MP

2016 MSCA Process Updates and the Importance of Medicare Meetings

Ironically, the old adage that does not change in healthcare is “The only thing that is constant is change.” Year two of the IRO on-sites is now over, and there is always a lot we can take away as an organization from these audits. Oftentimes, it makes us reflect upon the processes that we have in place in both operations and compliance, and how effective they are in preparing our facilities for success.

With that said, there will be some tweaks in the works for the 2016 MSCA compliance auditing process to help capture where we may be vulnerable and also to mimic the process of IRO on-sites more closely. Also, one of the areas we always focus on but that still needs constant fine-tuning is our Medicare Meeting and how we, as an organization, can be better. A question you may want to ask yourself when looking in the proverbial mirror is, “How can I be better?”

MSCA Process Updates

The MSCA process for 2016 will remain relatively the same in terms of the number of audits and the types of things we will be auditing. One of the things that will be changing is how we select some of the claims we will be auditing. The biggest change with the claims selection process comes with our “High Risk” facilities. We will still have a split audit for these buildings, but for the first portion of the audit, we will use Length of Stay reports found in PCC to help guide the claim selection process. This makes sense, as we know and have learned (sometimes the hard way) that our claims with longer lengths of stay are the most vulnerable.

The other things that are changing are the additions of therapy treatment observations and DOR interviews during the on-site portions of the MSCA. This will closely mimic what is done during IRO visits and will help us not only prepare for possible IRO selections, but also help us at the facility level to identify possible root-cause weaknesses in our processes. Your compliance partners will inform their facilities of the changes and will be happy to go over these new processes with you and your facility teams should there be any questions.

Importance of the Medicare Meeting

The Medicare Meeting is always an emphasis to look at and improve upon, even in the best of our meetings. This year’s IRO on-site helped us identify some areas where we can definitely improve not only as an IDT, but as DORs.

For one, make your voice known. We found yet again, the best meetings were the ones where IDT members were fully engaged and challenging each other, asking the right questions about patient care, discharging of therapy disciplines, appropriate lengths of stay, etc. So, what if you notice your IDT members are relatively quiet or things are going a little too smoothly and everyone agrees completely with everything? Ask yourself if all the right questions have been asked and key factors have been analyzed regarding the patient’s care. Take the onus and help engage your fellow IDT members if need be.

The improvement in use of standardized testing was great to see and was noticed by the IRO. However, let’s not lose sight of the fact that our IDT members may not be as well-versed in these tests as you may be. Take the time to help educate and explain to the team what these tests are and how the scores impact the patient. The more they know, the more relevant the information and conversation you will have with standardized testing.

Finally, we all have full days and run busy programs, relying greatly on our therapy staff to support us. Gathering information from the therapy staff about resident care is vital to providing pertinent information during the Medicare Meeting. I think it’s safe to say that we all do that in one form or another, but how sure are we the information we are providing during the Medicare Meeting is being captured in the actual therapy documentation? Unfortunately, it was a hard lesson learned this year, that that situation can occur. So I ask all of you not to rest on your laurels and your past successes, but rather to re-evaluate your current systems to answer the question, “How can I be better?”

Congratulations to our 3rd Quarter recipient of the SPARC award, Cindy Syrovatka! Cindy is an OT Student at The University of South Dakota, and will graduate in December 2015. Her inspiration and drive for occupational therapy stems from the example and guidance of peers, family and educators she has experienced. Read her story below, and we think you will agree she is a most deserving recipient of our support.

