News

By Mahta Mirhosseini, Therapy Resource

Have you wondered what it would be like to go paperless with Therapy documentation? You can stop wondering, because our Optima software has features and modules that can help us go paperless today!

Clinisign is Optima’s answer for getting timely and efficient physician signatures for our therapy documents. Facilities that utilize Clinisign do not have to print out any of their therapy documents, because each eval and/or recert is electronically sent to the physician for signature. Once the physician e-signs the document, it is automatically returned to Optima and PCC, thereby getting rid of the need to scan our therapy documents into the Misc tab of PCC!

And that’s not all. Did you hear the great news about the revision to our therapy clarification orders policy? If you joined our last leadership meeting, you also heard that we do not need to write clarification orders for Part A residents whose physicians are using Clinisign. This is because our therapy evals/recerts have all the required fields of a clarification order, and by getting an MD Clinisign signature on our therapy document, we are meeting the requirements for a physician order. This is another huge step toward going paperless while maintaining compliance. Please reach out to me or your local therapy resource if you are not already using Clinisign, or if you want to use Clinisign to its full functionality.

By Chad Long, Therapy Resource

As we close out June, we find ourselves only three months away from PDPM! So how are we doing?

Overall in May we are providing 5% clinically appropriate Group & Concurrent to all Payers and 17% to our Non-PPS Payers.

How does each affiliated company stack up? Here are a few stats through May:

Highest percentage for All Payers in May goes to … Monument! Great job last month with 9%!

Best performance Year-to-Date for Non-PPS payers goes to … Bandera! They’re consistently delivering over 20% in functional multi-participant therapy programming!

Who has had the greatest increase from January to May? Midwest increased 13% in May compared to the beginning of 2019!

Each company has made significant gains in statistical improvement; however, what does that say about quality? Every week, we see emails about highly skilled functional groups from several facilities. Here are a few great examples to follow:

THE SOUTHLAND OCTAGON

The “Southland Octagon” was their creation in order to have functional, skilled and evidence-based group programming. For example, each bar was carefully measured to also allow for functional assessments such as the seated step test.

Additionally, they developed clinical group treatment protocols such as:

Functional Transfer Group

Equipment:

Southland Octagon, blood pressure, stethoscope, pulse oximetry, RPE scale/Borg Scale, standard height chair and patient’s own W/C

Purpose:

• To strengthen LE Hip & knee extensor and Hip Abductor/Adductor group of muscles to improve functional transfer
• To promote safe functional transfer technique
• To promote motor learning through repetition
• For the individual to learn, encourage and motivate one another

Procedure:

• Therapists and pts may introduce themselves to each other. Briefly discuss the goal.
• Check and record vital signs, RPE and pulse oximetry.
• Demonstrate the task.
• Patient is instructed to stand up (may utilize arm rest) and hold on to the Southland Octagon bar.
• Make two to three side steps to the next practice chair (return to/from)
• Let the patient repeat as many as possible until they feel fatigue.
• Observe and record the form, smoothness of movement, movement compensation, etc.
• At the end of the last attempt, have the individual sit, take and record BP, HR, RR, PRE and oxygen saturation.

Seated Step Group

Equipment:

Southland Octagon, blood pressure, stethoscope, pulse oximetry, RPE scale/Borg Scale,

metronome (set at 60 bpm)

Purpose:

• To strengthen LE Hip flexor and knee extensor group of muscles to improve mobility
• To improve aerobic capacity and endurance
• Suitable for those unable to stand up safely with less assistance
• For the individual to learn, encourage and motivate one another

Procedure:

• Therapists and patients may introduce themselves to each other. Briefly discuss the goal.
• Check and record vital signs, RPE and pulse oximetry.
• If one of your goals is to improve aerobic capacity, determine target heart rate (Karvonen’s formula). Monitor heart rate during the procedure.
• Demonstrate the task.
• Patient is instructed to alternately touch each foot to the edge of the step at the rate of set bpm (metronome) to touch the edge of the step; next beat brings the foot to the floor, and next beat the opposite foot touches the edge of the step.
• Let the patient repeat as many as possible until they feel fatigue.
• Observe and record the form, smoothness of movement, movement compensation, etc.
• At the end of the last attempt, take and record BP, HR,RR, PRE and oxygen saturation.

