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Collaborating for a successful transition to the new Medicare payment model

HTS is excited to collaborate with our partners for a successful transition to the new Medicare payment model. Our ongoing focus on clinical quality, patient-centered programs, and functional outcomes has prepared our staff in advance to succeed under PDPM. In addition to implementing proprietary clinical program efficacy analysis, HTS has assessed the financial impact of PDPM and is committed to supporting our partners through the challenges of adapting to the new reimbursement model.

HTS will be providing PDPM solutions that include:

  • Staff Education and Training in Critical Areas such as Section GG and ICD.10 Coding
  • PDPM Live Trainings for Partners and Staff in Multiple Locations
  • Internal System Transitions
  • RUGs IV to PDPM Facility-specific Impact Analysis

Our alliance with Proactive Medical Review, the PDPM experts currently providing education on this topic to 25 states, allows us to uniquely provide our partners with additional support for strategic planning, MDS coding efficacy, and nursing best practices.

Patient-Driven Payment Model (PDPM) training dates:

  • Friday, September 21 – Evansville, IN
  • Thursday, October 4 – Fort Wayne, IN
  • Thursday, October 11 – Louisville, KY
  • Tuesday, October 16 – Greenwood, IN
  • Tuesday, October 23 – Kokomo, IN
  • Friday, November 9 – Edmonton, KY
  • Thursday November 15—Phelps, KY

We remain optimistic considering the enormous changes we are facing with this new payment model. As partners in therapy, you can be confident in our resources and unmatched expertise to navigate this change while working together toward a successful transition.

If you have any questions at all about this information, please contact us directly.

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October is Physical Therapy Month

National Physical Therapy Month is a celebration held each October by the American Physical Therapy Association (APTA). PT month is designed to recognize the impact that physical therapists and physical therapist assistants make in restoring and improving motion in people’s lives. Physical therapists are movement experts who can help you overcome pain, gain and maintain movement, and preserve your independence, often without the need for surgery or long-term use of prescription drugs. Physical therapy is a cost-effective treatment that allows patients to participate in a recovery plan designed for their specific needs.

Goals of physical therapy include:

  • Restore physical function
  • Improve the ability to ambulate
  • Strengthen the body affected by injury/illness
  • Reduce pain and inflammation
  • Education and prevention

We offer comprehensive rehabilitation services including physical, occupational and speech therapy. Our therapists are experts in treating conditions affecting adults ages 50+. Therapy is a cost-effective treatment that allows patients to participate in a recovery plan designed for their specific needs to regain function and independence for a better quality of life.

For more information, contact www.htstherapy.com.

 

October is National Physical Therapy Month!
National Physical Therapy Month is designed to recognize the impact that physical therapists and physical therapist assistants make in restoring and improving motion in people’s lives. Physical therapy may be necessary for those recovering after an illness, a fall, injury, surgery or chronic condition. Physical therapists work hard to help patients retain and regain their quality of life.

 

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

 

Resource: APTA, www.apta.org

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Prevent and Manage Functional Decline in Active Adults – Including Fall Risk Management

As the average age of entry for licensed assisted living is 85 years of age, senior living providers are very focused on keeping their residents as independent for as long as possible. As a provider of contract physical, occupational and speech therapy in Assisted Living and Continuing Care Retirement Communities (CCRCs), our goal is to proactively address functional and cognitive decline so that residents can maintain their highest level of ability. From what we see on a daily basis, and reviewing ER admissions and national reports, most functional declines in active adults happen because of five primary reasons:

Lack of muscle building exercise

  1. Environmental factors
  2. Chronic illness
  3. New injury or illness
  4. Medications

Functional decline means that a person shows a decreased ability to do daily tasks properly compared to their ability to do these same tasks three months prior. A decline often signifies the presence of an acute onset, a new underlying medical condition or exacerbation of an existing condition.

