Discharge Function Score

Imagine the interdisciplinary team at a SNF preparing to capture a snapshot of a patient’s readiness to “leave the nest” of the healthcare facility to return to their home. It’s a multifaceted process, assessing everything from how smoothly they move to how adeptly they tackle daily tasks.

 

Out with the Old. In with the New.

Currently, healthcare providers and therapists, armed with tools like the Functional Independence Measure or the Barthel Index meticulously assess every aspect of a patient’s functional prowess. Can they stride down the hallway? Can they complete daily tasks such as eating and oral hygiene without breaking a sweat? These scores paint a vivid portrait of their independence and self-sufficiency.

October 2024: CMS will replace the Percentage of Residents Who Made Improvements in Function (Short Stay) measure with the new Discharge Function Score measure which was finalized in the FY2024 SNF PPS Final Rule for use in the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) and the SNF Value-Based Purchasing (VBP) program. The remaining four measures will remain frozen until January 2025 while the data for the equivalent measures are collected.

The new Discharge Function Score Measure determines how successful each SNF is at
achieving an expected level of functional ability for its patients at discharge.

 

Why Should You Care About The Discharge Function Score?

These scores aren’t just numbers in a chart; they’re the cornerstone of how CMS will determine if the patient function is progressing in a manner that is expected and will be used in the SNF Quality Reporting Program. The final Discharge Function Score for a given SNF is the proportion of that SNF’s stays where a resident’s observed discharge score meets or exceeds their expected discharge score. According to CMS, SNFs with low scores are “not producing the functional gains they could be for a larger share of their patients.”

And let’s face it, this measure’s first year in the program is 2027 which is fast approaching. The first performance period begins FY 2025 (October 1, 2025) and everyone needs to be prepared.

 

The Roles of Each Stakeholder

We have been preparing each therapist through the ongoing education of Section GG. HTS Therapists continually receive additional education, auditing, and coaching to ensure accuracy. Therapy will be coding Section GG as is the norm. However, this is a great time and opportunity to modify your systems so that a collaborative approach from all stakeholders is well-defined when coding Section GG on the MDS. Also, it is of utmost importance that facilities ensure information is being coded to the best of their ability. Otherwise, statistical imputation occurs and it could skew data to seem like the facility isn’t doing as well as it could have been if the information had been input as intended.

Therefore, when you hear about a discharge function score, remember—it’s definitely not just a number. It is the key to showing a SNF’s collaborative, interdisciplinary approach to rehabilitating a patient to their prior level of function as expected.

For additional information, view the CMS Discharge Function Score for SNFs Technical Reports: snf-discharge-function-score-technical-report-february-2023.pdf (cms.gov)

 

HTS Partners, feel free to contact me or your Regional Director for more information. As your partner in therapy, we will continue to keep you apprised of this topic along with many others.

Written by: Sheena Mattingly, M.S., CCC-SLP, RAC-CT

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When to Use a Cane or Walker – Tips from Therapy

Staying mobile and independent is key to living a fun and active life. But as you get older or recover from injuries, it may be necessary to use a walking aid to help you stay steady and get around safely.

 

Cane: A cane is great if you need a little extra support and balance. It’s perfect if you have mild pain in one leg or hip, feel unsteady while walking, or need extra support on one side of your body after a minor injury.

  • The handle should line up with your wrist when you’re standing.
  • Hold the cane on your stronger side to help you balance better.
  • Move the cane forward at the same time as your weaker leg.

Walker: A walker gives more stability and support than a cane and is perfect if you have major balance issues, feel unsteady often or have frequent falls, or need support while recovering from surgery or an injury that affects both legs.

  • The handles should line up with your wrist when you stand straight.
  • Push the walker slightly ahead of you, then step forward with your weaker leg first, and bring your stronger leg in line.
  • Stand straight and avoid leaning too far forward or hunching over the walker.

 

How Therapy Can Help

Physical and occupational therapy can make a big difference if you’re dealing with mobility issues. Therapists work with you to improve your strength and balance, helping you to move more easily. They can also teach you how to use canes, walkers, and other aids properly, ensuring you get the most benefit from them.

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A Little Sunshine to Brighten Your Health

One simple yet powerful way to support our health is by spending a little time in the sun. Exposure to sunlight offers a host of benefits, from enhancing your mood to strengthening your bones.

Key Health Advantages of Soaking up Some Sunshine:

  • Enhance Your Mood: Sunlight increases serotonin levels, a hormone that boosts mood and promotes a sense of well-being.
  • Better Sleep Quality: A daily dose of sunlight can help regulate our circadian rhythm, signaling to our body when to be awake and when to sleep.
  • Boost Vitamin D Levels: Sunlight helps our bodies naturally produce Vitamin D which also helps maintain healthy bones and a strong immune system.
  • Heart Health: Sunlight can help lower blood pressure by stimulating the production of nitric oxide in the blood vessels, improving blood flow, and reducing risk of hypertension.