Progression:

• May progress to 12”, to 18” with UE movement. Right shoulder flexion to 90 degrees when raising right Leg. Repeat with the opposite side.

Sit to Stand Group

Equipment:

Southland Octagon, blood pressure, stethoscope, pulse oximetry, RPE scale/Borg Scale

Purpose:

• To strengthen LE extensor group of muscles and improve functional transfer
• To promote motor learning by repetition
• For the individual to learn, encourage and motivate one another.

Procedure:

• Therapists and patients may introduce themselves to each other. Briefly discuss the goal.
• Check vital signs, RPE and pulse oximetry.
• Demonstrate the proper form of doing sit <> stand.
• Patient is instructed to stand up (patient may utilize the arm rest), hold on to the Southland Octagon bar then sit down, doing as many as possible until they feel fatigue.
• Observe and record the form, smoothness of movement, movement compensation, etc.
• At the end of the last attempt, have the individual sit, take and record BP, HR, RR, PRE and oxygen saturation.

Point of Service Documentation: Part 2 in a 2-Part Series, by Mahta Mirhosseini, Therapy Resource

In Part 1 of our Point of Service Documentation (POS) series, we discussed how POS style documentation can have great therapeutic benefits over traditional treating first and documentation at the end of the day. If you missed the first part of this series, click here.

Today’s post on POS documentation will highlight our therapy EMR’s POS platform: Optima’s Point of Care or POC (pronounced “pok”). Let’s see how POC helps with efficient POS documentation.

POC is designed with the treating and documenting therapist in mind. That is why it does not have administrative and reporting features to slow down the system.

POC is many (and I mean many) times faster than traditional Optima, saving our evaluating and treating therapists time, not having to wait for documents and screens to open up.

POC is designed to work on any tablet (iPad, Chromebook and laptops) because it is device-agnostic.

POC can work offline, so once therapists download their caseload onto the device, they are able to complete billing and documentation even in areas of poor connectivity in the facility.

POC has the names of the other disciplines’ therapists that are scheduled with each patient, so no need to constantly refer to the assignment board to find that info.

POC’s documents have an “H” button that offers all historical info that has been added in that field since the day of the eval.

Last but not least, POC has a feature called the “side by side viewer.” Anytime a therapist is working on a document, this feature offers a split screen and instantly loads all prior documents (including TENs) that can be referred to as the therapist completes the current document.

Please reach out to me or your local therapy resource if you would like more information about getting started with POC. Remember that POC can be used on any device, including your existing laptops.

Point of Service Documentation (First of a 2-part series), By Mahta Mirhosseini, Therapy Resource

Traditionally, therapists have approached treatments and documentation in a compartmentalized fashion; a hands-on treatment session was provided, then documentation was done after the session was over, often times at the end of the day. With increasing use of technology and EMR software in healthcare, you may be hearing more talk about Point of Service documentation in our therapy settings. Some therapists wonder whether POS documentation can be done effectively, or if it may take quality treatment time away from patient care. Here, we discuss how POS charting can be an effective adjunct to the therapeutic process when it is done correctly.

• Think of when you were in your therapy school, did you wait till class was over to take notes? It is very similar to our therapy sessions. When you document during treatment, you can ensure that your documents are more accurate and detailed. POS documentation helps to include details that may otherwise be forgotten by end of the day.
• Do you find yourself overwhelmed at the end of the day trying to complete all your evals, encounter notes, or recert documents? POS approach helps the clinician get documentation completed as they go on throughout the day, thereby reducing end of day documentation stress.
• Do you have lots of chicken scribble on your daily activity schedule when recording patient levels and measurements? Our field is driven by objective tests and measures. POS documentation allows therapists to take detailed notes while collecting data during the session, therefore establishing and advancing appropriate goals in real-time. In fact, using EMR for POS data collection may trigger the therapist to perform additional testing to ensure that all relevant areas are addressed.
• Do you worry that POS documentation may affect relationships and quality connections with our residents? Our patient population has been seeing their physicians and healthcare professionals take notes using technology. You might even say that they have come to expect to see their providers actively capture data. The key is to engage your patients in that process and find a balance of documenting data while fostering an active and engaged therapeutic session.

