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Top 5 Therapy Clinical Outcome Focus Areas

HTS has identified the top 5 therapy clinical outcome focus areas for 2021 based on our experiences from 2020 which makes us better equipped to overcome COVID-19 related obstacles. Furthermore, after attending a 15-hour training and certification process, HTS management staff have all become “PDPM Masters.”

These additional “feathers in our cap” allow us to uniquely champion process improvement initiatives alongside your interdisciplinary team. As HTS continues to identify opportunities for clinical growth, we look forward to discussing these key process improvement areas in the coming months.

Top 5 Therapy Clinical Outcome Focus Areas:

  • Working Smarter with Workflow Processes
  • PDPM Case Mix
  • Medicaid CMI
  • Section GG Outcomes
  • Part B Programming

*In February, we announced all HTS Regional Directors and Assistant Regional Directors earned their PDPM Master Class Certification. This 12-month course for skilled nursing facilities was offered through Leading Age Indiana in 2020. The certification process included 15 hours of training and competency assessment provided by nursing and MDS experts at Proactive Medical Review.

HTS supports our valued partners with access to high demand IDT toolkits, trainings, and many other process improvement resources conveniently available on HTS PartnerHQ web portal. Not a partner? Contact us to discuss how your community can be part of these focus outcome discussions.

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There is Power in Being Present

Blog by:  Jessica Duffy, OTR, Regional Director, Healthcare Therapy Services, Inc.

The word relationship is defined as: “The way in which two or more concepts, objects, or people are connected, or the state of being connected.” I think it is fair to say that COVID has completely changed how many of our interpersonal and working relationships operate now. As we look at this from a higher perspective, however, what has that really changed for us?

When I think of the relationships that are very important in our life, I am acutely aware of the importance of being present. For example, as a mother, it is not an option for me to miss any of my children’s events. I would not be happy with just getting the “rundown” after the big game; I would want to experience it with them first hand! Who wants to hear the exciting tale of making the game point–an hour after it occurred?! Not me. I want to see it and experience it. There is power in being present. This power and concept of being present applies in our professional lives as well. Let’s discuss how we can be present at our workplace.

With all of the new regulatory changes, quarantining, the elimination of group gatherings, etc., it has become all too easy to lose track of some of the systems we have in place to continue relationships in our buildings. We have at times, just given a document or report, in lieu of having our normal meeting because it more readily meets the demands of COVID-19 restrictions. Perhaps in a larger site, we stayed only in the healthcare area to prevent cross-contamination. I’m sure as you read this, ten more scenarios have popped in your mind of how we have changed our operations, but is what we are doing right or even optimal? Is it truly meeting that need of “staying connected”?

As in my parenting example, would you be ok with just getting the report of your child’s big event, or would you somehow finesse the opportunity to be more personally present? If entry is not permitted, is it live-streamed? Can you Zoom, Facetime, etc.? I have done it all, by the way, this past year. As a proud sports mama, I have watched live-streamed sporting events through the school and Zoomed my children’s teammates or coaches who could be at the event so that I can experience it firsthand while working in the red zone.

When it comes to our clients and our daily operations, HTS Therapy chooses to be PRESENT. Instead of assuming it is ok to substitute a connection, such as the morning meeting, a clinical or Medicare meeting by simply passing out forms, we want to finesse that personal interaction. If an in-person meeting is not an option, then we will leverage a virtual meeting or conference call. Our team believes best practices happen through an interdisciplinary team collaboration.

HTS Therapy chooses to be present.

Need a Powerful Therapy Partner? Contact Amanda Green, Executive Director of Strategic Development amanda@htstherapy.com for information about our contract therapy partnerships.

 

Jessica Duffy, OTR
Regional Director | Healthcare Therapy Services, Inc.

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Available Now! Recovering After COVID

Post COVID-19 Rehabilitation Program

The HTS Post COVID-19 Rehabilitation Program was created by HTS clinical staff to improve strength, endurance, balance, activity tolerance, functional mobility, swallowing, and cognitive-communication… all of which can be adversely affected during the COVID-19 recovery process.

This program will help those individuals who are recovering from COVID-19 and are unable to return to the daily tasks they were able to complete at a prior level of function.

Achieving the highest possible quality of life and independence with the use of therapeutic exercises and training are used to facilitate successful COVID-19 recovery.

Who Can Benefit From This Program?

