Therapy Management & Consulting Services Blog

Further Expansion into Southern States with Key Acquisition 

 

HealthPRO® Heritage Expands into Key States in the
South with Acquisition of Summit Health & Rehab

April 10, 2018. HealthPRO® Heritage  completed the acquisition of Summit Health & Rehab  on March 30, 2018.

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Tags: Acquisitions

April Advisor Newsletter

Define Your Value Proposition

If you are a Life Plan or Senior Living Community, the time is now for you to understand your value proposition.

Life Plan and Senior Living Communities are in a unique position to be THE strategic solution to a growing marketplace need. Hospitals are seeking partners to lower overall cost, and Seniors don’t always want to go to Skilled Nursing Care. Your community can be the cornerstone of a win-win-win strategy to support patients and a network of care providers in your area.

First, ask whether your Life Plan/Senior Living Community is prepared to leverage these newly identified opportunities.

Readiness Checklist Requirements:

  1. Are you a medical model in AL/IL/PCH?
  2. Can the nursing care at your community adequately support residents with higher acuity needs? Can you take those higher acuity needs?
  3. Have you established a network of preferred home health partners to strategically optimize clinical/financial outcomes?
  4. Do you have a rehab provider that offers strategic operational/marketing support along with the full continuum of therapy services (including outpatient services and collaborations with home health)?

If the answer is “YES” to these four (4) “Readiness Checklist Requirements” then your community is an opportune position.

For those Life Plan Communities and Senior Living Communities that answer “NO” to these important questions, HealthPRO® Heritage offers the following preliminary ideas to spark your imagination.

Enhance your value proposition for the hospital partners in your network
Establish a direct admit program in a skilled nursing facility (SNF). In this scenario, your community is a next step for Seniors who experience a non-emergent issues at home. Example: Seniors who fail to take medications, experience a fall, etc. Rather than visiting the ER, your community can offer this alternative solution if you work closely with local MDs/ERs/managed care organizations to get this program off the ground. 

Leverage personal care (PC) or assisted living (AL) capabilities by offering a short-stay program
Provide well-coordinated care between your nursing staff, home health and potential outpatient services in scenarios where there isn’t a qualifying 3-night stay, such as a patient undergoing hip replacement who lives home alone.

This innovative program offers a less expensive option for those private pay patients who prefer your community to a SNF stay. Consider the trend of a growing market for short-stay programs that offer a private room, around-the-clock nursing and on-site outpatient therapy until ready to return home independently. Your community should be taking advantage of this census-stabilizing opportunity! 

Care ReDesign initiatives to ensure an operational/strategic foundation is in place

  1. Process for consistent communication with your hospital partners and managed care organizations
  2. Review your clinical capabilities, and define admission criteria
  3. A well-defined communication pathway for your team re: new admissions
  4. Rigor around nursing assessment at time of admission
  5. Readmission mitigation strategies (e.g.: risk assessment and clinical rounding)
  6. Clarity re: expectations for home health and outpatient care
  7. Advanced discharge planning process
  8. Enlist the support of a forward-thinking rehab provider to serve as “the glue” in building cross-continuum services

The safe, efficient transition for seniors between levels of care is akin to a new frontier in quality care delivery, and Life Plan Communities and Senior Living Communities are well-positioned to be in the driver’s seat to offer optimal solutions. The steps outlined above provide a glimpse at a well-thought out approach to building and sustaining your value proposition with far-reaching implications. Fortify your census, grow your network and position your community for success!

Contact HealthPRO® Heritage to optimize the value propositions of your Life Plan or Senior Living Community! 



Survey Tip of the Month

Surveyors will look for triggers on and off-site;  observations may focus on altered diet, wounds and weight loss. Observations will include:

  • Are residents getting the supervision that they need during meals (especially residents who eat in their rooms and trigger for one of the areas listed above)?
  • Is feeding equipment present and utilized properly?
  • If feeding assistants are part of the facility culture, what are the policies and are they being adhered to?
  • What is the policy for food storage (especially food that is brought in by families)? Are families educated regarding the policy?
  • Positioning during meal times will be a focus during observations on all units.

Three Easy Steps in Response to More MDS Changes

EDUCATE
Make Sure Your MDS Team is Up-To-Date. On October 1, 2018 new version of the Data Specifications for the MDS RAI Manual Version 1.16.0 goes into effect. Three types of updates are outlined in the most recent draft version (released January 2018): 

  • technical corrections/revisions addressing grammar or punctuation,
  • items modified for clarification, and
  • new/modified items addressing the SNF Quality Reporting Program.

Also note that several changes specific to Section GG admission and discharge reporting intervals are included.