Cindy’s Essay

A devoted 65-year-old rural farmer with Scleroderma and Type II Diabetes returned to his hospital room after a surgical procedure. The kind gentleman’s comorbid diseases were worsening, and therefore the physician decided to surgically remove all of the farmer’s toes on both feet. The doctor told the farmer he would never be able to walk again. The farmer understood the procedure had to be done, but since he was a dedicated farmer, he worried he would not return to daily farming with his son. The farmer was able to go home with home health services after a few nights stay. Luckily, the farmer had a supportive family who lived nearby, of which one 12-year-old granddaughter invested her time in helping her grandparents daily as needed. The farmer explained to his granddaughter how sad he was that he was not going to be able to walk anymore, which meant he wasn’t going to be able to get in the shower alone, make supper, or get a glass of water, but more importantly, wasn’t going to be able to complete any farming activities. The passionate farmer had tears in his eyes while talking to his granddaughter and depression set in over time. Then, one day, while the granddaughter was at the farmer’s house, a lady came in to the home for an appointment saying she was an “OT.” The lady proceeded to tell the farmer and his granddaughter how she was an occupational therapist and was there to help him find a way to complete his daily tasks as independently as possible. The farmer looked up at the lady and said, “it doesn’t matter what I can do, I just want to be able to farm.” The occupational therapist took this statement as a challenge. The farmer was doubtful that an occupational therapist could help him, but he was determined and worked hard during therapy. Week after week the occupational therapist came to the house to work with the farmer, and the granddaughter observed and participated in as many sessions as possible. With the occupational therapist’s devoted time, passion to help people improve their daily lives, and education and training on ways to modify or adapt tasks, the farmer was able to complete his daily activities independently in a new way. Now, the farmer could independently get in and out of the shower with the help of durable medical equipment, utilize equipment to get dressed, get a glass of water, and most importantly, was able to utilize an automobile four-wheeler with adaptive methods to complete some farming activities once again. The farmer was so delighted and thankful for the occupational therapist’s help.

Even though the farmer was told he would never walk again, he was motivated and devoted, and achieved much more in his life. He even verbalized to his granddaughter and therapist that he had a better quality of life and felt he had a purpose to live. Not only did the therapist spark and motivate the farmer, but the granddaughter as well. The granddaughter knew that someday she wanted to be able to enrich the lives of all individuals, just like the occupational therapist did for her grandfather. Today, the granddaughter is completing her fieldwork clinical experience using her education, training, and her grandfather’s story to help motivate others as well as identify ways to help all individuals engage in meaningful occupations in order to improve their daily living skills. The granddaughter in the story… is me.

As an occupational therapy student and future occupational therapist, I envision using my education and training to advocate and spark my patients and all individuals about the importance of occupational therapy, what it is, what it can do, but most importantly what it can help individuals do in their lives. I visualize myself using evidence-based interventions, to continue learning, being an accountable therapist, and advocating for the best interest of my patients.

I decided I wanted to be an occupational therapist because I have a passion for helping individuals gain the ability to be as independent as they can as well as helping them engage in meaningful daily activities. As a student, I’ve developed a passion to learn what specific interventions and strategies truly help each individual improve their skills. Learning evidence based strategies helps me during my level-two-fieldwork placement that I am currently completing, and will continue to benefit me as a therapist. During my therapy sessions, I strive to utilize evidence based practice techniques and educate my patients on the success of these strategies. Throughout my school years, I have participated in various research opportunities that help demonstrate my passion for learning. Currently, I am working on an evidence based systematic review focusing on the interventions that modify, establish, or maintain occupations of adults living with dementia or other related disorders. My passion for learning helped me strive to not only complete the difficult school work and time associated with graduate school, but also an additional time consuming task of completing extra research. Therefore, I have already started utilizing evidence-based practices into my daily routine with patients, and I envision myself to continue completing research during my career and keep it as an important aspect of my own daily routine. My dedication to enhancing my patient’s well-being not only links to my passion for utilizing evidence based practice, but my understanding that everyone is different and unique in their own way. Knowing that everyone is different reminds me that not all interventions are appropriate or successful with all individuals. I will need to continue learning not only from textbooks, but from my patients in order to learn what intervention strategies are successful for each patient specifically. Being client-centered will help me find and ignite each individual’s own spark to believe in themselves, improve their abilities and engage in meaningful occupations.

My desire to be client-centered with my patients will help me establish accountability with them as well as my employer. My education and training has helped me gain the ability to establish rapport with patients and coworkers. I will demonstrate accountability with my patients by providing them with the skilled services I have gained from my education and training. I will be held accountable as a professional by ensuring that I am up to date with research and new therapy practices and technologies. My accountability as a therapy professional will benefit my employer in regards to being able to perform successfully, clinically, and culturally with all patients, as well as increase success rates and patient caseloads for my employer. Essentially, my provider will be able to hold me accountable to provide adequate safe care to my patients, be well educated and trained to make appropriate clinical judgments and complete documentation appropriately. I will also practice client-centeredness, provide just right challenges for my patients, and be able to establish an appropriate level of revenue.

