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OPTIMIZE THERAPY UTILIZATION UNDER THE NEW RULE

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OPTIMIZE THERAPY UTILIZATION UNDER THE NEW RULE

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    1. OPTIMIZE THERAPY UTILIZATION UNDER THE NEW RULE Arnie Cisneros, P.T.

    2. 2008 NEW RULE SEIZE THE OPPORTUNITY

    3. “ROUNDING FOR INTERVENTIONS”

    4. CLINICAL SYNTHESIS

    5. CLINICAL SYNTHESIS SERVICE UTILIZATION REVIEW for CARE in the HOME (S.U.R.C.H.) OBQI CASE CONFERENCE

    6. 2008 NEW RULE REALITIES

    7. THE “S” SCORE

    8. EQUATIONS 1 AND 3 0-13 VISITS S1 = 0 to 5 S2 = 6 S3 = 7 to 9 S4 = 10 S5 = 11 to 13

    9. EQUATIONS 2 AND 4 14 - 19 VISITS S1 = 14 to 15 S2 = 16 to 17 S3 = 18 to 19

    10. ALL EPISODES 20 OR MORE VISITS S1 = 20+

    11. NEW RULE REIMBURSEMENT

    13. EARLY VS. LATE EPISODES

    15. NEW VS. OLD RULE HOW TO COMPARATIVELY INTERPRET THE CHANGES

    16. COMPARATIVE ANALYSIS (5 – 9 VISITS)

    17. COMPARATIVE ANALYSIS (10 – 13 VISITS)

    18. COMPARATIVE ANALYSIS (14 – 19 VISITS)

    19. COMPARATIVE ANALYSIS (20 + VISITS)

    20. STOP COMPARING

    21. SERVICE UTILIZATION REVIEW for CARE in the HOME (S.U.R.C.H.)

    22. S.U.R.C.H. Employs best practices Like DRG management in hospitals Not a component of traditional QA dept. Watch-dog approach for clinical services Accurate billing on RAP

    23. FUNCTIONAL DOMAIN MO 650 DRESSING UPPER BODY MO 660 DRESSING LOWER BODY MO 670 BATHING MO 680 TOILETING MO 690 TRANSFERS MO 700 AMBULATION

    24. S.U.R.C.H. DEMO CASE #1

    25. S.U.R.C.H. DEMO CASE #1 MO 650 0 --- 2 MO 660 0 --- 2 MO 670 1 --- 3 MO 680 0 --- 1 MO 690 0 --- 1 MO 700 1 --- 2

    26. S.U.R.C.H. DEMO CASE #1 RN 1x1; 3x1; 2x1; 1x3; 2 PRN HHA 0x1; 2x5 HHRG C3 F2 S1

    27. FISCAL REALITIES – DEMO CASE #1 Multiple functional changes Needs PT and OT services ($?????) HHA without OT (less HHA visit costs) PT - 0 visits vs. 6 - 8 visits OT - 0 visits vs. 3 - 6 visits

    28. CLINICAL COMPARE PT - 0 visits vs. 6 - 8 visits OT - 0 visits vs. 3 - 6 visits 9 S3

    29. FISCAL RESULT C3 F2 S3 (EQUATION 1) $3,330

    30. CLINICAL COMPARE PT - 0 visits vs. 6 - 8 visits OT - 0 visits vs. 3 - 6 visits 14 S1

    31. FISCAL RESULT C3 F2 S1 (EQUATION 2) $5,150

    32. FISCAL COMPARE C3 F2 S3 = $3,330 VS. C3 F2 S1 = $5,150

    33. S.U.R.C.H. DEMO CASE #2

    34. S.U.R.C.H. DEMO CASE #2 MO 650 0 --- 1 MO 660 0 --- 2 MO 670 0 --- 3 MO 680 0 --- 3 MO 690 0 --- 1 MO 700 1 --- 2

    35. S.U.R.C.H. DEMO CASE #2 PT 1x1; 3x3 HHRG C2 F2 S4

    36. FISCAL REALITIES – DEMO CASE #2 Multiple functional changes Needs OT services ($?????) PT - 10 visits vs. 8 -10 visits OT – 0 visits vs. 4 - 6 visits