Tips to enjoy the sunshine safely:

  • Aim for 5 to 15 minutes of sunlight exposure a few days per week
  • Apply broad-spectrum sunscreen with at least SPF 30
  • Wear protective clothing, a hat, and sunglasses
  • Stay hydrated, especially on hot and sunny days

How Can Therapy Help?
Therapy can help you safely enjoy the benefits of spending time outdoors. Physical therapy focuses on improving mobility, strength, and balance, making it easier and safer to get around. Occupational therapy offers strategies and tools to handle outdoor challenges, such as walking on uneven terrain or gardening activities. Additionally, occupational therapists may recommend assistive devices like canes, walkers, or specialized equipment to make outdoor activities more accessible.

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Feeling Tired?

As we age, it’s common to notice an increase in tiredness and a decrease in energy levels. While no one keeps the same high-energy levels as we did in childhood, there are ways to combat fatigue and maintain an active lifestyle as you age.

Tips to Reduce Tiredness & Boost Energy:

  Prioritize Sleep: To improve your quality of sleep, try to maintain a regular sleep schedule and a relaxing bedtime routine. Aim for seven to nine hours of uninterrupted sleep each night.

  Stay Active: Engage in regular exercise to boost energy levels and improve your mood. Whether it’s brisk walks, swimming, yoga, or strength training, the key is to find activities you enjoy and make you feel energized.

  Eat Well: Fuel your body with a balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats for continued energy throughout the day.

  Stay Hydrated: Drink plenty of water throughout the day and limit caffeine and alcohol consumption, as they can disrupt sleep and lead to dehydration.

  Manage Stress: Practice stress-reduction techniques such as deep breathing, meditation, or tai chi to promote relaxation and increase energy.

If you’re experiencing persistent fatigue, it’s important to consult with your healthcare provider. They can help identify any underlying causes contributing to your tiredness and discuss the potential benefits of physical, occupational, and speech therapy. These therapies focus on strengthening exercises, pain management, energy conservation, stress management, and activity modification, helping older adults manage fatigue and maintain an active lifestyle.

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Swallowing Problems? Speech Therapy Treatments For Dysphagia

Swallowing is a complex process that involves over twenty-five muscles all working together to move food from the mouth to the stomach. For many older adults, swallowing can become a challenge.

Swallowing disorders, also known as dysphagia, can greatly impact our ability to enjoy meals and stay properly hydrated. If you find eating or drinking feels hard, experience symptoms such as coughing, choking, or feeling of food being stuck – you might be dealing with dysphagia.

Here are some common signs that may indicate you have a swallowing problem:
• Frequent coughing or choking while eating or drinking
• A feeling of food or liquid getting stuck in your throat or chest
• Pain or discomfort in your throat or chest when swallowing
• Unintentional weight loss or dehydration
• Recurrent respiratory infections or chest congestion

 

How Can Speech Therapy Help?

Speech-Language Pathologists (SLP) are uniquely qualified to help people who are experiencing problems with eating and drinking. During treatment, a SLP may recommend swallowing exercises along with other strategies to help manage dysphagia. If you or a loved one experience difficulty swallowing, talk to your doctor about Speech Therapy. Early identification and treatment of swallowing problems can help prevent complications and improve your quality of life.

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Keeping Bones Strong and Healthy

As we get older, our bones can weaken, which might cause osteoporosis—a condition where bones become fragile and break easily. However, osteoporosis is not an inevitable part of aging. By learning more about it and taking action early, you can significantly reduce your risk of osteoporosis and keep your bones strong and healthy.

Did you know?
Osteoporosis is often referred to as a “silent disease” because it progresses without symptoms until a fracture occurs.

 

Prevention Tips:

Preventing osteoporosis is crucial because it is easier to maintain bone density than to rebuild it once it’s lost.

  • Get enough calcium and vitamin D from food or supplements.
  • Do weight-bearing exercises like walking, jogging, dancing, and strength training to strengthen bones.
  • Avoid smoking and limit alcohol consumption.
  • Prevent falls by keeping your home safe, improving balance, and wearing proper shoes.
  • Talk to your healthcare provider about bone density testing and, if necessary, medications to help prevent or treat osteoporosis.

 

How Therapy Can Help
Physical and occupational therapy can help individuals improve their bone health by focusing on improving bone strength, reducing the risk of falls and fractures, enhancing functional abilities and promoting safety and independence.

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Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Spotlights and Announcements

Now available! New Provider Data Catalog makes it easier to search and download publicly reported data. Also, Medicare’s Compare sites have been improved.