Optima‘s point of service documentation solution is called Point of Care (POC), and unlike its traditional desktop Optima counterpart, POC is designed with the treating therapist in mind. Many of our therapy programs have been reporting great success using Optima’s POC to render point of service documentation. Stay tuned for our next POS documentation post which highlights efficient documentation tools that exist only in Optima’s mobile POC. If you would like to get more information on these tools before the next post, please reach out to me or your local therapy resource.

Deciding the Principle Medical Diagnosis, By Lori O’Hara, MA, CCC-SLP

Although the PDM only affects therapy buckets, determining the most appropriate diagnosis to put in the first position is an IDT Decision. It is meant to reflect the condition that most strongly explains the reason the patient needs to be skilled in the SNF, and sometimes that is not necessarily the condition for which they need rehabilitation (although it will be often!) The DOR and the therapy team should discuss the reasons the patient needs any therapies they’re receiving, and then the DOR discusses that with the IDT to reach a decision.

Here are few decision making examples:

• A patient admits who had a hip replacement, and then while in the acute hospital had a stroke. Both the hip fracture and the CVA are high-needs conditions and either could legitimately be considered the principle medical condition. When this is true, the facility is allowed to select the best prioritization. In this case, selecting the hip replacement is the best choice. While this does mean that we are opting to miss out on a neuro condition for the SLP case mix index, the benefit to the facility is greater from the hip fracture diagnosis. The patient will still need all the aggressive therapy that comes with those two conditions, so selecting the one that aligns best reimbursement with the amount of resources the patient needs is perfectly fine when it’s clear that the choice is well-supported in the record.
• A patient admits with ulcerative colitis. The patient is on immunosuppressants and close diet monitoring. The patient has suffered significant muscle wasting and is severely debilitated. The patient also has a history of Parkinson’s disease for which they’re receiving a Sinemet regiment that is unchanged in three years. While Parkinson’s would land in a more advantageous clinical category (Acute Neuro) than the ulcerative colitis (Medical Management), that decision is not consistent with the CMS requirement that the principle medical diagnosis reflect the reason the patient needs to be in a SNF. So Parkinson’s disease should not be in the first position, but should be listed as a diagnosis in a later slot.
• A patient admits for pneumonia and also has a fractures of the 4^th toe. The patient is still on antibiotics, requires supplemental oxygen and has an order for a follow-up x-ray. In this instance, while the impact of a toe fracture will certainly need rehabilitation, the patient’s management for pneumonia requires markedly more resources and interventions. So in this instance while the toe fracture would create a more financially advantageous case mix impact, it cannot be validly reported as the principle medical condition.

Congratulations to our newest SPARC Award winner, Brindy Klym, OT, Florida Gulf Coast University, Grad Date: May 2019. Read her winning essay below:

Daily, I do my best to live by Mahatma Gandhi’s words, “Be the change you wish to see in the world.” I envision a world of greater creativity, compassion, and empathy, and strive to embody these traits in order to help others live happier, healthier lives.

My career began as an elementary education teacher. I taught for five years, inspiring children with special needs and those learning English to embrace the world and make a positive impact on others. I strived every day to show up in utmost presence, enthusiasm, and love for my students. I taught over one hundred kindergarteners and first graders, guiding with a sense of adventure and commitment to life-long learning. Each day I was committed to bringing a “spark” to my classroom, a spark that ignited a sense of optimism, confidence, and love for learning in the children that I taught. This spark was evident in my students when they came back to visit me years later, and their families still express gratitude for it to this day as the young children grow into middle schoolers.