Falls are the single largest reason of decline among active adults. Falls can happen any due to any of the five primary reasons listed above. Think of a fall as the ultimate loss of balance. There are multiple factors to a fall that present themselves well before a fall takes place. Through QAPI, standardized therapy testing and formalized Fall Risk Management programs, we are able to peel back the layers to determine “root cause” for the fall. A strong Fall Risk Management program is often tailored to treating the root cause factor that caused the fall, rather than all of the risk factors a patient has for falling. Falls are due to intrinsic factors (illness or medications) may not be prevented easily. Falls due to extrinsic factors (environmental factors) can be prevented or significantly reduced with extra precautions and education.

Provision of safety devices such as: grab bars & handles, high friction floors and footwear, as well as even (meaning no shadows to throw off depth perception) high power lighting can prevent or reduce a significant number of environmental falls. Regular exercise focused on core and lower body strength, consistent monitoring of and review of medications and therapeutic interventions for ongoing medical problems can significantly help to reduce the number of falls associated functional decline.

Functional Decline could be physical and/or cognitive in nature. When partnering with senior living providers, we take special care to train all staff including environmental, housekeeping and dietary to identify functional and cognitive decline. This could be anything from “furniture walkers”, increased maintenance calls to someone coughing through a meal in the dining room. There are consistent characteristics for a resident at risk for falling:

  • Functional decline include difficulty with ADLs (Activities of Daily Living) such as dressing or undressing safely.
  • Lack of balance, any unexplained bruises
  • Loss of flexibility
  • New pain, taking more medication than usual
  • New medication
  • Significant weight loss within 30 days
  • Speech impairment or inability to follow simple commands
  • Signs of anti-social behavior or depression, not participating in life enrichment as usual
  • Decreased activity tolerance or coordination, lack of attention
  • Decreased stamina or strength.

Everyone working around active adults should be trained and be able to report a decline to the clinical team. Although prevention is best for any decline, recognizing and reporting resident declines in a timely manner helps to manage the decline efficiently. Timely intervention will help the resident maintain or regain functional independence.

Aretoula Nahas is a Physical Therapist Assistant (PTA) and the Director of Outpatient Services for Healthcare Therapy Services, Inc. (HTS). HTS is an independent, therapist-owned contract provider of physical, occupational, speech therapy and wellness for assisted living, skilled nursing facilities and hospitals. HTS currently employs over 1,800 therapists and provides contract rehabilitation to over 100 clients in Indiana, Kentucky, Tennessee, Michigan and Ohio. For more information, contact www.htstherapy.com.

 

October is National Physical Therapy Month!
National Physical Therapy Month is designed to recognize the impact that physical therapists and physical therapist assistants make in restoring and improving motion in people’s lives. Physical therapy may be necessary for those recovering after an illness, a fall, injury, surgery or chronic condition. Physical therapists work hard to help patients retain and regain their quality of life.

 

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

 

Resource: APTA, www.apta.org

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An On-site Outpatient Therapy Program Specialized for Assisted Living

Finding the right therapy provider for your building can be a challenge. As assisted living providers handle increasing clinical complexity, you need quality rich, expertly delivered rehabilitation to meet the unique needs of each resident.

You need a therapy partner with expertise in the senior care industry that collaborate with your staff, doctors, hospitals and home care providers to provide a well‐rounded, strategic approach to aging in place.

Experts in Therapy for Senior Living Providers

Your Complete On-site Outpatient Therapy Program Includes:

  • Physical, Occupational & Speech Therapy Up To 7 Days a Week
  • Complete Management, Staffing, Scheduling and Billing
  • Therapy Exercise Equipment & Technology
  • Patient Satisfaction & Outcome Measures
  • Comprehensive Value—Added Services and Programs
  • Close Collaboration with Physician—Therapy is Directed by the Physician and Progress is Noted at Each Session and Communicated.

