Dust off your textbooks and literature on evidence-based practice, throw out the therapy arch and peg board, bookmark cms.gov, and get yourself in gear for 2019.

There are many changes coming to the long-term care as whole in 2019, including and in addition to PDPM.

Communities should, as a result, review how and when they engage their therapy team regarding current regulation, what positive impacts full engagement of therapy can generate, and how they can collectively measure success.

So, where should we stay laser focused regarding current and future regulatory change and the impacts of therapy?

Patient-Driven Payment Model (PDPM) implementation 10/1/2019

Effective October 1, 2019, CMS will begin using the case-mix based Patient-Driven Payment Model, which utilizes MDS coding elements as determiners of patient’s conditions and care needs for determination of Medicare payment.

KKey here: With clinical coding as a sole determiner for reimbursement as part of the initial MDS assessment, accuracy will be pivotal.

Therapy teams should begin engagement now in coding accuracy within the Minimum Data Set for key sections, including C, K, GG and I, in order evaluate current opportunities for increased accuracy and promote greater levels of interprofessional practice across the interdisciplinary team.

Value Based Purchasing, VBP, which began on October 1, 2018 (the start of fiscal 2019)

The Program will begin awarding incentive payments to SNFs based on performance on the SNF 30-Day All-Cause Readmission Measure (SNFRM) (NQF #2510)

The VBP Program uses the Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM) to estimate the risk-standardized rate of unplanned readmissions within 30 days.

The SNF VBP Program focuses on better outcomes and rewards skilled nursing facilities with incentive payments for the quality of care they give to people with Medicare, in particular reducing hospital readmissions. 

Therapy teams play a significant role in ensuring patients under their care are safe not only during their skilled rehab stay, but following including reducing their risks for returning for another acute-care stay.

This can be achieved via implementation and monitoring of systems related to home evaluations performed early in the rehab stay, education of patients related to their chronic disease processes, and greater levels of engagement across care providers within the post-acute care spectrum.

State Survey, Phase II ROP Requirements, implemented 11/28/2017

Let us not forget the updated critical element pathways now included as part of the updated state survey process.

Therapist should be prepared and comfortable with being interviewed by surveyors and able to effectively answer questions including the following:

ADL Critical Element Pathway: Therapy-Specific Interview Questions

  • When did therapy/restorative start working with the resident?
  • How did you identify that the interventions were suitable for this resident?
  • What are the current goals?
  • How do you involve the resident or resident representative in decisions regarding treatments?
  • How often do you meet with the resident?
  • How often does therapy screen residents? Where are screening results documented?
  • How much assistance does the resident need with [ADLs]?
  • How do you promote the resident’s participation in [ADLs]?
  • If the resident is not on a therapy or restorative program: How did you decide that the resident would not benefit from a program?
  • Does the resident have pain? If so, who do you report it to and how is it being treated?
  • Does the resident refuse? What do you do if the resident refuses?

Specialized Rehab and Restorative Critical Element Pathway: Therapy Specific Interview Questions

  • What are the current goals and interventions for the resident?
  • How were the interventions determined to ensure they were suitable for the resident’s needs?
  • How was the resident/representative involved in decisions regarding their goals, interventions, and treatments?
  • How and by whom were you trained on the resident’s therapy or restorative program needs?
  • How and by whom are therapy and nursing staff supervised and monitored to ensure they are implementing care planned interventions?
  • How much assistance from staff does the resident need with their therapy or restorative services?
  • How do you promote and encourage the resident’s participation in these services?
  • How often and how is the resident assessed (e.g., quarterly therapy screen) for a change in function and where is it documented?
  • Does the resident have pain or shortness of breath? If so, who do you report it to and how is it being treated?
  • Does the resident ever refuse therapy or restorative services? If so, why and how is this handled?

Quality Measures and Quality Reporting

Quality Measures and Quality Reporting also should remain a focus for communities regarding impacts of the rehab team.

Both short and long stay quality measures are impacted by therapy programming related to pain reduction, pressure ulcers, cognitive programs aimed at reduction of antipsychotics, bowel and bladder continence programming, skilled dysphagia and nutrition interventions tied to weight loss, and balance and fall reduction programs associated with prevalence of falls.

In closing, when looking at the scope of the post-acute therapy team in 2019, remain focused on the old, prepare for the new, and resolve collectively to make a greater patient impact in the New Year.

Renee Kinder, MS, CCC-SLP, RAC-CT, is Vice President of Clinical Services  for Encore Rehabilitation and is the Silver Award winner in the 2018 American Society of Business Publishing Editors competition for the Upper Midwest Region in the Service/How To Blogs category. Additionally, she serves as Gerontology Professional Development Manager for the American Speech Language Hearing Association’s (ASHA) gerontology special interest group, is a member of the University of Kentucky College of Medicine community faculty, and is an advisor to the American Medical Association’s Relative Value Update Committee (RUC) Health Care Professionals Advisory Committee (HCPAC).