Archive for September, 2011
September 30, 2011
Maintaining Stable RUG Levels with New MDS Schedule
Beginning October 1st the new MDS schedule for PPS remains the same for the 5 day assessment with days 1 through day 5 with grace days extending out to day 8. Possible assessments dates for the 14 day assessment have been reduced to achieve compliance with the 2012 SNF Final Rule. The new window for ARD selection for the 14 day assessment will now be day 13 and 14 with a grace allowance to day 18; an overall reduction of 3 potential assessment days. The 30, 60 and 90 day assessments have been shorten by 7 days each.
The following ARD options will be effective October 1, 2011:
30 Day: 27-29 with grace a grace day allowance to day 33
60 Day: 57-59 with grace a grace day allowance to day 63
90 Day: 87-89 with grace a grace day allowance to day 93
Will your therapy company be able to provide adequate staffing and management to maintain stable RUG levels?
September 29, 2011
Care Not Cuts: Let’s Take Action
Cuts to Medicare and Medicaid threaten access to quality care for America’s growing population of seniors.
Nursing homes, skilled nursing facilities and assisted living are all part of the solution to both rising health care costs and local job creation.
Take action today — call your Member of Congress and tell them to preserve, protect and defend quality skilled nursing and rehabilitative care for seniors and people with disabilities.
Learn more at www.carenotcuts.org
September 27, 2011
Therapy Tech Spotlight: Shelly Gatte
Join us as we highlight our longest-tenured therapy techs during therapy tech month:
Shelly Gatte
Where is your hometown? Crowley, LA
Year you started working with Therapy Center: 2003
Areas you work/Main job responsibilities: I work at the Therapy Center Outpatient Clinic in Jennings where I am responsible for patient care, some billing and medical records. I also work at the Basile Care Center as a therapy tech.
Why did you choose the field you work in? I always wanted to work in the medical field and helping people is a top priority!
What is the most rewarding part of your job? Seeing people get better!!
Favorite part of working at Therapy Center? The family orientation. It is like family away from home!!
Hobbies/other areas of interest:
Spending time with family and friends is my biggest hobby.
We are lucky to have Shelly on our team! Thank you for all that you do and for being dedicated and very compassionate.
September 22, 2011
Therapy Tech Spotlight: Melinda Chenevert
Join us as we highlight our longest-tenured therapy techs during therapy tech month:
Melinda Chenevert has been with Therapy Center since 2004 and is originally from Plaucheville, LA. Melinda says that her responsibility as a floating tech allows her a career where she gets to work with people and help them at the same time. The most rewarding part of her job is seeing the residents improve their function and seeing their smile when they take their first steps. Melinda’s favorite part of working for Therapy Center is her wonderful co-workers! In her spare time, Melinda loves to do anything outside, especially gardening.
We are proud to have Melinda as part of the Therapy Center team!
September 20, 2011
The Truth Behind Speech Therapy
Article written by Ava Hebert, Recruitment Manager for Therapy Center.
A common misconception about speech therapy is that it only addresses problems with the act of speaking. Not so. As someone new to the therapy industry, I have found it particularly interesting that there are so many facets to speech therapy and what a speech therapist does as part of treatment. My first observation of a speech therapist left me with many questions. I was in the therapy room of a skilled nursing facility and my expectations were blown out of the water. As I quietly watched, I thought to myself, “Why is she asking the patient to give her today’s date? Why is the patient doing a puzzle? Why are they using a deck of cards to play a memory game? What does any of this have to do with speech?” Afraid to ask too many questions, I did a little research of my own and found many things that people may be surprised to learn about a speech therapist.
What is a speech therapist? How can speech therapy benefit me or my loved one?
When trying to educate an individual on therapy services in a skilled nursing facility, there is a good possibility that they may not see the value in working with a speech therapist. In my dealings with case managers and social workers, I understand that they face objections from patients and their families quite often when it comes to seeing a speech therapist. They think, “Why? I already know how to speak.” What most people do not realize is that a speech therapist is a communication specialist; educated in the study of human communication, they are knowledgeable in many different areas. Speech therapists, also known as Speech Language Pathologists, are trained in areas of oral motor skills such as swallowing, cognitive communication and orientation such as memory and problem solving, fluency such as stuttering, literacy, social skills, articulation, and most obviously… speech. They can treat patients with any condition that could hinder their ability to communicate. A speech therapist working in a skilled nursing facility would be less likely to treat literacy, stuttering, and articulation, yet more likely to treat memory and swallowing problems. They can teach individuals how to improve swallowing by working and strengthening their muscles thereby reducing the chances of choking or inhaling food or liquid, a problem seen frequently within skilled nursing facilities.
