Renee Kinder
Renee Kinder

Two weeks ago, I came to you with a blog focused on quality. Specifically, “Proposed rule and quality: What your rehab team should know.” 

Following this piece, I received the comment below from a reader I know simply as Billy.

Most therapists want to provide good quality of care. However, some providers have reduced therapy minutes and increase productivity since Oct, 1, 2019. So nursing home providers need to come on board to allow therapists to reach the highest outcome results for residents. 

I agree.

So, thank you to Billy, for the clear, common sense response which inspired today’s piece.

As a provider, what do you really know about your rehab team, their service delivery, the outcomes they achieve and if shifts have occurred over the past year and a half as we transitioned from the RUG-IV model into the Patient Driven Payment Model?

If I were you …  I would start with this:

  1. Volume: The conversation around minutes and volume of service. I know, I know, many of you are throwing your hands up to me and saying, “Renee, can you get over this? Don’t you remember that RUG-IV gave us an arbitrary number of minutes and PDPM is tasking us with providing the appropriate volume?” Perhaps, and believe me, I have heard it all. Also, while I don’t expect everyone to agree with me, the sudden and abrupt shifts in volume in some areas, combined with recent research including the TOPS study, warrants further discussion. 
  • How many minutes (i.e. volume) on average are you delivering to patients in my community? 
  • Across this volume, can you define which therapy disciplines are providing care between your physical therapists/physical therapy assistants; occupational therapists/occupational therapy assistants; and speech language pathologists.
  • Furthermore, how and by whom are the volume of services delivered determined? 
  • And if we were to compare your volume of services pre- and post-PDPM implementation, would I, as a provider, see a significant shift in services?
  • If I do see a shift, can you explain further? Has there been a significant change in patient population? Tolerance of care? Or an evidence-based approach to treatment specific to your therapy discipline that warranted a change in clinical practice?
  1. Outcomes: And while I appreciate that we are all seeking more insight into how future payment models will define, measure and reimburse for quality and outcomes we do have a few regulatory guidelines we could use to measure effectively across care teams.
  • Section GG Self Care and Mobility. Logically, you should be asking what do the start versus end of care outcomes look like for residents in my community? Is there variance in specific diagnostic categories? How do your outcomes in these areas compare with others? 
  • Rehospitalizations and transitions to least restrictive levels of care. Start with your metrics here. Then consider tapping your rehab team for guidance on how you can collaborate to reduce and increase success in each area. When does traditional discharge planning begin? How is this outlined in the therapy treatment plan? When are home evaluations completed, and by whom? Finally, what level of return demonstration and competency testing is included in rehab practice to facilitate patient and loved one’s success? 
  • What other, creative or perhaps even physician-specific measures are your rehab teams using? Do they have standardized testing, for example, that they are using as a metric? Are they gauging patient and family satisfaction consistently?
  • More importantly, what is the data collection practice for overall outcomes and how can these be used accordingly to highlight care provided in your site specifically to support our communities?
  1. Finally, as outlined in the last Rehab Realities post, there is a quality tie-in to upcoming regulatory initiatives: So ask, specifically, how does your provider integrate, measure and monitor areas of clinical practice which align with current regulatory initiatives and proposed changes?
  • How are you proactively measuring areas associated with PEPPER prior to my receiving yearly reports which allow for formal comparison of billing statistics with national, jurisdiction and state percentile values for each target area? Specifically, the following target areas: PDPM High Utilization Codes; 20-Day Episodes of Care; 90+ Day Episodes of Care; 3- to 5-Day Readmissions.
  • What initiatives are in place now to give support for current quality measures tied to claims and the MDS?
  • How are quality care and documentation areas audited and at what percentile/frequency?
  • How can we work collectively to prepare for forthcoming Standardized Patient Assessment Data Elements (SPADES)?

In closing, I hope folks find this piece helpful. Transparency, above all, is key to guide these conversations. 

Hopefully, this list can facilitate teams learning more about each other, planning more effectively together and in the end being more equipped for job #1 — serving our patients at the highest level daily. 

Renee Kinder, MS, CCC-SLP, RAC-CT, is Executive Vice President of Clinical Services for Broad River Rehab and a 2019 APEX Award of Excellence winner in the Writing–Regular Departments & Columns 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).

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.