Set Your Community Apart

60+ Clinical Pathways
We utilize current practice standards and evolve clinical programs to achieve the maximum potential for even the most clinically complex patients.

  • Fall Prevention
  • Bone & Joint Recovery
  • Cardiac Recovery
  • Stroke/CVA
  • Pain Management
  • Arthritis

Dementia Specialization
HTS therapists are highly trained in maximizing each person’s ability with a dementia diagnosis. Our Embracing the Cognitive Spectrum Dementia Care modules are designed to provide person‐centered and intentional care delivery, while coaching your staff on programming and care mapping.

All Staff Training & Care Collaboration
Prevent and decrease resident falls with root cause-based programming. Improve strength, self care and confidence. Reduce hospital readmissions. Utilize training to all of your staff to address resident decline at every level. Work closely with home health care and other providers to develop and execute a collaborative care plan.

Improve Census & Outreach
Help create your message to share the benefits of having on-site outpatient therapy. Full marketing collaboration to increase your occupancy and provide a competitive advantage over your competition. Customized marketing strategies to strengthen outreach efforts to hospitals, physicians and community.

Whole-Person Wellness
We provide you with your own customized whole‐person wellness program including health and wellness assessments and workshops to create a powerful all‐campus program that improves the lives of every resident in your building. Wellness software that provides measurable outcomes. Library of specialty classes including personal training.

Keep Your Residents Strong, Independent & Living to the Fullest

  • Proactively Prevent and Reduce Risk for Falls
  • Maintain & Improve Mobility
  • Address Even the Subtlest Declines in Physical and Cognitive Health
  • Improve Activities of Daily Living
  • Improve Cardiopulmonary Health
  • Improve Muscle Strength & Stamina
  • In-depth Cognition Testing for Those Challenged with Memory Impairment
  • Reduce Effects of Progressive Conditions, like MS, Parkinson’s & Dementia
  • Improve Confidence in Social Situations
  • Teach Compensation Skills to Residents, Caregivers & Families
  • Initiate Wellness & Promote Successful Aging

 

 

October is National Physical Therapy Month!
National Physical Therapy Month is designed to recognize the impact that physical therapists and physical therapist assistants make in restoring and improving motion in people’s lives. Physical therapy may be necessary for those recovering after an illness, a fall, injury, surgery or chronic condition. Physical therapists work hard to help patients retain and regain their quality of life.

 

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

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Balance & Fall Prevention

Balance disorders are very common in older adults and are a major cause of falls. Balance problems can lead to injury, disability, loss of independence, and a limited quality of life. Maintaining proper balance and sense of body position is critical to preventing falls.

Therapy Can Help Reduce and Prevent Falls

Improve Balance: A Physical Therapist will assess your ability to balance while performing many activities. They will work with you on specific exercises that will train you on balancing while doing things such as catch a ball or reach for an item.

Build Endurance: Getting fatigued while walking can increase your risk of falling. Therapy can help you gain endurance through supportive exercises.

Increase Strength: Therapy will focus on strengthening your leg, hip and core muscles. These muscles are essential to mobility and will lessen your likelihood of falling.

Safety Awareness: Your therapist can make recommendations on how to make your living space safer in order to prevent falls. Also, help you with learning to walk with a cane or walker and adjust it to fit your height specifications.

October is National Physical Therapy Month!
National Physical Therapy Month is designed to recognize the impact that physical therapists and physical therapist assistants make in restoring and improving motion in people’s lives. Physical therapy may be necessary for those recovering after an illness, a fall, injury, surgery or chronic condition. Physical therapists work hard to help patients retain and regain their quality of life.

 

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

 

Resource: APTA, www.apta.org

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Maintaining Balance As You Age

Good balance is being able to easily control and maintain your body’s position. Maintaining good balance and sense of body position is critical to preventing falls. Falling is the ultimate loss of balance and the leading cause of debilitating injury and premature death in older adults. Good balance is being able to easily control and maintain your body’s position. Maintaining good balance and sense of body position is critical to preventing falls. Falling is the ultimate loss of balance and the leading cause of debilitating injury and premature death in older adults.  Each year, 1 in 3 adults over 65 fall each year. With millions of people falling each year, less than half will contact their doctor for help.