I recently visited with one of our own speech therapists, Leslie Lemoine, who works in our partner facility, Courtyard Manor Nursing Home in Lafayette, Louisiana. She has been with Therapy Center for over three years and had some very insightful information about her profession. “We treat patients with dementia, Alzheimer’s, stroke patients, and several other diagnoses that can affect the patient’s cognition, memory, and speech. We also treat patients that have swallowing problems, also known as dysphagia. We collaborate with physical therapists, occupational therapists, nursing, and family members regarding ways to improve the patient’s cognition, communication, and swallowing function.” Who knew that you could seek help from a speech therapist for help with cognitive problems? I didn’t.
“The main misconception is that we treat only patients that have speech problems, like stuttering for example. Many people don’t know that we can recommend diet modifications and teach patients ways to increase safety with swallowing to reduce the risk of aspiration. Also, many people are surprised to know that we help to teach patients how to increase their orientation and safety awareness and independence, whether in the nursing home or if they are planning on returning to home,” Leslie explained.
When I asked Leslie about a typical day and the treatment plans for her patients, I learned that there is no cookie cutter treatment plan that can be applied to all patients. Each patient is different; they each require different levels of care and focus in various areas. Working in a skilled nursing facility, therapists notice that needs change frequently. It is not uncommon for an elderly person to have the occasional bout of confusion, but when a therapist or family member begins to notice a change in behavior, communication, or weight loss, this could be a red flag and a sign that speech therapy is needed.
Weight loss can be a sign speech therapy might be needed? Really?
If a patient shows signs of sudden weight loss, this could indicate that he/she is having difficulty with swallowing, therefore is not maintaining a sufficient caloric intake in order to maintain a healthy weight. Leslie says that she has seen this many times in the nursing home and she “communicates with nursing regarding ways to maintain the patient’s nutrition and hydration when necessary.” That is why in a skilled nursing facility, it is important for the speech therapist to conduct regular screenings in order to notice if a patient has had a sudden decline of any sort. Sometimes, this may require a little troubleshooting. Leslie, as do many speech therapists, conducts her own assessments using various methods to determine and identify the area in which the problem lies. She then sets a goal and treatment plan. Patients are always treated on a case by case basis, as some may need work on swallowing, others with orientation. The treatment plans are individualized and created to fit the needs of the individual, and a speech therapist focuses a lot of time to developing a treatment plan that is most likely to be successful.
When asked if there was a specific tool or method of treatment that Leslie found particularly helpful, she gave me an answer that I was not expecting to hear. “As a therapist, I often like to use newspapers and magazines as part of treatment to increase my patients’ orientation and knowledge of current events for opportunities for conversation with peers and family members,” Leslie says. Yet again, I was unaware that this seemingly obvious daily activity was something that speech therapists incorporate into treatment.
After learning so much about the profession and expertise of a Speech Language Pathologist, I find myself very impressed with their work and I’m am very happy to know that such a unique and specialized therapist exists. Even Leslie has to educate her patients on what she can do to help them and gaining their trust is typically half of the battle. “When I am able to create a comfortable, home-like environment for my patients and they begin to trust me and allow me to address their needs, I know that I can make a difference. I feel very rewarded and successful when I see that my patient is following my direction and making strides of improvement for an increased quality of life. It’s a good feeling,” says Leslie.
If you are ever in a position where you’ve got to explain what a speech therapist does, or why someone needs to see a speech therapist, remember, a speech therapist is a communication specialist, trained and educated in the study of human communication.
September 14, 2011
Therapy Center Conducts Innovative Cooking Therapy
Who says therapy can’t be fun? The innovative Therapy Center therapists at Amelia Manor conducted a fun cooking session for its patients!