Notice of Upcoming SNF QRP Measure Removals – January 2024

The Centers for Medicare & Medicaid Services (CMS) is alerting Skilled Nursing Facility (SNF) providers of upcoming measure removals from the SNF Quality Reporting Program (QRP). The following quality measures are planned for removal from the iQIES Review and Correct Reports, Facility-Level Quality Measure (QM) Reports, and Resident-Level QM Reports in January 2024:

  • Application of Percent of Long-Term Care Hospital (LTCH) Patients with an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function
  • Application of IRF Functional Outcome Measure: Change in Self-Care Score for Medical Rehabilitation Patients
  • Application of IRF Functional Outcome Measure: Change in Mobility Score for Medical Rehabilitation Patients

Once removed from reports, users will no longer have access to any data or measure results for these measures.

Click here to read more.

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Elevating Patients Care & Maximizing Facility Reimbursement

The Opportunity:  Medicaid is a major source of funding for many nursing homes. CMI analysis is crucial for understanding how the acuity and needs of a beneficiary affects reimbursement. A higher CMI directly correlates with increased Medicaid payments which covers the cost of patient care.

Changes on the Horizon: States have an additional two years after October 1, 2023, to implement PDPM methodology. This implies that Medicaid will no longer recognize RUG-III or RUG-IV for federal assessments after PDPM adoption.

Here is what we know so far:

  • Effective July 1, 2024, Kentucky will implement PDPM methodology for Medicaid.
    • Rates effective 1/1/2024 are calculated using RUGs. Rates effective 4/1/2024 will be frozen at the prior quarter’s rates (those effective 1/1/2024). Beginning 7/1/2024, rates will be calculated using PDPM. Rebasing provider rates is also being considered. Additional calculation details to be released.
  • Ohio will continue to determine direct care rates using RUG-IV for this biennium.
    • Effective 10/1/2023, RUGs case mix scores could only be calculated from the Optional State Assessments (OSA). After 10/1/2023, providers were allowed to freeze their case mix for the biennium, thereby eliminated the need for OSAs.
    • No additional information is available for Indiana or Michigan at this time.

Current Methodology:  By benchmarking facility data compared to state and national averages and breaking down report components, we as a team can better assess how we measure up in terms of resident acuity and case-mix. This information guides quality improvement initiatives in a targeted manner.

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Stronger Census Starts Here

Scope Out Your Competition Get Your Bragging Data Gain Insight on Your Hospitals & Physicians

HTS offers valuable market insight reporting that delivers an important 360-degree view of competitive data for our post-acute care providers. Our valued customers gain access to the most up-to-date healthcare market data needed to up their strategic game to increase admissions and strengthen referral relationships. Data is derived from CMS and updated quarterly with the most recent Medicare claims data.

Data Points include:

  • Top Referring Hospitals & Physicians
  • Market Share by County
  • Inpatient Claims Data – Medicare FFS & Advantage
  • Hospital Admissions & Utilization Trends
  • Hospital Discharges to SNF Detail
  • Readmission Rate: 30 Day FFS & MA
  • Competitor Insights & Benchmarking
  • Total Patient Cost Following SNF

What Can You Do with this Data?

The opportunities are vast! Our Market Insight data allows you to put numbers behind your census efforts and quantify your goals based on current and potential market share. Additionally, you can compare your metrics against your competition and find new potential referring partners. Maximizing this data invites strategic conversations and future growth plans to further strengthen your network and relationships.

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Maintain a Healthy Back & Active Lifestyle

Your back plays a big role in your overall well-being. By protecting it, you can sleep better, feel happier, and maintain an active and fulfilling lifestyle. A healthy back means you can do the things you enjoy, like going for walks, gardening, or playing with grandkids.

Regular, low-impact exercises play a crucial role in maintaining the strength and flexibility of your back muscles. Activities like walking, swimming, and tai chi are excellent choices for promoting spinal health without putting excessive strain on your back. Engaging in these exercises helps support your core muscles and keeps your spine well-aligned.

Consistent good posture is key to preventing back pain. Whether sitting, standing, or walking, be mindful of your posture. Keep your shoulders back, head aligned with the spine, and distribute body weight evenly. Avoid slouching or hunching over, especially during prolonged periods of sitting. These adjustments can significantly reduce the risk of developing back pain.

Use proper lifting techniques to protect your back from unnecessary strain and potential injuries. When lifting objects, bend your knees and keep the object close to your body. Avoid twisting your back while lifting, and if an object is heavy or awkward, ask for assistance. Being mindful of how you lift and carry things can go a long way in preventing back pain.

 

How Therapy Can Help

If back pain is impacting your quality of life, talk with your doctor about physical therapy. A physical therapist will assess the underlying cause of your back pain and guide you through exercises to strengthen the muscles around your spine, improve flexibility, and promote proper body mechanics. They may also use various techniques to alleviate pain such as massage, joint mobilization, heat or cold therapy, ultrasound, and electrical stimulation.

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