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Every 42 seconds, a person suffers a heart attack. Despite the fact heart disease remains the leading cause of death in both men and women in this country, the incidence of death because of heart disease is declining. And if you are one of the more than 30 percent who survived a heart attack last year, consider yourself lucky. Your second chance at life is about to get better, and the staff at Monte Vista Hills Health Care Center is here to help.

“I’ve seen this Heart PARC (cardiac post-acute rehab care) program help numerous lives for the better,” said Clayton South, executive director for Monte Vista Hills. “It has provided excellent outcomes throughout the industry, and I’m excited about its implementation here at Monte Vista.”

The concept of providing rehabilitation therapy is not new, but to offer services that cater specifically to cardiac care is a tremendous resource for patients and their families who are facing a permanent life-changing event. Here are four reasons why this cardiac program makes my heart skip a beat.

1. The staff provides focused care.

While other rehab therapy centers address a variety of conditions, this program focuses on the heart and all of the factors associated with recovery and education. Many patients are not yet ready to return home after cardiac surgery or a cardiac episode. This program bridges the gap that ensures patients are physically and emotionally prepared to return home safely.

“This isn’t just therapy. Instead, this is an interdisciplinary program,” said Dr. Jared Lundquist, director of rehabilitation for Monte Vista Hills. “It’s not just about the therapy but the skilled nursing and everyone else involved in this program.”

This multi-disciplinary approach focuses on the specific needs and concerns often shared by cardiac patients.

“Our team works together to progress each patient through five care levels and prepare them to succeed at home,” Lundquist said.

2.The staff communicates with the hospital.

The highly skilled, board-certified cardiac specialists review each patient’s medical history and regularly collaborate with the cardiologist to design a personalized care plan that matches the patient’s level of needed care, diet, risk levels, and ability to function.

“Each care plan is specific to the patient,” South said.

And the cardiologist is kept informed and conferred with during each phase of recovery.

3. The staff builds a relationship with each patient.

The one-on-one care each patient receives creates a unique and helpful relationship; the weekly interaction with patients means staff can perform ongoing assessments and evaluate the patient’s progress, subtle changes in symptoms, and projected responses to recent procedures, diet, medications, exercise levels, among other things. Should symptoms worsen, the staff can perform acute therapies to improve the patient’s condition.

4.The staff is prepared should immediate care be required.

The PARC environment is designed to focus on progress and recovery. During treatment, patients are assisted by a staff possessing acute knowledge in overall heart function, abilities, diseases and behaviors. This staff also knows the history and past procedures of each patient and directs a patient’s treatment plan to prepare them for existing challenges at home. But should a setback occur and emergency care is needed, it is good to know patients are surrounded by a qualified staff that can perform life-saving care until the patient can be admitted to the hospital. This reduces the chance of irreversible damage and increases a patient’s prognosis for a full recovery.

“The comfort and safety our patients feel while in this care makes a huge difference in the overall recovery process,” South said.

By being able to provide focused care, collaborate with team members and specialists, build a supportive relationship with patients and be prepared for whatever need should arise, the Monte Vista Hills is proud to offer this high-level cardiac care to the community.

Published online by The Idaho State Journal, Nov. 4, 2016

Submitted by Monte Vista Hills Health Care Center, Pocatello, ID

Why should cardiac programs matter to you? Research shows that most hospitals have a cardiac diagnosis within their top five admitting diagnoses. CMS has identified heart failure and MI as two of the most expensive diagnoses for Medicare, and new cases are increasing at a rate of 550,000 annually. The next mandatory bundled payment being considered by CMS is cardiac conditions.

Where Does the SNF Fit Into All of This?

We can be the best post­acute care partner in our communities by sharpening our clinical skills in nursing and therapy to bridge the gap between a hospital stay and home.

Since implementing the Heart PARC (post­acute rehab center) program in 16 of our buildings over the past year, we have begun to see some encouraging results:

• Increased skilled census for this condition type
• Reduced re­hospitalization
• Increased functional outcomes using the CARE data
• Increased confidence in working with clinically complex patients due to focused training and education
• Increase confidence from our health partners in our clinical expertise

The graph below shows the cardiac-­specific skilled census at Park View Post­Acute (PVPA) in Santa Rosa, California, from September 2015 (first month of Heart PARC implementation) to December 2015:

 

 

This graph shows the shift in skilled census at PVPA from September 2015 to December 2015:

 

 

The below graph shows PVPA hospital readmissions from September 2015 to July 2016:

 

 

 

 

So How Do I Get Training in My Building?