As mentioned previously, I envision my future self to be efficient at documentation skills and I understand the value and importance of documentation. However, with this said, if I had freedom from corporate limitations in healthcare, I would attempt to have all therapists complete more one on one time with their patients and less time solely completing documentation. To allow for these changes, productivity rates may need to be lowered at first and overall documentation amount may need to be reduced. Essentially, I would educate therapists on the importance of documenting more efficiently and to have more one on one time with their patients instead of alone documentation time. I will train therapists to complete their paperwork while they are educating patients on various topics such as their personal goals. I believe that by completing documentation while with the patients, this will help keep the therapists more goal oriented during treatment, as well as keep the patient up-to-date on their progress overall. Providing more one on one care is a valuable component that I hope to establish in my treatments.

I, as a current occupational therapy student and future occupational therapist, will attempt to utilize evidence-based practice, continue to learn, be an accountable therapist, and advocate for the best interest of my patients. My occupational therapy education, training, passion, and values, will help individuals, such as the rural farmer, overcome barriers and engage in meaningful occupations to improve their daily living skills

Cindy’s Service and Volunteer Activities

The University of South Dakota has provided me with various involvement opportunities where I have been able to service others and volunteer. Specifically, as part of the University of South Dakota’s Occupational Therapy Club, I have gratefully been given opportunities to help increase the quality of life for numerous people through my dedicated service. For example, I served as the 2014-2015 University of South Dakota Occupational Therapy’s Institute of Health Care Improvement (IHI) representative where I was able to meet with other healthcare disciplines and discuss ways to promote and advocate for healthcare. We, as an organization, advocated for healthcare in various ways such as displaying movies about healthcare for community members or students to attend, and created and dispersed handouts about healthcare. I also participated in a panel for USD’s pre-occupational therapy club where I advocated for occupational therapy by sparking students’ interest towards the field as well as general knowledge about occupational therapy. I have also completed numerous phone and email interviews for high school students who were interested in an occupational therapy career. In these interviews I explained what occupational therapy is and how important it is to health care. I have volunteered my time for Vermillion, SD’s Community Health and Wellness Fair, Meals on Wheels, played Wii at an assisted living community residence in Vermillion, and provided faculty supervised occupational therapy treatments to a community member in need. Additionally, I have volunteered my time at a local backpack program where food was gathered, bagged, and then sent to schools to be dispersed to lower social economic status school-aged children to ensure the they would have adequate food to eat during the weekend. During my time as an occupational therapy student, I donated to local book drives to help disperse books to children in need. I also donated to Special Olympic programs. Lastly, as a student, I was given the opportunity to implement a program at a rural long-term care center to help improve leisure participation in older adults. These volunteer and service activities have helped me advocate for a career field I love as well as obtain a more diverse appreciation for all different people. Gratefully through these activities mentioned previously, I was able to provide opportunities for individual’s to be involved in activities and improve or enhance their participation in enjoyable activities.

Poster Presentations

Research Involvement

• Systematic review (January 2014-present): Currently co-author/researcher completing a systematic review through the American Occupational Therapy Association, focusing on interventions designed to establish, modify, and maintain occupations for adults with Alzheimer’s disease and related disorders.
• Presentation speaker at 2015 National AOTA Conference in Nashville, TN: Systematic Review on Occupational Therapy and Alzheimer’s Disease and Related Disorders
• Presentation speaker at 2015 University of South Dakota School of Health Sciences Research Day: Systematic Review on Occupational Therapy and Alzheimer’s Disease and Related Disorders • Presentation speaker at 2015 University of South Dakota Occupational Therapy Research Symposium: Impact of Tablet Technology Use on Social Isolation Among Older Adults: A Pilot Study
• Biochemistry Lab Technician at South Dakota State University (October 2011-May 2012): Aided researchers in cardiac testing and performed basic lab functions such as making transparent gels

Poster Presentations/Critically Appraised Topic Presentations:

• Effectiveness of Pet Assistive Intervention to Help Improve Social Participation in School-Aged Children with Autism
• The Effectiveness of Early Mobilization within 1 week of a proximal humeral fracture compared to immobilization for 3 or more weeks for decreasing pain levels in adults aged 40-85
• The Effectiveness of Behavioral/Cognitive Behavioral Strategies in Facilitating Transition to Supportive Employment Compared to Less Directive Client-Centered Strategies with Adults Diagnoses with Schizoaffective Disorder
• Effectiveness of Sensory Integration with School Aged Children with Disabilities

About SPARC

Ensign Therapy SPARC (Scholarship Program And Recognition Campaign) is inspired by its namesake and the sense of liveliness and excitement that therapy students and new graduates bring to our facilities and in-house therapy programs. With this scholarship program, we are deliberately seeking out those individuals who ignite a desire for excellence in themselves, their patients, their colleagues and co-workers.