The Post COVID-19 Rehabilitation Program can benefit those who have recovered from COVID-19 and are experiencing lingering health issues, such as:

  • Poor Endurance
  • Decreased Activity Tolerance
  • Muscle Weakness and Decreased Strength
  • Inability to Complete Daily Tasks when Compared to Prior Level of Function (walking or moving from bed to chair)
  • Difficulty Swallowing (coughing, choking, excessive throat clearing, swallowing pain)
  • Memory Problems or Difficulty Focusing
  • Soft Voice Difficult for Others to Hear
  • Difficulty Finding Words During Conversation

HTS Therapists are equipped with the knowledge and training to provide this critical treatment intervention to help patients achieve a successful COVID-19 recovery.  For more information about the HTS Post Covid-19 Rehabilitation Program, please contact your HTS Regional Director.

Need a Powerful Therapy Partner? Contact Amanda Green, Executive Director of Strategic Development amanda@htstherapy.com for information about our contract therapy partnerships.

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The Importance of Grip Strength

Why is hand and grip strength so important? Having a strong grip makes it easier to perform normal daily tasks like holding a coffee cup, carrying grocery bags, or brushing your teeth. Research has shown that a person’s grip strength can be an indicator for overall muscle strength, upper limb function, bone mineral density, increased fractures and falls, and overall quality of life.

It’s common as we age to see a decrease in grip strength due to natural age-related loss of strength and muscle mass. Additionally, other causes may include scar tissue, carpal tunnel, arthritis, and nerve or tendon damage. As a result, a person may experience trouble holding and opening items and other activities they enjoy.

Now that we recognize why grip strength is so important, below are exercises that can help to improve your overall hand and grip strength.

  • Improve Crush Grip (ability to squeeze something between your fingers and palms) with hand strengthening equipment like stress balls, therapy putty, and hand exercisers.
  • Improve Finger Strength & Dexterity with a finger-walking exercise. Put your hand on a table, palm facing down. Slowly lift each finger moving toward the thumb.
  • Improve Support Grip (ability to hold on to an object) with farmer carries. Hold a weight or bag and walk with it across the length of the room, then turn around and walk back.
  • Improve Pinch Grip (the grip strength between the tips of your four fingers and thumb) by pinching clothespins or using tweezers to manipulate small objects.
  • Improve Hand Range of Motion with finger stretches. Put your palm down on the table, straighten your fingers, hold the stretch for 30-60 seconds, and release.

Physical & Occupational Therapy Can Help! If you are having difficulty with hand strength or pain due to weakness, injury, or illness, you may find that performing a simple task is troublesome. Physical therapists recommend exercises to improve range of motion, build strength, and regain function. Occupational therapists offer strategies to overcome challenges so you can fully participate in daily and leisurely activities.

Talk with your doctor about a prescription for outpatient therapy.

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The COVID-19 Recovery Process & Your Body

The COVID-19 virus has impacted the health of millions of people. Research studies have shown that COVID-19 affects your body in several different capacities. As pulmonary issues are the most widely known complication from COVID-19, the virus can also affect your heart muscles, brain function, muscle strength, activity tolerance, and overall functional mobility. If you had COVID-19, you may need therapy to get you back to good health.

 

Our Post COVID-19 Recovery Program helps individuals who continue to have lingering effects from a battle with COVID-19. Our program utilizes physical, occupational, and speech therapists to provide strength training that aims to restore lost muscle and exercises focused on improving lung function and activities of daily living. Our goal is to ensure you get back to an independent and active lifestyle.

Treatment can help improve:

  • Strength
  • Endurance
  • Balance
  • Mobility
  • Swallowing
  • Communication
  • Memory
  • Daily Living Skills (bathing, dressing, cooking, and cleaning)

In order to participate in this program, you must have a doctor’s order for therapy. For more information about this program, please contact your on-site Therapy Department to discuss your concerns and treatment options.

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Medicare B Cuts in the Midst of the Pandemic

On December 2nd, the release of the CY 2021 Medicare Physician Fee Schedule Final Rule confirmed that we would face a huge overall 9% cut in our Med B Therapy CPT code reimbursement beginning January 1, 2021. I talked to many of you as we shook our heads and shared our mutual concern about such a large cut. The impact on our senior care providers and specifically, our rural locations would be devastating.  It was clear that the outpouring of advocacy efforts in response to the fee schedule proposed rule were being ignored. During a pandemic, that has overwhelmingly impacted our geriatric population, our critical rehabilitation services were gravely at risk of not being accessible due to such significant reimbursement cuts.

Thankfully, our industry has once again proved to be irrepressible! Our associations, industry leaders, and stakeholders nationwide persevered by rallying together to fight for our rehab services to be regarded as essential and to reduce the financial impact that was imminent in the final rule. We at HTS, as an active member of NASL (National Association for Support of Long-Term Care), urged all of our therapy team members to fervently become part of the advocacy for our patients and our profession. Proudly, countless HTS employees reached out to our federal legislators to provide the necessary details of how this cut in reimbursement would affect our most vulnerable population during the PHE.

