Why the Concerns?


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Why the Concerns?

  1. 1. Why the Concerns? • Therapy Practice Pattern shifts? – 26% increase 14+ • OASIS Data Analysis – Support for referrals? • “Incentives” in the PPS structure? – 6, 14 and 20+ ©2011
  2. 2. MedPAC Report “MedPAC wrote in the March 2010 report(MedPAC, 2010, p. 206) that payment incentives continue to influence treatment patterns, andthat payment policy is such a significant factor in treatment patterns because the criteria for receipt of the HH benefit are ill-defined.” ©2011
  3. 3. Semantics? • PPS 2011 contains “Therapy Clarifications” not new regulations. • Drive the professions back to basics to support skilled care. ©2011
  4. 4. Qualified Therapist“We believe that when a unique condition of an individual patient requires more therapy than atypical Medicare HH rehabilitation patient, such a patient should be more closely monitored by aqualified therapist to ensure high-quality, effective services are being provided and/or acceptable progress towards goals is being achieved.” ©2011
  5. 5. Foundation • The plan of care must be built upon a solid initial assessment. • Periodic reassessment Plan Plan ensures the building is Of OfCare Care progressing as planned or explains why there are delays. ©2011
  6. 6. Initial Assessment• Prior Level of Function: – NOT optional• Tests and Measures: – Connected to functional activity• Determining the “need” for therapy: – Not based on diagnosis• Establish rehabilitation potential: – Restorative versus maintenance ©2011
  7. 7. Coverage Issue “Therapy would not be covered to effect improvement or restoration of function when a patient suffered a transient and easily reversible loss or reduction of function.” ©2011
  8. 8. Tests and Measures • Standardized: – Must follow the directions • Validated: – Assess research behind the tool • Value in repeating over course of care: – Support ongoing need and impact of care ©2011
  9. 9. Connecting the Dots• Measurements: • Functional Impact: – ROM – Ambulation – Strength – Transfers – Balance – Bathing – Vision – Dressing – Pain – Toileting – Sensation – Incontinence – Communication – Medication – Cognition Management – Environment – Swallowing – Equipment – Home Management ©2011
  10. 10. What Does a Therapist See?• “Gait Deficits”: – Patient 1 – Visual and cognitive issues – Patient 2 – Leg length discrepancy and pain• “ADL Deficits”: – Patient 3 – Anxiety and lack of transfer bench – Patient 4 – Balance and arm in a sling• “Swallowing Deficits”: – Patient 5 – Posture and muscular weakness – Patient 6 – Attention and memory ©2011
  11. 11. Don’t Forget OASIS• Improvement in ambulation/locomotion.• Improvement in bathing.• Improvement of oral medications.• Improvement in transferring• Improvement with pain interfering with activity.• Any emergent care provided.• Acute care hospitalizations.• Improvement in dyspnea.• Improvement in urinary incontinence.• Discharge to the community.• Improvement in the status of surgical wounds*.• Emergent care wound infections/deteriorating wound status*. ©2011
  12. 12. Now What? • Identification of deficits does not automatically support the need for skilled care. • Must determine what specific interventions are needed to enact change. ©2011
  13. 13. Selecting Interventions• Current Model: • Moving Forward: – Gait training – Use the assessment to – Transfer Training drive the interventions: – Ther Ex/HEP • “Why” is a certain level of assistance needed? – Balance Training – ADL Retraining • Examples: – Visual Training – Visual compensation techniques for macular – Oral Motor Training degeneration that – Cognitive Training impacts safe dressing – Fall Prevention Training and med management ©2011
  14. 14. Community Access• Can the patient: – Carry a 5 pound weight for >1000 feet? – Carry packages averaging 6-7 pounds for short distances? – Walk a minimum of 1000 feet per errand for 2 – 3 errands per trip? – Change speeds and maintain balance? – Negotiate safely around obstacles, slopes, or curbs while looking in a variety of directions? – Multi-task while walking (walk and talk, walk and look from side to side or up and down)? – Carry a package up and down the stairs? – Safely engage in postural transitions such as changing directions, reaching, looking up or down or sideways, move backwards? – Rise from a chair without the use of arms with minimal effort? – Walk at 4 feet per second for at least 1 minute to cross a street? – Walk at a minimum speed of 160 feet per minute or about 2.6 feet per second? ©2011
  15. 15. Components of Well Written Goals• Identification of person who is receiving therapy and will carry out the program.• Description of the movement or activity that the patient will perform.• A connection of the movement/activity to a specific function.• Specific conditions in which the activity will be performed.• Factors for measuring performance.• Time Frame for achieving goal.Physical Therapy Reimbursement News, Volume 13, Number 3 ©2011
  16. 16. Measureable AND Meaningful• Patient will amb 300 feet independently over driveway surface with walker to allow access to mailbox and vehicle.• Patient will shower with intermittent SBA and use of a transfer bench.• Patient will demonstrate independent ability to utilize thickener to maintain nectar consistency for safe intake of liquids. ©2011
  17. 17. Reassessment Timeframes • Minimally every 30 days. • Key areas around 13 and 19 total therapy visits. • Done by “qualified therapist” who actually participates in the assessment directly. • Done as part of a treatment visit. ©2011
  18. 18. ckrafft@fazzi.com fazzi.comTwitter ID: FazziRehab800 379 0361 ©2011