Congratulations to our newest SPARC Award Winner, Rebecca Stadler, who is studying Speech/Language Pathology at Marquette University, Milwaukee, WI. Rebecca graduates in May 2016. Read her winning essay below:

I was introduced to the field of speech-language pathology at a young age when my brother Bobby was born with cerebral palsy. From that day forward, I went along to countless doctors’ appointments, therapy sessions, and even day camps. I quickly grew into a wide-eyed five year old who asked Bobby’s neurologist about his brain scans and was shown around the clinic during his speech therapy session. My childhood observations contribute to my interest in communication sciences and disorders, and have begun to prepare me for my future as a speech-language pathologist.

I personally experienced language acquisition when I studied abroad in Granada, Spain, influencing the way I approach speech-language pathology. Along with working towards my Spanish major, I volunteered my time teaching science classes to Spanish-speaking middle school students. I facilitated the students’ first exposure to a new language by recapping the material they learned that week in English. I experienced a language barrier first hand through the students’ frustration in understanding the material, and through the challenge I faced working with their teacher who spoke solely Spanish. Ever since this unique experience of immersing myself in another culture, I have been eager to work with a diverse clinical population. My firsthand experience provided me with a unique point of view as I approach therapy with my own clients. My passion for learning the Spanish language and also learning about language development contributes to my ability to provide therapy that is the best for the patient’s wellbeing. I am eager to continue learning the most current evidence based practices to best meet the needs of my individual patients.

After my involvement with adolescents in Spain, I was eager to learn more about the research aspect of speech/language pathology. I began research as an assistant in Dr. Leann Smith’s Transitioning Together lab at the Waisman Center. I worked on the Transitioning Together project providing intervention and a support group for adolescents with autism spectrum disorders (ASD) and their families focusing on the transition after high school. In addition, I worked with CSESA (Center on Secondary Education for Students with ASD), which is a research and development project that supports optimal outcomes for students after graduation. By providing support as a leader of the teen intervention group, I put research into practice as I encouraged teenagers with ASD to set goals and plan for their future. Throughout my research experience, their robotic speech and inability to easily pick up on social cues became more apparent. I saw first hand that speech and language intervention is not only crucial early in life, but also for adolescents. As such, this area of research investigating new methods to evaluate and eventually treat adolescents with communicative disorders is one I would like to continue as a clinician. Clinically, I am drawn towards working with children and adolescents with social disorders, but have been exposed to a variety of other patient populations at Marquette University. My eyes have been opened to multiple methods for assessment and treatment and have given me insight as a clinician to always consider the patient’s functional outcomes. Everything I have learned over the last year has made the decision of where and with what patient population to work much more difficult.

In the Speech and Hearing Clinic at Marquette, I have worked with patients ranging from ages 2-65. My clients had diagnosis of aphasia, Down syndrome, autism, Dandy-Walker syndrome, cerebral palsy, and multiple disabilities. Collaborating with my supervisors, clients, and their families allowed me to take into consideration the patient’s diagnosis, abilities, and difficulties to create therapy activities that would lead the most functional outcomes for each client. My coursework and clinical experience over the last year have given me a unique perspective to take with me as I enter my second year as a graduate student. For example, I worked with 2 six year olds with autism spectrum disorders in a dyad therapy session and I used the current, evidence-based program, The Incredible Flexible You to teach and apply social skills necessary for their age. I planned lessons around the curriculum, modified the curriculum to meet each of their needs, and collaborated with my supervisor to create appropriate activities for each girl’s strengths and weaknesses. Their parents were extremely supportive and involved, so I created homework assignments and activities to use at home in order to see generalization of skills and to contribute to each girl’s well-being outside of the therapy room. With my one of my adult clients with aphasia, I discussed his goal ideas with him at the beginning of the semester in order to make sure I was working on his goals in therapy.

Over the last year, I have begun to understand that my client’s physical, social, emotional, moral and cognitive development influence learning as I was able to take this into consideration when working with all of my clients. I adjusted sessions when activities were too easy or too difficult and I modified materials that were not appropriate for individual clients. For example, with my 10 year old client with Down syndrome, I was able to recognize that further developing his expressive language would later lead to increased and more positive social interactions with peers to meet social and emotional needs. I was able to work with him to target appropriate conversations to be had and to include nonverbal communication to make sure listeners are aware he is attending to the conversation. I adjusted my sessions by providing more visual supports for him to begin understanding the importance of expressive language and social language skills. I understand that students have different learning styles, and was able to adapt my sessions in order to meet the needs of my clients. For example, my child clients’ sessions were after school causing them to be distractible. I created movement-based activities to keep them engaged. One client’s mother reported she was concerned at the beginning of the semester that the therapy time right after school would negatively affect her son’s performance. At the end of the semester, his mother reported she appreciated my effort to keep him engaged and learned that he still benefitted from therapy despite the time of day due to my abilities to adapt to his behaviors and meet his needs.