The outcry from stakeholders commanding legislative action to protect rehabilitative services paid off.  In late December, Congress passed the Consolidated Appropriations Act of 2021 (H.R. 133).  This provided a partial fix for the looming therapy cuts.
The overall impact to the Medicare B Therapy CPT codes was significantly diminished as a result of the provisions of this Act. Now, instead of an estimated overall 9% cut, therapy codes’ reimbursement will be reduced by approximately 3.5% (depending on the code). While this is still a financial hit in the midst of a pandemic, the ability for operators to compensate and adapt to lower reimbursement is more fathomable than the original 9% reduction. This partial fix is made possible by the following measures:

  • The bill delays the implementation of the new add-on fee schedule complexity code (G2211) for three years.
  • The bill infuses $3 billion into the 2021 fee schedule for one year only which adds 3.75% of payment for all codes.
  • The bill delays the 2% Medicare sequester cuts for three months.
  • The bill continues the current Alternative Payment Model thresholds for two additional years
  • The bill extends the work 1.0 geographic index floor which increases payments for the work component of the physician fee schedule payments through December 31, 2023 for geographical areas that labor cost is lower than the national average.

Here is an example of commonly used therapy CPT codes illustrating the impact of the Consolidated Appropriations Act of 2021 (H.R. 133) for both the 9% and 3.5% reductions.

As shown in this example, providers and therapy companies alike will be challenged to offset the reduction in reimbursement. This offset may additionally be exaggerated by the overall increased costs associated with the pandemic. The need for PPE, COVID testing for employees, as well as reduced efficiencies due to isolation and other restrictions, will continue through the coming months as we continue to power through the most difficult challenge in our industry.

HTS will continue to stay steadfast during this time and true to our mission of providing “a hope and a future” (Jeremiah 29:11) to maintain the best quality of life for those we serve. Please contact me with questions, and we will continue to keep you updated on any changes on this topic and many others in the future.

 

Cassie Murray, OTR, MBA, QCP
Chief Operating & Clinical Officer

 

 

References:
https://rules.house.gov/sites/democrats.rules.house.gov/files/BILLS-116HR133SA-RCP-116-68.pdf
https://waysandmeans.house.gov/sites/democrats.waysandmeans.house.gov/files/documents/Overall%20Summary%20Joint%20Committees%20Final%2012.21.pdf

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Get Moving for a Strong Heart

Did you know that physical activity is one of the best ways to lower your risk of heart disease? Regular exercise helps to strengthen the heart muscle, reduce blood pressure, lower cholesterol, and also is linked to better sleep and brain function. The CDC recommends that adults 65 and older should aim for at least 30 minutes of moderate-intensity exercise five days a week. Use the tips below to help you stay motivated and make exercise an enjoyable part of your everyday routine.

Find a Workout Partner – a workout buddy can help keep you encouraged and accountable so you’re less likely to skip out on a trip to the gym or exercise class.

Create a Schedule – Working out at the same time each day/week can help you keep a routine and also plan other activities so you don’t have to miss anything.

Start Small – Start with low-intensity activities such as walking for 10 minutes. Gradually increase the amount of time and intensity of your workouts.

Exercise for Free – Walking inside and outside are both free and easy ways to incorporate physical activity. Look within your community to find free exercise classes.

Talk with Your Doctor – If you are uncertain what exercises would be best for you, discuss your exercise plan with your doctor.

As you get older, you may find it difficult to exercise due to pain or have challenges with your balance and mobility. Physical therapists can teach you how to exercise appropriately for joint mobility, muscle strength, and fitness so you can regain a more active lifestyle. Talk with your doctor to see if physical therapy could benefit you.

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Skilled Therapy Need During the PHE

Providers are now tasked with the responsibility of mitigating the risk of virus exposure in their facilities which, unfortunately, sometimes requires preventing some staff from entering the building. At times the staff being turned away has included therapists. Lack of detailed guidance early on during the PHE created an environment in which key long term care decision-makers such as administrators were left to interpret regulations as best as possible until further clarification was received. However, thanks to the numerous studies recently published in 2020 and clarification from the CDC, it has become clear that providing early and consistent rehabilitation care throughout the SNF stay is important for successful outcomes.

Long-term negative physical, cognitive, and psychosocial effects for those not receiving the caliber of care required to meet their individualized needs are now evident. Furthermore, on March 19, 2020, a Memorandum from the Department of Homeland Security stated that therapy practitioners are critical health care workers and need to be a part of the treating team.  Simply put, if a patient requires skilled level of care, that service must be provided. If services required to rehabilitate the patient back to a prior level of function are not being delivered, this puts the facility at risk for substandard quality of care.