Currently therapy and clinical resources are being trained in a train-­the-­trainer format. Please signify your interest in bringing this program to your building by reaching out to your therapy or clinical resource, and we will get information to you on first steps.

We are well into year three of our Corporate Integrity Agreement (CIA)! Many of you have already had an onsite Medicare Systems Compliance Audit (MSCA) conducted by one of our compliance partners for Medicare Part A services provided to residents in our facilities. We have seen many examples of excellent therapy documentation supporting the vital therapy services that help our patients improve their quality of life and in many cases return home or to a lesser level of care.

One trend that has been observed while completing the MSCAs is either over-delivery or under-delivery of therapy visits according to the Plan of Care or Updated Plan of Care and subsequently, physician’s orders.

For the evaluating therapist, there are many things to consider when developing the Plan of Care or Updated Plan of Care. When determining frequency, factors such as the patient’s medical condition, activity tolerance and cognitive level should be considered. Services must be ordered by a physician and consistent with the Plan of Care or Updated Plan of Care. Ensign Rehabilitation Policy #215 “Clarification Orders” requires documentation of frequency as one of the components of a clarification order. If frequency of visits in a given week is exceeded without a physician’s order, this could result in a disallowance of services. Frequency of therapy treatment provided is not only something that we look at on our MSCAs, but historically by outside auditors as well.

There are situations when an increase in frequency is clinically indicated such as an improvement in the patient’s medical condition — effective pain management, change in weight-bearing status or a remediated precaution. In addition, there are situations when an increase in frequency is indicated on a practical level in order to facilitate outcomes related to a revised discharge plan or caregiver training. For example, a patient may be discharging home and the caregiver is only available on Saturdays for training. All of these scenarios would support additional treatments for the patient as long as a physician’s order is obtained and the POC/UPOC is revised to reflect the new goals, approaches and frequency of services.

Conversely, a reduction in the frequency of therapy services may also be indicated at times. The reasons for this may be related to a decline in the patient’s medical condition such as a UTI or low INR levels. In addition, there may be logistical reasons related to the availability of the patient for treatment such as scheduled dialysis treatments or medical appointments requiring travel. Documentation related to the reason for a missed treatment should be found in the medical or treatment record. If there is no documentation in the record for decreased treatment, then services are not compliant with the established POC/UPOC or the physician’s orders.

The following guidance was provided to the field with the recently updated POSTette titled “Plan of Care”:

Frequency refers to the number of times in a week treatment is provided.

In Rehab Optima the start of the care date (evaluation date) initiates the seven-day cycle in which therapy must be delivered to the patient as necessary to meet the physician-prescribed dosage.

In order to establish organizational consistency, the evaluation encounter (regardless of whether treatment was provided on the same day or not) will count as part of the frequency the first treatment week for most payers.

However, for RAI purposes, number of treatment visits refers only to the number of days in which treatment was provided during the week, and those treatment days are the only days counted for the purpose of the MDS, which may or may not be used for payment with some payer sources.

Exceeding frequency of visits in a given week (whether or not treatment was provided on the day of evaluation) may or may not result in a disallowance of services and will be reviewed on a case-by-case basis.

As an overall reminder of regulatory requirements for Medicare Part A, please see the additional information as follows:

According to the Medicare Benefit Policy Manual Chapter 8, skilled therapy services must meet all of the following conditions summarized below:

• The services must be directly and specifically related to an active written treatment plan that is based upon an initial evaluation performed by a qualified therapist after admission to the SNF and prior to the start of therapy services in the SNF that is approved by the physician after any needed consultation with the qualified therapist. In those cases where a beneficiary is discharged during the SNF stay and later readmitted, an initial evaluation must be performed upon readmission to the SNF, prior to the start of therapy services in the SNF.
• The services must be of a level of complexity and sophistication, or the condition of the patient must be of a nature that requires the judgment, knowledge and skills of a qualified therapist.

• The services must be provided with the expectation, based on the assessment made by the physician of the patient’s restoration potential, that the condition of the patient will improve materially in a reasonable and generally predictable period of time; or the services must be necessary for the establishment of a safe and effective maintenance program; or the services must require the skills of a qualified therapist for the performance of a safe and effective maintenance program.

• The services must be considered under accepted standards of medical practice to be specific and effective treatment for the patient’s condition.
• The services must be reasonable and necessary for the treatment of the patient’s condition; this includes the requirement that the amount, frequency and duration of the services must be reasonable.

References and Cross-References:

Centers for Medicare and Medicaid (CMS) Benefit Policy Manual 100-2; Chapter 8; Sections 30, 40.1

Ensign Rehabilitation Policy #215 “Clarification Orders”

POSTette: Plan of Care

RAI Manual