Throughout my clinical experience, I learned the value of self-reflecting in order to best maximize my client’s outcomes in therapy. Before each session, I used the previous session’s data to reflect upon my client’s progress in order to plan activities and create lesson plans. I valued short and long-term planning with my supervisors, clients, parents, and relevant professionals. With an ever growing eagerness and passion to immerse myself in the study of speech-language pathology, I am confident that both my experiences and my drive have prepared me for my clinical practicums in both the medical and school setting, as well as positioning me as a future asset to the field of speech-language pathology.

About SPARC

Ensign Therapy SPARC (Scholarship Program And Recognition Campaign) is inspired by its namesake and the sense of liveliness and excitement that therapy students and new graduates bring to our facilities and in-house therapy programs. With this scholarship program, we are deliberately seeking out those individuals who ignite a desire for excellence in themselves, their patients, their colleagues and co-workers.

Part B Cap Exception Extended. Transition to Value-Based Service Model Continues.

Some of our rehabilitation therapy revenue is paid by the Medicare Part B program under a fee schedule. Congress has established annual caps that limit the amounts that can be paid (including deductible and coinsurance amounts) for rehabilitation therapy services rendered to any Medicare beneficiary under Medicare Part B. The Deficit Reduction Act of 2005 (DRA) added Sec. 1833(g)(5) of the Social Security Act and directed the Centers for Medicare and Medicaid Services to develop a process that allows exceptions for Medicare beneficiaries to therapy caps when continued therapy is deemed medically necessary.

Annual limitations on per beneficiary incurred expenses for outpatient therapy services under Medicare Part B are commonly referred to as “therapy caps.” All beneficiaries began a new cap year on January 1, 2015, since the therapy caps are determined on a calendar year basis. For physical therapy (PT) and speech-language pathology services (SLP) combined, the limit on incurred expenses is $1,940 in 2015. For occupational therapy (OT) services, the limit is $1,940 in 2015. Deductible and coinsurance amounts paid by the beneficiary for therapy services count toward the amount applied to the limit.

An “exceptions process” to the therapy caps was expected to expire on March 31, 2015; however, the U.S. House of Representatives and Senate each voted to extend the Cap Exceptions process through December 31, 2017. For claims exceeding the $1940 therapy caps, therapy service providers and suppliers may request an exception when one is appropriate. When using the Cap Exceptions process to continue treatment beyond the $1940, the provider is attesting that the services are reasonable and necessary and that there is documentation of medical necessity in the beneficiary’s medical record. The passage of this bill repeals the sustainable growth rate (SGR) and moves toward payment systems based on quality, but does not end the Medicare outpatient therapy cap.

Instead of a full repeal, the therapy cap exceptions process will extend until December 31, 2017. The vote on the SGR ends payment system that would have resulted in 21% reductions in Medicare Part B Fee Screen. One of the most significant features of the bill is that it sets the stage for a transition to value-based health care services, and away from the fee-for-service model. The Centers for Medicare and Medicaid Services (CMS) has submitted the CARE (Continuity Assessment/Record Evaluation) Item Set as the Functional Outcome Measure for Proposed SNF, LTACH and IRF in the Final Rule. For the SNF, it has been built into the MDS for Data Collection. By partnering with Optima Health Care Solutions, the maker of our therapy software Rehab Optima, we are one step ahead of the curve. Optima HCS has built the CARE Tool into our documentation system and was also approved as a national repository for the data because the CARE Item Set is geared toward mobility and self-care, we have also incorporated NOMS (National Outcome Measurement System) as the functional outcome measurement tool for our SLP Services. Optima HCS has also made this tool available in our documentation system. We are beginning the transition to requiring these tools as a part of our Evaluation and Discharge Process. The tools are standardized through the therapist certification in their use. These standardized measures incorporated into the evaluation and discharge process of our patients, further support the efficacy of our services and helping to position us for the ongoing changes expected in healthcare. Ensign Therapy is staying ahead of the curve!