The CDC has also now provided guidance. When asked “should any diagnostic or therapeutic intervention be withheld due to concern about transmission of COVID-19?” The CDC answered by stating patients should continue to have the opportunity to get any interventions they would normally receive as a standard of care. The Journal of Physical Therapy Science recently published research study findings to further support this claim. The purpose of the study was to recommend methods of respiratory rehabilitation and psychotherapy for patients in different stages of the coronavirus.

“Physical therapy of COVID-19 patients will not only reduce the mortality rate of patients, hospital admission time, and medical expenses, but also save medical resources, reduce personal and national economic losses, and the probability of adverse social stability events such as medical collapse. Therefore, physical therapy should be introduced into the mainstream treatment of COVID-19 patients as early as possible.”

Although this example depicts the critical nature of service delivery from a physical therapist…occupational therapists and speech-language pathologists also play a pivotal role in patient rehabilitation. With respiratory distress comes a myriad of potential complications including insufficient breath support for communication and/or swallowing as well as the inability to complete one’s daily tasks due to insufficient pulmonary capacity required to complete the activity. The bottom line remains that therapists are highly skilled healthcare professionals that play a significant role in the rehabilitation of patients.

In order to further support HTS therapists, resources, and tools were created to not only educate on infection control but also to facilitate best practices in these unprecedented times. Check out the list below for just a few examples of recently created materials:

  • Breathe: A Pulmonary Intervention Program
  • Therapist Treatment Hierarchy Delivery Chart
  • Dining Assistant Emergency Program Toolkit
  • HTS Annual Training: COVID-19 Supplement
  • Teletechnology Quick Reference Tools
  • Virtual Home Assessment Tool
  • Waiver Related Claim Guidance

Written by: Sheena Mattingly, M.S., CCC-SLP, RAC-CT, HTS Director of Clinical Outcomes

 

Sources:

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Managing Stress

Older adults are faced with many stressful situations. Stress can be the result of coping with the loss a loved one, managing a chronic illness, being a caregiver, and challenges with loss of balance and mobility. If we don’t overcome these stressors right away and let it impact our daily lives, this is known as chronic stress.

Stress can significantly impact your overall health. The effect of chronic stress on the body can lead to heart disease, a weakened immune system, diabetes, high blood pressure, digestion issues, short-term memory loss, difficulty sleeping, depression, and anxiety. That is why managing stress should be a top priority for seniors. Here are a few ways to limit the health risks associated with stress and help clear your mind…

THERAPY’S ROLE IN STRESS MANAGEMENT

Physical and occupational therapists offer interventions to help people cope with stress. Physical therapists can customize an exercise plan, teach breathing techniques, and help manage your pain. Occupational therapists help you develop coping skills, offer support to manage daily activities, and intervene with mindfulness-based techniques.

Source: health.harvard.edu

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ACT NOW! Help us STOP Reimbursement Cuts in 2021.

Blog by Cassie Murray, OTR, MBA, QCP, Chief Operating & Clinical Officer

As you may already be aware, CMS has finalized cuts in reimbursement for our Med B therapy codes (physician fee schedule codes). These reduced payments are set to begin ‪on‬ ‪1/1/2021‬. We have a short time to appeal to our lawmakers to ask them to support a delay in these cuts while we are in the midst of the PHE. The population that our team serves is the most vulnerable to decline and the impacts of COVID-19. Please consider the implications of how reduced reimbursement for important therapy services may reduce access to care for many Medicare beneficiaries. The cuts are expected to result in 9% reduction in PT/OT reimbursement and 6% reduction in ST reimbursement. These cuts are significant and will create a hardship nationwide for providing therapy services, especially in rural areas that already experience therapist shortages and difficulties with access to care. Reducing the reimbursement of critical therapy services only increases the challenges of providing quality services to our most vulnerable patients.

ACT NOW! Please reach out to your representative to request support for therapy services. We, at HTS, are an active member of the National Association for Support of Long-Term Care (NASL). NASL has prepared a letter for you to email your lawmakers to fix this policy through legislative action. We only have a few days to act! This is very time-sensitive and requires all of us to act as advocates for our patients, as well as our professions!

Please follow this link to reach out to your representatives:
https://app.govpredict.com/portal/grassroots/campaigns/dd7scnxz/take_action

Thank you in advance for your advocacy! This is a critical situation that requires all rehab professionals’ attention.
Please share this information with colleagues and family/friends. Now is the time that we need to come together to ask our representatives to support our services!

Cassie Murray, OTR, MBA, QCP
Chief Operating Officer, Chief Clinical Officer
Healthcare Therapy Services, Inc.

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