    37. CLINICAL COMPARE PT - 10 visits vs. 8 - 10 visits OT - 0 visits vs. 4 - 6 visits 12 S5

    38. FISCAL RESULT C2 F2 S5 (EQUATION 1) $3,837

    39. CLINICAL COMPARE PT - 10 visits vs. 8 - 10 visits OT - 0 visits vs. 4 - 6 visits 16 S2

    40. FISCAL RESULT C2 F2 S2 (EQUATION 2) $4,846

    41. FISCAL COMPARE C2 F2 S5 = $3,837 VS. C2 F2 S2 = $4,846

    42. OBQI CASE CONFERENCE

    43. ESTABLISH THE CONVERSATION

    44. MULTIDISCIPLINARY CONFERENCES DON’T WORK

    45. OBQI CASE CONFERENCE TIMELY ORDERS POC DISCIPLINE PROVISION OT ORDERS HHA ONLY WITH OT REFERRAL HEP COMPLIANCE OBQI FOCUS DC REVIEW

    46. CASE CONFERENCE RULES ALL clinical staff participate Mandatory Weekly Scheduled Individually Reimbursed for time With consequences for noncompliance

    47. CLINICIAN RESPONSE Reluctance and/or denial Acceptance Participation Integration/appreciation

    48. CASE CONFERENCE FORMATS

    49. MULTIDISCIPLINARY CASE CONFERENCE

    50. HHSM CASE CONFERENCE

    51. OASIS ANALYSIS MO 175 MO 340 MO 650 – 700 MO 826

    52. CASE CONFERENCE EXAMPLE

    53. ESTABLISH THE CONVERSATION

    54. START TALKING

    55. PLAN OF CARE ORDERS SOC by PT PT only - total of 12 visits (3x4) Addressing gait deficits requiring new assist level Caregiver skilled instruction with HEP/gait safety OT not utilized – at facility with paid help If home alone, add OT for bathing, LE dressing

    56. REVIEW OF P.T. NOTES – WEEK 1 Review for OASIS OBQI initial status POC Discharge plan

    57. Week 1 – PT notes Written HEP (home exercise program): Supine - 10 reps, BLEs - glut/quad sets, heel slides, hip abduction, short arc quads, ankle pumps Sitting - 10 reps, BLEs - hip flex/ext, knee flex/ext Gait training with front-wheeled walker 75 feet with minimal assist and 50% verbal cues to increase bilateral heel strike for dynamic standing balance

    58. REVIEW OF P.T. NOTES – WEEK 2 Review for Frequency adherence Compliance issues – HEP daily? OBQI progress Progressive skilled documentation

    59. Week 2 – PT notes Written HEP progressed to: Supine -15 reps, BLEs heel slides, hip abduction, short arc quads, SLRs Sitting - 20 reps, BLEs, 2.5# PRE hip flex/ext, knee flex/ext Gait training with FWW 105 feet with SBA and 10% verbal cues to increase width of steps for Good dynamic standing balance

    60. KEEP TALKING

    61. REVIEW OF P.T. NOTES –WEEK 4 Review for discharge Frequency adherence OBQI goal achievement DC plan executed (Medicare form signed) DC documentation

    62. Week 4 – PT notes Review for skilled DC visit DC summary Post-DC instructions & documentation Caregiver instruction re: DC Patient agreement & understanding

    63. MAKE NEW RULE CHANGES TO OPTIMIZE THERAPY

    64. ORIENT STAFF TO S.U.R.C.H. & OBQI CASE CONFERENCE

    65. INSTALL S.U.R.C.H.

    66. SCHEDULE & BEGIN OBQI CCs

    67. IDENTIFY STRAGGLERS

    68. CHANGE YOUR AGENCY TODAY!

    69. Home Health Strategic Management 1-877-449-HHSM www.homehealthstrategicmanagement.com

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