Barbara Miller, an Amelia Manor short-stay rehab resident who plans to return home alone, led the group in cooking cheese and tomoato grilled sandwiches. The recipe was simple, but the long-reaching effects of the session were definitely multi-faceted. In one session, patients received Occupational Therapy, Physical Therapy, and Speech Therapy benefits – not to mention the social benefits of working in an encouraging and inspiring group.
Therapy Center hopes to implement the cooking therapy program in its other partner facilities. Watch for more information coming soon!
Pictured: (left) Barbara Miller; (right) Judy Duplechien, COTA
Therapy Center News: Christina Melendreras, DPT Student
We are excited to be part of the University of St. Augustine job fair today and want to introduce you to Christina Melendreras, DPT student from University of St. Augustine. She recently completed a clinical rotation with us and tells about her experience at Therapy Center’s outpatient clinic in Jennings! Stay tuned for more student interviews and news updates…
September 13, 2011
Final Rule for 2012: What does it mean?
SNF Medicare Rules Finalized for FY2012
ASHA, American Speech-Language-Hearing Association, posted the following Final Rule breakdown on their website. This article effectively explains details from the final regulations and how ASHA has served as an advocate for therapy services in SNFs. To read more on this subject, please visit www.ASHA.org.
The Centers for Medicare and Medicaid Services (CMS) issued final regulations for Part A services in skilled nursing facilities (SNFs) on July 29, 2011, effective October 1, 2011. Overall payments to SNFs in FY2012 will be reduced by 11.1%, mainly due to the over utilization of therapy payment categories compared to expected projections.
Reduced supervision of therapy students. CMS has removed specific student supervision restrictions in SNFs because hospitals have no such restrictions for Part A patients. The objective was to promote greater conformity with other inpatient settings. As stated in the proposed rule, the new requirement is that “each SNF will determine for itself the appropriate manner of supervision of therapy students consistent with applicable state and local laws and practice standards.” CMS emphasized that a new, different method of supervision would in no way alter the individual’s basic status as a student operating under the therapist’s supervision and “the time the student spends with a patient will continue to be billed as if it were the supervising therapist alone providing the therapy.”
Group therapy. The CMS proposal that defines optimal group treatment as requiring four-persons remains unchanged in the final regulation. Thus, if a group therapy session consists of two or three patients, the session length must be divided by four (e.g., a 30-minute session with three patients yields 30 ÷ 4 = 7 minutes counted toward the Resource Utilization Group (RUG) level of care). The proposed four-person group treatment standard was protested by ASHA, noting that there is no research to support the assumption that four persons are optimal. A longstanding SNF Part A rule remains, allowing up to 25% of therapy per discipline per week to be group therapy.
End of therapy OMRAs. Changes also affect Other Medicare Required Assessments (OMRAs). CMS proposed that an interruption of three days of therapy would require that the patient be discharged from therapy and require an OMRA when restarting therapy, whether or not the SNF maintained a five-day or seven-day therapy schedule. For example, if the patient received no therapy on Friday, Saturday, and Sunday then an assessment would be required, even though such an OMRA serves no purpose as a clinical management tool. ASHA pointed out that there are many reasons for a missed treatment on the last day of the work week – Friday (e.g., patient illness, therapist illness, patient refusal, visit to physician’s office), extending the interrupted therapy to three days. We recommended the requirement be revised to four days to avoid many unnecessary discharges and reassessments, but the minimum missed treatment period will stand at three days.
The final rule is posted on the Office of the Federal Register’s website [PDF].
Please contact us today to find out how we can help your facility through the October 1st changes!
Therapy Center partners with nursing homes to deliver high quality, cost-effective rehabilitation services. Our services are designed to provide our partner facilities with the highest standard of patient care, increased revenues, reduced responsibility, elimination of staffing problems and ease of compliance. Unlike staffing agencies, Therapy Center welcomes the responsibility of operating and managing a profit-generating rehabilitation department for our partner facilities. We provide highly skilled therapists and a full spectrum of rehabilitation services including physical therapy, occupational therapy, speech therapy and more. Our goal is to enhance clinical outcomes while maximizing financial reimbursements for our partner facilities.
September 8, 2011
Therapy can help increase your facility’s revenue.
Did you know that successfully managing your CMI can yield high value with little cost?