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Tags: CMS Update 2018, Section GG, Life Plan Community, MDS Changes, Senior Living Community

March 2018 Advisor

New Medicare Card Update

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Tags: CMS, Long Term Care, Safe Transitions, CMS Update 2018, Care Delivery, Medicare Card Update, Rules of Participation

Make The Choice To Prepare

Our ongoing efforts to prepare for payment reform has led HealthPRO/Heritage to develop the industry’s most informative RUGS to RCS-1 reimbursement crosswalk, allowing providers to see both patient and enterprise level reimbursement impacts and identify specific areas of risk and opportunity. This will help establish strategic processes for operational changes that minimize risks and help providers successfully navigate this fundamental payment shift.

We encourage providers to:

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Tags: CMS, RCS-1, CMS Update 2018, Payment Reform

Therapy Cap REPEALED!

GREAT NEWS! The cap on therapy services for Medicare beneficiaries has been repealed. We thank everyone who petitioned their respective legislators to help achieve this important legislative victory.

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Tags: CMS, Therapy Cap, CMS Update 2018

January Advisor Newsletter


Attention: CMS has released updated quality measure star ratings for all LTC providers. The Nursing Home Compare site was updated January 24, 2018.



RCS-1: Get Ready, While We Watch & Wait

HealthPRO®/Heritage continues to lead the industry in preparation for RCS-1 as we prepare for a likely reimbursement system overhaul.

Based on the fact that CMS received a high volume of comments from industry stakeholders during the extended public comment period through August 2017, we expect there will be some changes to the Advance Notice Proposed Rulemaking (ANPRM) regarding the complete overhaul of PPS. We do know that payment reform is coming, and we must be prepared for a big change in our industry. We will stay close to the proposed changes to be released in April 2018. 

HealthPRO®/Heritage strategy is to watch, to wait and to BE PREPARED! The providers who come out on top will be the ones most well prepared to weather the transition, should the system change occur as scheduled on October 1, 2018.

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Tags: CMS, HealthPRO/Heritage, senior living, Home Health, RCS-1, Nursing Home Compare Website, Bundled Payments, BCPI, Bundled Payment for Care Improvement Advanced

December Advisor Newsletter

What’s New with CMS?
Four Big CMS Changes and “Bottom-Line” Solutions from HealthPRO®/Heritage 

CHANGE #1: Comprehensive Care for Joint Replacement Model Policy Changes and Cancellation of Episode Payment Models and Cardiac Rehabilitation Incentive Payment Model

Details related to this change include:

  • Thirty-three of the 67 MSAs in CJR have an option to voluntarily participate in CJR for years 3, 4 and 5. These rural-area hospitals with low volume will be given a one-time opportunity to continue their participation.
  • From January 1 through January 31, 2018, CMS will hold a one-time participation election period for hospitals with a CCN primary address located in the voluntary-participation-MSAs, and for specified low-volume hospitals and rural hospitals in the mandatory participation MSAs. CMS must receive the hospital’s voluntary participation election letter no later than January 31, 2018 in order for a hospital to voluntarily continue to participate in the CJR Model.
  • For reference, the CJR webpage lists:
    • all CJR participating hospitals and respective MSAs
    • mandatory or voluntary MSA status
    • whether the hospital is rural or low volume
  • In the future, CMS anticipates:
    • more opportunities for providers to participate in voluntary initiatives
    • possible changes to current CJR pricing methodology

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November Advisor Newsletter

IMPORTANT REMINDER: November 16 is the deadline for submitting staffing data for the period of July 1 to September 30. Providers that miss this deadline are subject to suppression of your “Overall Staffing Rating” and “Registered Nurse Staffing Rating” for the December 2017 Nursing Home Compare update.

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Tags: skilled nursing facility, CMS, Long Term Care, Advisor Newsletter, Advisor, Home Health, QAPI Plan

Important Payroll Based Journal (PBJ) Update

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Tags: CMS, Long Term Care, CMS Update 2017, Advisor Newsletter, Advisor, Payroll Based Journal, Update, Long Term Care Facilities, CMS-671 Form, Five Star Quality Rating System, Payroll Based Public Use File, 5 Star Quality Rating System, Nursing Home Compare Website

Advisor Newsletter - September 2017

RCS-1 Reimbursement Crosswalk ModelLooking for Guidance on Jimmo v. Sebeilus?Countdown to Major Home Health Changes



RCS-1 Reimbursement Crosswalk Model
HealthPRO®/Heritage has developed a proprietary, sophisticated RCS-1 Reimbursement Crosswalk Model that will help us work strategically with partners to assess aggregate reimbursement risk and understand the interplay between nursing and therapy reimbursement components. The model is dynamic, allowing behavior changes to be modeled so providers can see the impact of specific elements that significantly drive reimbursement under RCS-1 (e.g.: such as diagnostic coding, cognitive assessment, and ADL scoring).

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Tags: Jimmo V Sebelius, PAC provider, HealthPRO/Heritage, Advisor Newsletter, Advisor, Home Health, RCS-1, Jimmo v. Sebeilus, CMS policy, Crosswalk Model, CMS Calculator, Skilled Therapy