Common Risk Factors of Poor Balance:

  • Lower Body Weakness
  • Foot Pain / Poor Footwear
  • Difficulty Walking & Balancing
  • Vision Issues
  • Medications Causing Dizziness
  • Hazards in Your Home

What You Can Do to Prevent Falls?

Falls can be prevented. By following these tips, you can reduce your risk for falling.

  1. Ask your healthcare provider to review your medications.
  2. Begin an exercise program to improve your leg strength and balance.
  3. Get an annual eye exam. Replace eyeglasses as needed.
  4. Make your home safer. Remove clutter and tripping hazards.

Therapy Can Help Reduce Falls & Improve Balance

A physical therapist works with individuals to identify risk factors and designs an individualized program of exercises and activities with an emphasis on strength, flexibility, and proper gait. Balance may be improved with exercises that strengthen the core, back, ankle, knee, and hip muscles along with exercises that improve the function of the balance system. Occupational therapists work with you to discuss changes and modifications that can be made around your home to help prevent falls from occurring.

If you have concerns about your balance, ask your doctor if therapy can help. When you receive a doctor’s order for therapy, our physical therapy team can start immediately to help your balance and fear of falling.

Resource: www.cdc.gov/steadi/; www.healthinaging.org

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CMS Issued the FY2019 SNF PPS Final Rule

As anticipated, the change to the Patient-Driven Payment Model (PDPM) was finalized to go into effect October 1, 2019 (FY 2020). CMS noted that this allows providers one year to prepare for this fundamental change from the RUG-IV case-mix model to the new PDPM methodology which is based on patient condition and care needs. Preparations will involve staff education and training, internal system transitions, software development, and impact analysis. The final version of PDPM is largely the same as proposed earlier this year.

Additionally, the rule finalizes the 2.4% market basket increase for SNFs as required by the Bipartisan Budget Act of 2018 which will result in an overall increase in Medicare payments to SNFs of $820 million (effective 10/1/18). There were no new measures adopted for the SNF Quality Reporting Program (SNF QRP); however, CMS is including an added factor to consider for removal of measures for the SNF QRP.

CMS will publicly display the four assessment-based quality measures and increase the number of years of data used to display the two claims-based SNF QRP measures from one year to two years (Discharge to the Community and Medicare Spending Per Beneficiary). The SNF Value-Based Purchasing Program using the one claims-based measure (all cause 30-day hospital readmission measure) continues with updates to policies and an adjustment to the scoring methodology and an Extraordinary Circumstances Exception (ECE) policy.

Links for CMS details:

FY 2019 SNF PPS Final Rule Fact Sheet:
www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-07-31-3.html

FY 2019 Final Rule (pre-publication copy):
https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-16570.pdf

This fall HTS will offer extensive education and training for our therapy staff and our partners in multiple locations to prepare for PDPM. Look for upcoming details.

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3 Stretches to Ease Lower Back Pain

Chronic and acute back pain can be debilitating and very disruptive to your daily life. Back pain can range from a dull constant ache to a sudden sharp pain that makes it uncomfortable to move. Acute back pain lasts a few days to a few weeks and will usually get better on its own. Chronic back pain lasts for more than three months. If you are experiencing back pain there are many ways to treat it, depending on the type of pain you experience and its root cause. Some common methods of treatment include hot/cold packs, exercise, physical therapy, injections, and surgery.

Research suggests that core strengthening exercises and stretching can be the best way to ease back pain. As we age, our muscles become shorter and lose their elasticity. By stretching the muscles in your back, you strengthen them. As your muscles become stronger you begin to avoid pain, improve posture and range of motion, and maintain a higher quality of life.