Did you also know that your therapy team can play a significant role in improving your facility’s bottom line if they are proactive and knowledgeable about how to effectively impact your CMI score?
At Therapy Center, it’s our business to make your rehab run better. We’re not just therapy providers, we’re business partners and we know how to help the facilities we work with improve their CMI scores and watch their revenues grow.
Therapy Center stresses the importance of knowing every resident in our partner facilities, whether on caseload or not, by completing accurate, timely, and effective quarterly screenings. This screening process can not only help identify potential fall risks, weight loss concerns, contractures/positioning problems, and other declines impacting Quality Indicators, but it can also dramatically affect CMI scores.
In addition to screens, Therapy Center plays an active role in referral of patients, training of staff, and assisting in competency checks in relation to Restorative Nursing Programs. We know the importance of communication between our therapists and nursing home staff and we strive to consistently educate and train staff to facilitate accurate reporting and optimal quality of life for patients.
With a full-time, dedicated compliance department, Therapy Center is able to stay on top of the ever-changing laws and regulations that determine CMI, along with other standards for appropriate reimbursement. We assist staff in understanding these changes as they occur, decreasing stress and maximizing productivity by avoiding unnecessary paperwork.
Don’t let precious reimbursement dollars leave your facility. Contact Therapy Center and let us help you succeed in maximizing your CMI.
Please feel free to contact me to discuss how Therapy Center can serve your business needs: Kristi Fredieu, Business Development & Marketing Manager, 337-384-9791 / kfredieu@therapyctr.com.
Therapy Center partners with nursing homes to provide high quality, cost-effective rehabilitation services. Our services are designed to provide our partner facilities with the highest outcomes of patient care, increased revenues, convenience, elimination of staffing problems and ease of compliance. Our goal is to provide the best rehabilitation care possible while maximizing financial reimbursements for our partner facilities.
September 7, 2011
Therapy Center Expands Compliance Department
In a proactive approach to impending audits, Therapy Center has expanded its compliance department to include on-site chart auditing in addition to computerized auditing. “We recognize the importance that all necessary documentation is timely, organized, and readily available on medical charts and we want to ensure accessibility and completeness in the event of an audit,” says Rachel Manuel, Mentor/Speech Therapist for Therapy Center and the newest addition to the compliance staff.
Rachel has over 8 years’ experience in nursing home care and has served as a Manager and Mentor for Therapy Center since 2008 in the Basile and Jennings areas. Currently, she provides staffing services for speech therapy company-wide and will be transitioning to a new role in compliance alongside Lance Hill, Therapy Center’s Director of Regulatory and Clinical Compliance.
It is Therapy Center’s mission to make sure that the facilities it services not only receive top-notch treatment, but that all monies collected are retained should an audit occur. In addition to Rachel, Therapy Center welcomes Renee Bult and Lisa Parker to its compliance team as part of the on-site audit staff.
Therapy Center is excited about the value these new efforts will be adding to our current long term care partners. To find out how our on-site compliance officers can help your facility prepare for audits, click here to contact Therapy Center today!
September 6, 2011
Therapy Center hosts internal therapist training
On August 19th, Therapy Center hosted an internal staff training in Lafayette where members of our management team presented on the most important and relevant topics in the therapy world today. Below are just a few of the topics that were covered during our training!
Identification and accurate diagnosis of dementia and dementia staging and functional assessment for PT, OT, and ST focusing on an interdisciplinary team approach:
Rachel Manuel, SLP and Therapy Center mentor presented on the utilization of an interdisciplinary approach to dementia care in the SNF. The focus of the presentation included accurate assessment and staging of dementia patients by all disciplines so that appropriate interventions can be selected and implemented as dementia progresses. Additionally, Rachel discussed a variety of treatment approaches to increase patient cooperation and progress to maximize functional independence and reduce burden of care on family and staff.
Upcoming changes for the SNF 2012 Final Rule: Lance Hill, Director of Clinical & Regulatory Compliance outlined the upcoming changes and the impact they will have not only on therapy but globally with our facilities as well. Lance also discussed how we can work with our partner facilities to make the transition as smooth as possible October 1st. Because Therapy Center is a huge proponent for pro-active measures in the area of compliance, he re-iterated the importance of self-regulating our documentation to avoid and prevent future audits and denials and also discussed our audit program and the criteria on which quarterly audits are scored and measured.
