home residents will be excluded from the Discharge to Community Measure.
  • The quality measure for Drug Regimen Review Conducted with Follow-Up for Identified Issues will be publicly displayed.
  • The “5-Day Assessment” will be called “Initial Medicare Assessment.”
  • Clarification on the optional Interim Payment Assessment was provided stating, “…the SNF’s underlying responsibility to remain fully aware of (and respond appropriately to) any changes in its resident’s condition is in no way discretionary. Moreover, the discussion of the IPA in the FY 2019 SNF PPS final rule (83 FR 39233) clearly envisions a role for this assessment that is not strictly limited to payment alone: “We continue to believe that it is necessary for SNFs to continually monitor the clinical status of each and every patient in the facility regularly regardless of payment or assessment requirements and we believe that there should be a mechanism in place that would allow facilities to do this.” At the same time, in making the IPA optional, we recognized “. . . that providers may be best situated, as in the case of the Significant Change in Status Assessment, to determine when a change has occurred that should be reported through the IPA.”

 

For more information see  the CMS Press Release and Fact Sheet.

HTS is not only your partner in therapy – Power through PDPM with HTS’ strategies for success. HTS is able to provide comprehensive tools, policies, clinical pathways and education at all levels to ensure success under PDPM. Contact us today for more information on the HTS Partner Plus Program.

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HTS Hosted Site Visit for US Senator

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

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QIO Contract Updates

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.

Move More. Sit Less.

According to the CDC, more than 25% of all American adults sit more than 8 hours a day. In fact, adults spend more time sitting and being couch potatoes than sleeping. That number increases even more for older adults; statistics show that 75% of older adults are sedentary.

Sitting too much can be very harmful to your health. Numerous research studies show that the more you move and stop sitting, the longer you will live. Sitting too much increases your risk of obesity, diabetes, cancer and early death.

What Happens to Your Body When You Sit?

  • Electrical Activity in Leg Muscles Shuts Off
  • Calorie Burning Drops to 1 per Minute
  • Enzymes that Help Break Down Fat Drop by 90%
  • Good Cholesterol Drops by 20%
  • High Amounts of Stress are Placed on Your Lower Back and Neck

 

The World Health Organization suggests adults aged 65 years and above should do at least 150 minutes of moderate-intensity physical activity throughout the week. Regular physical activity of moderate intensity has significant benefits for health. At all ages, some physical activity is better than doing none. By becoming more active throughout the day in relatively simple ways, people can quite easily achieve the recommended activity levels. Walking is the easiest form of exercise for older adults and swimming is a good option as well.

 

Therapy Can Help Aging Adults Stay Active & Independent

Exercise is extremely important in managing many common symptoms of aging. Physical therapists evaluate your needs and 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. Therapy can help with pain associated with sitting too much, address postural issues, and create strategies to get you moving more and sitting less.

References: World Health Organization, CDC, AARP.org

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We’re proud to be partners with Byron, changing lives.

Byron Health Center Fights to End Alzheimer’s
Byron is a class act group who laughs in the face of mediocrity and never stops challenging the status quo. Be sure to follow them on Facebook and check out their gorgeous website as they recreate senior living at their new location coming soon! We are proud to be your partner in therapy and changing lives!

Follow along with our Facebook page to see how we’re helping communities just like yours!

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Congratulations, Ripley Crossing!

Ripley Crossing Receives National Accreditation For Excellence
Congratulations, Ripley Crossing and thank you for your commitment to quality! We are proud to be your partner in therapy.

Follow along with our Facebook page to see how we’re helping communities just like yours!

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We’re proud of our community partners and patients!

We LOVE our friends and partners at Golden Years Homestead!

Set Your Community Apart with Rehab Services
HTS Outpatient Rehabilitation provides your senior living community with convenient, on-site therapy and wellness services to support independence, safety and quality of life for your residents. We provide the very best in programming, equipment and care collaboration to restore your residents to their maximum potential.

Follow along with our Facebook page to see how we’re helping communities just like yours!

Managing Chronic Pain

Physical & Occupational Therapy

More people in America suffer from pain than diabetes, cancer and heart disease combined. When pain lasts for a long time (more than 6 months), it is called chronic pain. Chronic pain affects more than 130 million Americans.

“Older Adults should not accept pain as a common and accepted part of ageing.
There are ways to manage it.” – American Chronic Pain Association

 

Managing & Treating Your Pain

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 therapists can assess your chronic pain and 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 therapists understand that pain is subjective and complex. OT’s work to evaluate how pain may be impacting your desired activities and quality of life. They can teach skills and strategies to help 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 therapy and a combination of heat and cooling therapies may be used to reduce pain.

If pain is affecting your ability to perform daily tasks or keeping you from enjoying activities, talk with
your doctor about physical and occupational therapy treatment options.

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The Leading Age Spring Conference & Trade Show 2019

The Spring Conference Season has Sprung!

HTS leadership and corporate office team members exhibited at the Leading Age Indiana Spring Trade Show on May 6th, 2019 in Indianapolis. It was wonderful to see our partnering communities and hear all the wonderful things they have to say about our therapists. Hot topics this year included staff retention and PDPM.

Pictured left to right: Holly Skidmore, Shaleen Bhatnagar, Katie Grissom, Amanda Green, Cassie Murray, Steve Chatham and Kory Coleman.

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Quality Speech Therapy Programming Under PDPM: 5 Things You Need to Know

Article by:  Sheena Mattingly, HTS Clinical Specialist

Speech Therapy’s role is going to become exceedingly important under PDPM. This is due to the change in reimbursement which will be focused on patient characteristics rather than therapy minutes. Here are the top 5 things you need to know:

  1. Medical complexity and clinical outcomes are the basis for the new patient-driven payment model (PDPM). SLPs will play an important role in determining SNF payment which will require system optimization for timeliness in order to code the most accurate information.
  2. PDPM does not change coverage criteria for skilled care. SNF care is still only covered if all four of the following are met:
    • SNF or skilled rehab services are required to be performed by or under the supervision of professional or technical personnel and is ordered by a physician for the condition which the patient received inpatient hospital services.
    • Skilled services are required daily.
    • Daily skilled services can only be provided on an inpatient basis in a SNF.
    • Services delivered are consistent with the nature of the severity of the illness or injury, medical needs, and accepted standards of medical practice, and are reasonable in duration and quantity.
  3. Understanding the components related to the payment model will help with adjustment to the new system. The need for ST is related to the presence of a swallowing disorder, a mechanically altered diet, a ST comorbidity related, and/or cognitive impairment. Combinations of these characteristics produce 12 ST case-mix groups. Our data analytics have observed a trend in need for optimization especially in section K of the MDS. For this reason, we have created tools and resources to help your SLP, dietician, and nursing staff code section K. Please contact us today for more information!
  4. Sections B, C, K, and I are crucial for accurate coding for the ST reimbursement component. Check out our 5 Day Assessment Tool to optimize IDT communication to improve your coding.
  5. CMS will monitor provider practice during PDPM implementation to audit changes in volume and intensity of therapy services, compliance with group and concurrent therapy limit, and coding practices.