While working with students’ with special needs, I discovered occupational therapy (OT) and felt I had discovered my purpose. With my spirit of adventure, sincere care for others, and commitment to personal improvement, I began my pursuit of a career in OT at Florida Gulf Coast University. My commitment to helping others evolved into teaching in a new way: guiding individuals to maximize their functional potential in all aspects of life. OT delights and inspires me because I am able to help others find purpose and independence in their lives. OT is more than a profession; it is an opportunity to teach others holistically and facilitate change at the individual, group, and community level. I feel empowered by my decision to break out of my comfort zone and follow my heart into a new profession, despite the financial and academic challenges it brings. I will never stop learning and will hold strong to my commitment to helping spark a confidence in others that ignites opportunities, happiness, and independence. My purpose is to change the world by inspiring others and teaching a diverse range of individuals to make life better for themselves through occupational therapy.

I appreciate any and all support received and am committed to paying it forward through my commitment to learning so that I may better serve others through OT.

Congratulations to Cody Lemmons, DPT, of Austin, TX, and Runner-up Brent M Giacchetti, COTA, of Pueblo, CO on winning our SPARC Awards! Read their winning essays below!

Essay by Cody Lemmons, DPT, University of St. Augustine, Austin, TX, Grad Date: 8/23/19

A spark can be defined physically as transferal of energy or symbolically as “a new beginning” or “hope”. Therefore, it is crucial that every physical therapist embed themselves with a spark to change each of our patient’s lives. In a world infiltrated with pessimism, deceit, poverty and carelessness, we very well maybe the only ignition to provide meaning and purpose to our patients. Patients come from many walks of life, various generations and cultures with a multitude of diagnoses who desperately need the hope, faith and spark that therapists can provide. While I come from the lens of a physical therapist and athletic trainer specifically, every patient can benefit from a multidisciplinary team of professionals in order to produce physiological and psychological change.

This past Spring, I was blessed to be given the opportunity to travel abroad to underdeveloped regions of Guatemala City, Guatemala in order to provide physical therapy and general medical services. I remain humble while writing about this heartwarming and rewarding experience to share my spark with many individuals that have lived their entire lives without hope or motivation. The primary goals and mission were to teach others about general health conditions, educate the community with exercise prescription/benefits, train other medical professionals and provide medical advice/treatment daily to those with no access to healthcare. My experience in Guatemala was to say the least the most humbling and enlightening adventure of my life. I aspire to return that same experience to my patients wherever I practice in the future. My goal is to restore hope, faith, life, meaning and spark to patients that otherwise wandered from their path by providing education, training, treatment and habitual change to carry on long past discharge.

Clinically, my journey has taken me around the states and abroad to learn from mentors and professionals, share my knowledge and skills, and gain experience with patient care. My journey began about 10 years ago when my undergraduate assignment prior to graduation was held at an inpatient rehabilitation hospital. Then, it was uncertain where my career path would take me; however, at the end of that rotation, I knew that I enjoyed patient care and improved their lives and “human experience”. While attending this rotation, I also had the privilege of working with sports medicine professionals at the local college in which I developed much of my patient and hands-on skills with emergency medicine and orthopedics. To this point, I was involved with the medical management, treatment and physical therapy to one of my classmates and football athlete that suffered a severe SCI. I was fortunate to work with him for the duration of his inpatient rehabilitation and witnessed the power of therapy and “spark” that allowed him to walk and enjoy life with his family again. He now travels to give motivational speeches and involved with the Fellowship of Christian Athletes to share his story and provide that spark.

I continued my education to become an athletic trainer and assisted with physicians in office treating a myriad of patient populations. In many ways my duties included patient care and education but did not feel that was my purpose. Patients were effectively treated but often returned for recurrent treatment in order to improve their quality of life short term. In some cases, these recurrent in-office treatments were warranted as options were limited; however, a majority of patients could have simply required the self-management education for their injuries. I decided that further education was warranted to be able to share my knowledge and skills to improve my patients’ quality of life.