Contracture Management/Positioning, Bowel and Bladder, and Low vision programs: Insuring maximal patient independence in SNF setting is always our goal! Our occupational therapists/mentors, Danielle Keyser and Amber LaPrairie, and our Women’s Health physical therapist Alayna Brewer discussed the establishment of internal programs and the importance of caregiver education. Both of these measures are able to facilitate increased independence and reduce risk of contracture, incontinence and falls among individuals in skilled nursing facilities.
Laurie Riquelmy, Education For Living Presentation: The primary objective of this presentation was to provide distinctions and practices that allow participants to observe and manage their moods. Our physical and emotional well-being is intimately tied to our moods. Participants learned the importance of moods and their influence on our personal effectiveness and interaction with other people. By learning distinctions regarding moods we increase our ability to identify moods in others, and ourselves, see what actions are possible within a certain mood, and shift or design a more effective mood. For example, by observing and shifting out of a mood such as resentment or resignation, we are able to reduce stress and communicate more effectively with others.
Therapy Center partners with nursing homes to provide high quality, cost-effective rehabilitation services. For more Therapy Center news and developments, find us on Facebook and follow us on Twitter!
What should you be doing? 2012 SNF PPS
From the desk of Harmony Healthcare’s CEO Kris Mastrangelo:
SNF Leaders do not have a long lead time between July 27 and October 1 when SNF PPS changes posted in the Final Rule go into effect. The next two months will be filled with reading and re-reading the SNF PPS Final Rule, working on assimilating and interpreting the planned changes as well as participating in the CMS ODFs and web education to confirm each facet of this complex reimbursement program. Language in the Final Rule regarding MDS 3.0 guidance, billing allowances and documentation requirements can easily be misinterpreted.
Team meetings are essential at this time to allow the Medicare Team to review new requirements, strategies for implementation and schedule education for the entire SNF staff.
What to Consider?
1. How will the team incorporate the new the MDS assessment window schedule to avoid payment of default days?
2. Who will be primarily responsible for tracking rehab provision of care to monitor minutes, days and RUG classification requirements?
3. What type of systems will need to be implemented to monitor rehab service delivery?
4. Who should the Facility or Center contact to get answers to questions left unclear in Final Rule language? CMS directly, the MAC, state RAI Coordinator, software vendor or outside consulting agency?
5. Skilled therapy delivery and nursing skilled care oversight to maintain the Medicare Part A revenue stream.
6. Where to begin?
How to Prepare:
• Schedule on a minimum, biweekly meetings to outline and discuss upcoming systems changes.
• Review and post the new MDS assessment schedule options for the team to memorize immediately.
• Educate Therapy professionals on the new definition for group therapy, documentation requirements and mode of therapy billing revisions scheduled to be implemented October 1.
• Select a leader to begin auditing rehab minutes and days of delivery to identify patterns which will impact reimbursement come October 1 under the new guidelines.
• Obtain and implement the tools necessary to accurately track therapy minutes and days that fall below or exceed the planned RUG category. (Tools should flag significant overages or missed minutes that will effect reimbursement levels).
• Track and analyze therapy productivity.
• Schedule mandatory education for all nursing staff focused on Medicare Part A skilled care coverage criteria including RUG classifications and Medicare eligibility and entitlement.
CMS has posted a transition document for implementation of changes scheduled for October 1, 2011. To access this document follow the link below: http://www.cms.gov/snfpps/03_RUGIVedu12.asp
To read the full article, please visit Harmony Healthcare’s website.
Please contact us today to find out how we can help your facility through the October 1st changes!
Therapy Center partners with nursing homes to deliver high quality, cost-effective rehabilitation services. Our services are designed to provide our partner facilities with the highest standard of patient care, increased revenues, reduced responsibility, elimination of staffing problems and ease of compliance. Unlike staffing agencies, Therapy Center welcomes the responsibility of operating and managing a profit-generating rehabilitation department for our partner facilities. We provide highly skilled therapists and a full spectrum of rehabilitation services including physical therapy, occupational therapy, speech therapy and more. Our goal is to enhance clinical outcomes while maximizing financial reimbursements for our partner facilities.