These simple stretches may help you treat and avoid acute back pain:

Piriformis Stretch: Lie on your back and cross one leg over the other; gently pull the knee toward the chest until a stretch is felt in the buttock area. Hold for 30 seconds. Rest. Repeat 3 times.

Back Stretch: Lie on your stomach. Use your arms to push your upper body off the floor. Hold for 30 seconds. Let your back relax and sag. Repeat.

Seated Gentle Back Bend: Starting seated, feet flat on the floor. Bring your hands to your lower back, with your fingers facing down and thumbs wrapped around your hips toward the front of your body. Press your hands firmly into your hips/lower back and inhale. As you exhale, gently arch your spine, leading with your head. Your chin should be tilted up, face to the ceiling. Hold for 5 full, deep breaths. Gently and slowly come back to the neutral starting position. Repeat 3 to 5 times.

*Stretches should never cause pain. Stop immediately if you feel any discomfort. Consult with your doctor before starting a new exercise program.

How Therapy Can Help

If these simple stretches don’t alleviate your back pain, physical therapy may be an option for you! A physical therapist will assess your condition and come up with an individualized treatment plan with key exercises to improve your condition. Talk to your doctor today about how physical therapy could help!

 

Source: American Chiropractic Association, National Institute of Arthritis

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Fun Ways to Stay Active Indoors this Summer

Summer allows us to enjoy many outdoor activities and time with family and friends. Barbecues, swimming, and trips to the beach make summer an exceptional time of year! For aging adults, the summer months can also be hazardous to your health. Problems like dehydration, sunburn and exasperation of pre-existing conditions are common after too much sun exposure. It’s important to stay safe when the temperature rises.

Staying active is very important no matter the season. On days when the summer sun is too intense for outdoor activities, moving indoors may be the best option. Here are some fun activities older adults can do to stay active and beat the heat:

  1. Get your steps in and explore a museum or aquarium
  2. Visit a local senior center to socialize and enjoy outings and activities
  3. Take dance lessons for a fun way to stay active
  4. Walk and window shop at an indoor shopping mall
  5. Join a health club that offers group fitness and aquatic classes
  6. Go bowling with friends or join a bowling league
  7. Workout at home with weights and bands or invest in easy-to-use home gym equipment

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. It can help strengthen the muscles around your joints, help you maintain bone strength, give you more energy to get through the day, help you control your weight, improve your balance and help you enhance your quality of life. 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 therapy!

Cool off this summer with a refreshing slice of watermelon!
At 92% water, this favorite summer snack is a great source of hydration and loaded with essential vitamins. Watermelon also contains high levels of the antioxidant lycopene, a famous cancer-fighting substance found in tomatoes.

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7 Things We Know Up-front About the Patient-Driven Payment Model (PDPM)

HTS is feeling optimistic as we read the latest reimbursement model change proposed by CMS and released late afternoon on Friday, April 27th. If you haven’t had the chance to dive into RSC-1, this was gearing up to be the biggest reimbursement overhaul since PPS.

The RSC-1 has now been modified and renamed to the Patient-Driven Payment Model (PDPM). The new model is designed to improve the incentives to treat the needs of the whole patient, instead of focusing on the volume of services the patient receives. CMS noted that RCS-1 received considerable feedback expressing concerns with the complexity of RCS-1. As a result, CMS has made significant changes that we are feeling pretty good about. If passed, this would take place starting October 1, 2019 — which means we don’t have much time before it becomes reality.

