PDPM Ready – Speech Therapy

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By Lori O’Hara, MA, CCC-SLP, Therapy Resource – ADR/Appeals/Clinical Review

CMS thinks that speech therapy is so special that it gave speech five different considerations for the payment category. Thanks, CMS!

So here are a few tips for being an SLP CMI Ninja Warrior:

  • If you have a patient with concomitant ortho and CVA diagnoses driving their stay, you will generally select the ortho condition for the principle medical condition. But then you should always get an SLP co-morbidity because Active Dx: CVA/TIA (item I4500) would be checked on the MDS. There might be additional co-morbidity diagnoses coded from the SLP treatment conditions, but you only need one to count!
  • While we no longer require the inclusion of an ICD-10 medical diagnosis on our therapy POC/UPOCs, the treatment plan still needs to make sense. That means that a patient who needs treatment for a cognitive impairment without a clear medical condition that causes cognitive impairments will necessitate conversations with the attending medical team. A hip fracture still doesn’t cause a cognitive decline.
  • When your SLP (or OT, too!) are treating cognition and are going to perform the BIMs, it’s a good idea to do this before the patient’s cognition function is changed by treatment. The recommendation is that the BIMS is done the day of or day before the ARD, but we are allowed to complete it anytime during the lookback. Special note: If the ARD is day 8, a BIMS completed on the day of admission cannot be counted in the MDS. Watch those lookback periods!
  • It is best practice to have your SLP screen all patients admitted on an altered diet. First, if the patient has the potential to advance to normal foods, we should endeavor to make that happen. Second, an altered texture can mask the presence of swallowing problems — if the altered diet improves the function sufficiently, it can be difficult for a non-expert eye to see an underlying impairment. An SLP will often choose to intervene in that instance for the optimum health and safety of the patient, but even in those rare cases where SLP intervention isn’t indicated, the screening note can document the observed symptoms such that they can be properly included in the MDS.
  • When an SLP is involved for swallowing, make sure they report diet changes to the IDT. Day 7 or 8 diet adjustments can sneak under the radar of even the most diligent MDS Coordinator, so make sure your SLP is making noise about those changes.

Pilot Programs Provide New Ideas for Enhancing Patient Care

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By Deb Bielek, Therapy Education Resource

Currently, several of our facility therapy teams have been supporting efforts toward identifying best practice approaches as well as new tools and resources available to help us continue on our path toward effective and efficient delivery of therapy to our residents and patients. Not only do we see more and more specialty programs popping up where our patients and residents are receiving state of the art care and getting better because of it, but we are also finding effective ways to engage them in care throughout their recovery process. Currently we have facilities who have been participating in Pilot Programs with focus on innovative care delivery systems partnering with technological resources, enhancements to our therapy software system, interdisciplinary assessment processes for measuring functional outcomes through Section GG, leadership of Restorative Nursing programs.

The following Pilot Programs have been used over the recent weeks to help us grow in our understanding of how these tools and approaches can help us succeed in our current operations. We are excited to share some detailed results of the following pilot programs during our Leadership WebEx meeting scheduled for Friday, August 9 from 12:15 – 12:45 pm Pacific:

  • Jintronix is a PDPM-ready, “gamified” clinical product that is transforming the therapy experience in both Post-Acute and Long-Term Care. The treatment allows therapists to enhance their skills by customizing specific treatment protocols for individuals, resulting in patients who are much more engaged and applying themselves in a whole new way and we’re seeing the positive impact on outcomes. The results during the pilot program have been exciting.
  • Section GG is being used as part of our Quality Reporting System to demonstrate functional outcomes with the Medicare Part A patients, and we are expanding this outcomes tool into all of our post-acute payers beginning August 1! Our recent pilot program with 9 facilities across the organization yielded best practice approaches to accurate Section GG reporting, which will be critical to our Case Mix groupings for PT, OT and Nursing under the new PDPM. There are also some unique findings with the role therapy can play in the accuracy of these results.
  • Optima is creating tools to streamline documentation that is relevant for outcomes tracking, clinical pathway implementation and documentation that supports the Case Mix classifications under PDPM. Hear about the exciting results so far as shared by some of our pilot leaders.
  • Do you use Home Exercise Programs to enhance your SLP, PT, OT service delivery? Our pilot project with Medbridge is giving us the opportunity to incorporate the HEP experience through some unique offerings to our patients. We are also beginning to integrate the idea of HEP as an extension to the therapy program by incorporating RNA support into the HEP practice prior to discharge. We are analyzing our NOMS and GG Data to begin honing in on best practices for the HEP. Hear directly from some of our therapists using these unique tools!
  • Is your facility struggling to maximize the effectiveness of the RNA program to achieve better results with your patients and residents? Our East Texas Market has been trialing a new approach to RNA Management, and we’ll be sharing more about the program, therapy’s involvement, how it works and the status of the early results.

Exciting Changes to Reduce Administrative Burden of our Therapy Teams!

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By Tamala Sammons, Senior Therapy Resource

In an effort to ensure our clinical practice and policies match regulatory requirements, we frequently review therapy policies and POSTettes. Recently, we identified a number of areas where we could make changes to help reduce the administrative burden of our therapists.

Effective Aug. 1, 2019, the following changes were put into practice:

  • Because the IDT determines the reason for skilled admission, the need for a Medical ICD-10 code on therapy documents was removed for Part A Payers. Clinicians can now add a treatment ICD-10 code in both sections of the POC and UPOC. No changes were made to Part B documentation, because therapy determines the Medical ICD-10 in most cases.
  • With clinical measures shifting to section GG for functional outcomes, we removed the need for therapists to also have to complete CARE Item sets data.
  • We removed the requirement for Part A payer clarification orders when the POC/UPOC documents are signed by MDs using Clinisign. Optima’s Clinisign product ensures timeliness of MD participation with therapy POCs/UPOCs. Clarification orders for Part A payers are still required for documents that are not signed by MDs through Clinisign.
  • We identified that IDT discussion around Part A payers should be different than Part B payers. We removed the requirement for a Med B UDA and updated the IDT policies to allow the IDT process of Part A and Part B payers to be different.
  • We also updated triple check forms to match these changes where applicable.

Our goal is to continue to ensure our policies and practices are designed to support clinical treatment and care of our patients and only require the administrative activities that are supported by a state or federal requirement. We hope these changes help the teams to be able to provide more hands-on care.