I am currently beginning my final year of physical therapy school and had the privilege to attend a skilled nursing facility for my initial rotation. I had the pleasure of seeing patients admitted in our facility with severe functional decline and discharged with modified independence with all ADLs. Many of our patients often felt hopeless, helpless and without direction. My mentor and I not only provided essential physical therapy with enthusiasm but also education/training that could be used long after discharge. Patients often discharged with new life goals, new skills and friends/support that could provide a path to better quality of life and return to share their knowledge one day.

I have been blessed with so many opportunities, experiences, knowledge, mentors, students, peers, family and support in order to become a strong future clinician. These experiences have provided a strong foundation and will create opportunities to grow as a professional and person. Although my schooling is nearing its end, my learning is ceaseless. I hope that I can provide the same knowledge, skills, opportunities, foundation and “spark” that so many have given me and change every patient’s life one step at a time.

Essay by Brent M Giacchetti, COTA, Pueblo Community College, Pueblo, CO, Grad Date: 5/1/19

I am writing to you to apply for the Spark Scholarship. It has taken me many years of my life in and out of college, traveling the world, volunteering, and working many different seasonal jobs to realize my calling is where I am currently at in the Occupational Therapy Assistant Program. I look forward to doing so many things as a Certified Occupational Therapy Assistant (COTA) to give back to the community here in Pueblo or Colorado Springs, CO.

After passing my National Exam I will work part-time and plan to return to Pueblo Community College for their Nursing or Radiology Tech program. With these Associates degrees I will have the means to work abroad and improve health conditions of under privileged communities with disabilities. I would love to go back to India, return to the Himalaya’s and live there for a few years, and network through my Catholic Priest friends to be of assistance in small mountain towns where a COTA/RT/RN is needed. Using this experience from being in the mountains it will be enriching and humbling to bring those experiences back to Colorado and integrate more yoga and meditation into therapies with children and adults so they have behavioral coping mechanisms through Heavy Work yoga motions and breathing. I think it would be extremely beneficial to those in the school systems so as a whole, these holistic approaches with evidence based research and practice could bring more peace to the kids and faculty as a whole. With the success of this kind of program, it would be implemented into the routine of the teachers to do this for children, since many are sitting all day for hours in a chair, would decrease joint and ligament stress from repetitive motion fatigue and make school increasingly fun through movements that are silly, fun, and relaxing.

As I have lived my adult life in poverty and continually struggle in school due to a learning disability, it is increasingly challenging to make ends meet. I have taken to being a homeless student out of my Subaru Forester. It would be nice to lift myself out of this homelessness to afford some comforts, pay off school loans and credit card debt that have accumulated trying to complete my formal education over the past many years. Working part-time for Pikes Peak Community College as a Pre-Nursing tutor helps me manage my finances some, though the real financial support is from loans, grants and scholarships to make car payments, pay for insurance, and food. Starting Spring 2019 in January, I will have to let go of working due to the intensity and long hours of school and with clinical field work. With your generous support it will help me stay afloat from the concerns of financial instability. I appreciate your time, and I thank you for reading this.

Warm Regards!

Congratulations to our newest SPARC Award Winner, Jane Song! She is an Occupational Therapy student at Dominican University of California, and plans to graduate in May 2019.

Read her winning essay below:

In late 2012, I watched my father be nursed back to health after a serious automobile collision left him barely able to move on his own. Though the accident was difficult to deal with, the positive experience with his medical team thereafter led me to believe in the value of occupational therapy. Watching him regain the ability to engage in the functional activities that were important to him was an emotional experience. I still remember the proud look on my father’s face after he used the bathroom independently for the first time since the accident. I, too, felt extremely proud of his accomplishments. This experience led me to pursue a career in occupational therapy. The experiences I’ve had since then continue to validate my decision and reinforce my passion for this profession.