 

Here are 7 things we know up front about the PDPM changes to note:

  1. PDPM will be Much Less Complex than RSC-1
    Under the RSC-1, there were actually over 130,000 different possible classifications. The PDPM reduces this by nearly 80%. RUGs will certainly be going away, but this may make the reimbursement calculations much less of headache for all parties involved.
  2. Therapy is Detailed in the Discharge PPS Assessment
    A proposed modified section O requires PT, OT and ST details on all PPS discharge assessments for all Medicare A discharges (including those who DC from the facility). Therapy details include: start and end dates, total individual minutes provided, total concurrent minutes provided, total group minutes provided, and total days provided. This may be CMS’s way of safeguarding against underproviding and ensuring that patients receive what they need versus greatly reducing or eliminating necessary therapy services.
  3. PT & OT are Separate Payment Categories
    Under the RSC-1 model, PT and OT were a combined payment and ST was considered separate. Noting the obvious concerns, we are happy that each discipline will receive their own payment classification. Additionally, the new model eliminates the cognitive impairment factor from the PT and OT classification.
  4. Group & Concurrent Allow for a Total of 25%
     Under RSC-1, it was proposed to allow 25% group therapy and 25% concurrent therapy. Under the PDPM, there is a 25% group and concurrent therapy combined allotment.
  5. Section GG is Even MORE Important
     Replacing section G with GG for the functional component is required for PT & OT payment classifications, as well as,nursing case-mix classification. 6 areas are scored and totaled for the functional measure: eating, oral hygiene, toileting, sit-to-lying, lying-to-sitting on bed, sit-to-stand, chair/bed-to-chair, toilet transfer, walk 50 feet with 2 turns, and walk 150 feet. HTS implemented mandatory use of the CARE Tool for all therapists in 2014 to ensure that our outcomes and benchmarks are congruent with CMS.
  6. Reduced Burden of Multiple Assessments
     The reduction in required assessments as proposed with RCS-1 remains in the PDPM. Only 2 PPS assessments are required: 5-day assessment and D/C Assessment. PDPM adds an optional “Interim Payment Assessment” (IPA) which would allow for a resident to be re-classified if criteria are met.
  7. Reduction in Reimbursement with Length of Stay
    PDPM calls for reduction in reimbursement correlating with length of stay for PT, OT, and Non-Therapy Ancillary (NTA) classifications. For PT and OT, days 1-20 would be reimbursed at the full rate. On day 21, a decreasing adjustment factor of 2% is applied every 7 days throughout the remainder of the stay. NTA days 1-3 are reimbursed at an increased adjustment factor of 3. Day 4 through the remainder of the stay, the reimbursement is adjusted to a factor of 1. These adjustments are based on Medicare’s research indicating PT, OT, and NTA costs decrease the longer the resident stays.
Read More About the PDPM:

We Are Optimistic and Committed

We continue to be optimistic considering the enormous changes we are facing with this new payment model. CMS has an open forum and NASL and other groups are already collaborating on the details. CMS posted provider-specific impact data reflecting FY 2017 payment under RUG-IV compared with what the payment would have been under PDPM. After a full review, the total payment was indeed budget neutral.

You may view your SNF’s impact by following the link above (“CMS provided tools”). As we know more information, we will gladly pass it along. We are committed to being good partners in rehabilitation by informing our clients and colleagues with the most up to date information on rehabilitation and post-acute care.

Cassie Murray, OTR, QCP, IASSC CYB
Executive Director of Clinical Services
Healthcare Therapy Services, Inc.
cmurray@htstherapy.com | 800.486.4449 ext 210

HTS is a leading contract therapy and wellness provider in the Midwest. As the trusted authority in post-acute rehabilitation, our clients look to us to not only maintain exceptional clinical collaboration and outcomes, but also to be a trusted partner in helping their organizations perform better. Since 1988, HTS has been an independently owned, trusted, ethical provider of therapy services for senior living communities, home health agencies and hospitals.

Therapist owned and managed, our mission is to provide the very best people and programs to move our clients and employees forward so that together we can provide a “hope and a future” Jeremiah 29:11 to those we serve. We have grown from a single provider (who has been a longstanding client since 1988) to a company employing over 1,800 therapists in the Midwest and Southern states.

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