Initially, I had a desire to work in pediatrics. I first-handedly witnessed the benefits of early intervention when I worked as a volunteer with a young girl who was born with an orthopedic disorder that disallowed for fluid movements of her extremities. After several months of therapy, she was able to independently perform various functional tasks such as taking off her jacket. Her progress was remarkable to watch, but seeing her become more confident in herself was what left a lasting impression of this entire experience. This was the first time I had played a role in facilitating progress as a healthcare provider, and I felt the same, incredibly proud feeling I had felt with my father for this young girl and her accomplishments.

As my clinical knowledge and skills continued to develop throughout graduate school, the want to help individuals discover their potentials and feel more confident remained the same. This desire was especially strong during my recent level two fieldwork experience in an inpatient acute mental health setting. An experience I had with a patient not only reinforced this passion but also enabled me to gain real-life experience of the importance of engagement in functional activities. This patient spent all day in his room and refused to speak with the staff for the first three days of his stay. On the fourth day, I briefly made his acquaintance in the hallway when he momentarily stepped out of his room. I introduced myself and welcomed him to find me in the occupational therapy office if he needed anything. The next day, I invited him to group therapy. A full week nearly passed before he took his first steps into the occupational therapy room to join us for art group. With much encouragement, he picked up a paintbrush and painted his first picture. He, then, painted everyday until he was discharged. Not only did he start coming out of his room more often, but he also began to open up to the staff, making jokes and laughing. The positive changes in his behavior when he discovered this leisure activity was an eye-opening experience that demonstrated the effectiveness of occupational therapy. I, again, found myself feeling proud of this individual and the progress he had made.

Throughout the pursuit of my professional career, I am constantly reminded of the incredible potential that people have to achieve their goals. My experiences continue to solidify the notion that I am undoubtedly in a field that not only enables me to meet my professional goals but also incorporates values that I hold most dear: serving others and making a difference.

By Brian del Poso, Associate Compliance Partner

With just about three-fourths of the year completed, it’s a good time to provide an update on where we stand compliance-wise and what’s on the horizon for the rest of the year. Therapy documentation and technical accuracy has come a long way, so kudos to all of you. There are still a few areas, however, that we can pay closer attention to. These items will sound familiar as they have been identified in years past and have improved, but we definitely still need to consistently get better at:

1. Physical agent modalities documentation
2. Co-tx documentation
3. Personalized clinical assessment in Progress Reports
4. Documentation and justification for billing patient education, especially when residents are difficult and/or refusing treatment

Again, there has been improvement in these areas, but there’s definitely a high ceiling for growth. I encourage you all to seek further education and training in these documentation areas. The easy way out would be to look at some of these things and just say, “Well, we just won’t do co-tx anymore,” or “We don’t use physical agent modalities often, so…,” but the easy way out isn’t who we are. Let’s invest in each other and in the spirit of our core value of PASSION FOR LEARNING, and utilize the therapy resources, POSTettes, and compliance partners we have at our disposal to move ourselves forward.

Part A MSCAs were on a bit of a hiatus as the IRO summer season began, but they are starting up again as we speak. With that said, here’s a YTD look at some of our top-performing facilities from the MSCAs. Congrats and keep it up!

If you’d like to know where you rank within your company, please reach out to your local compliance partner, and we will get that information out to you.

Coming up in Q4, we’ll be wrapping up any leftover MSCAs, and similar to recent years, we will also be starting up Part B MSCAs. As a reminder, not all facilities will receive a Part B audit this year. Facilities chosen for Part B audits will be dependent on the size of your Part B program. Essentially, if your YTD Part B revenue hits a certain threshold, you’ll be in the pool for a Part B audit. We’re currently working on the threshold to see how much revenue makes sense for a cutoff point, so more to come from your local compliance partners.

Lastly, I’m sure you all have heard or seen the emails about our Independent Review Organization (IRO) audits. We’re not out of the woods yet and still have the remote portion coming up, but we wanted to give a shoutout to this year’s on-site facilities (Legend Oaks Kyle, Golden Acres, Rehab Center of Des Moines, Grand Oak, Redmond, HCR CO Springs, Heritage Park, Brookfield) for doing such an awesome job in our very last CIA and IRO year!